Optimizing Provider Attitudes and competence in Learning mental health systems (OPAL)

OPAL (Optimizing Provider Attitudes and competence in Learning mental health systems) was a cross – country research project funded by National Institute of Mental Health (NIMH), USA (https://www.nimh.nih.gov/index.shtml ) via The George Washington University, Department of Psychiatry and Behavioral Sciences. (https://www.gwu.edu/ ). Along with Nepal, this project was also taking place in Ethiopia through Addis Abba University (AAU).

Stigma against persons with mental illness by health care providers contributes to lack of delivery of evidence-based care, long duration of untreated mental illness before initiation of care, and lack of appropriate medical care for persons with mental illness. This is compounded by structural stigma within health systems, which is exemplified by policies and practices that fail to meet needs for mental health budgets, psychiatric supervision of primary care providers, and physical infrastructure for safe and effective care. The purpose of this research was to address the vital need for development of intervention packages to address provider stigma and structural stigma, with a focus on psychotic disorders.

The goal of this project was to develop an intervention package for Optimizing Provider Attitudes and competence in Learning mental health systems (OPAL). Drawing on the evidence base for addressing provider stigma, OPAL included facilitated social contact between providers and persons with mental illness. For structural stigma, learning health systems served as a model to improve attitudes and clinical care through patient engagement in service design, enhanced provider access to systems data, and promotion of team-based health system administration.

To accomplish the objective of developing the OPAL package to reduce provider and structural stigma, three aims were undertaken:

1. Developing a draft intervention package through qualitative research including a stakeholder analysis of the package and a pilot training of trainers for consumers
2. Adapting and developing measures to evaluate the package, and
3. Strengthening capacity for implementation science in LMIC (Nepal and Ethiopia).

The impact of successful completion of this research project aimed for (1) an intervention package that could be added to mhGAP (http://www.who.int/mental_health/mhgap/en/ ) and piloted by WHO, and (2) intervention content and measures to apply for funding to conduct effectiveness trials to evaluate improving provider attitudes and competence as mechanisms to improve patient outcomes.

Target group: People living with mental illness (PWMI) and their caregivers, primary health workers

Implementation area: Chitwan district

Time frame: 2016 – 2018

Supported by: GWU, Department of Psychiatry and Behavioral Sciences and National Institute of Mental Health (NIMH), MD, USA

Partners: George Washington University, Department of Psychiatry and Behavioral Science; Duke University, Duke Global Health Institute and Kings College London, IOPPN (Institute of Psychiatry, Psychology and Neuroscience)