PRogramme for Improving Mental health carE (PRIME)

PRIME was a eight-year multi-national research project funded by  DFID (Department for International Development) UK to consortium partners in five countries (South Africa, Uganda, Ethiopia, India and Nepal). The study was led by the University of Cape Town, South Africa with partners in the UK and the World Health Organization (WHO). The overall aim of PRIME was to generate world-class research evidence on the implementation and scaling up of treatment programs for priority mental disorders in primary and maternal health care contexts in low resource settings which could be widely adopted by policy makers and practitioners.

In Nepal, the project was implemented in Chitwan district in close collaboration with Ministry of Health and Population, and Netherland based organization, Healthnet TPO. The project primarily focused on priority mental disorders – depression, alcohol use disorder (AUD), psychosis and epilepsy. The health workers of 12 primary health facilities were trained and equipped in mental health service delivery for the priority disorders based on WHO’s mental health Gap Action Programme (mhGAP). To increase detection and referral in the community level, we had developed a tool called Community Informant Detection Tool (CIDT) for each disorder. The female community health volunteer (FCHVs) were mobilized to undertake the task of detection and referral from the community level to the health facility level using this tool. The CIDT referred cases received basic mental health services from the health facilities. At the health facility, pharmacological treatment was provided by the prescribers (e.g. Health Assistants, Community Medicine Assistants) while the basic psychosocial support was provided by the trained non-prescribers (ANMs, MCHWs). In addition to this, considering the busy schedule of the health workers, psychosocial counselors were also been mobilized to provide (focused) counseling services. To ensure the quality service, regular supervision of the trained health workers and psychosocial counselors was conducted on a monthly basis by the psychiatrist and psychologist through monthly case conference. Patients in need of  specialized care were referred to psychiatrists at the district hospital. Community based mental health sensitization programs were also organized simultaneously to sensitize the community members on mental health issues and  stigma associated with mental health care.

PRIME was scaled up after some time and ran operations in 46 health facilities, thus covering the entire Chitwan district.

For further information about PRIME, visit http://www.prime.uct.ac.za/

Publications:

1. Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal
2. Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study
3. Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study
4. Evaluation of Proactive Community Case Detection to Increase Help Seeking for Mental Health Care: A Pragmatic Randomized Controlled Trial
5. Health service costs and their association with functional impairment among adults receiving integrated mental health care in five low- and middle-income countries: the PRIME cohort study.
6. Impact of a district mental health care plan on suicidality among patients with depression and alcohol use disorder in Nepal
7. Community-, facility-, and individual-level outcomes of a district mental healthcare plan in a low-resource setting in Nepal: A population-based evaluation
8. Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal
9. Using qualitative comparative analysis and theory of change to unravel the effects of a mental health intervention on service utilisation in Nepal
10. Prevalence and correlates of depression and alcohol use disorder among adults attending primary health care services in Nepal: a cross sectional study
11. Improving detection of mental health problems in community settings in Nepal: Development and pilot testing of the community informant detection tool
12. Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal
13. Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross-sectional community survey in Nepal
14. Prevalence and correlates of alcohol use in a central Nepal district: secondary analysis of a population-based cross-sectional study
15. Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal
16. Evaluation of outcomes for psychosis and epilepsy treatments delivered by primary health care workers in Nepal: a cohort study
17. Situational analysis to inform development of primary care and community-based mental health services for severe mental disorders in Nepal
18. Development and pilot testing of a mental healthcare plan in Nepal
19. Mental Health Care in Nepal: Current Situation and Challenges for Development of a District Mental Health Care Plan
20. Accuracy of proactive case finding for mental disorders by community informants in Nepal
21. Demand and access to mental health services: a qualitative formative study in Nepal
22. Setting priorities for mental health care in Nepal: a formative study

Cross-country publications:

1. Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform
2. How competent are non-specialists trained to integrate mental health services in primary care? Global health perspectives from Uganda, Liberia, and Nepal
3. Detection and treatment initiation for depression and alcohol use disorders: facility-based cross-sectional studies in five low-income and middle-income country districts
4. Partnerships in a Global Mental Health Research Programme—the Example of PRIME
5. Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol
6. Treatment contact coverage for probable depressive and probable alcohol use disorders in four low- and middle-income country districts: The PRIME cross-sectional community surveys
7. Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: the PRIME study
8. Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study
9. Maternal mental health in primary care in five low- and middle-income countries: a situational analysis
10. Stakeholder analysis of the Programme for Improving Mental health carE (PRIME): Baseline findings
11. Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda
12. Using workshops to develop theories of change in five low and middle income countries: lessons from the Programme for improving mental health care (PRIME)
13. Challenges and opportunities for implementing Integrated Mental Health Care: A district level situation analysis from five low- and middle-income countries
14. PRIME: A programme to reduce the treatment gap for mental disorders in five low and middle-income countries

Policy briefs:

1. Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal
2. Pathways to Healing
3. Demand and access to mental health services: a qualitative formative study in Nepal
4. Setting priorities for mental health care in Nepal: a formative study

Blog:

1. Chitwan: The district of one-horned rhinos and PRIME

Conference Presentations:

1. Narrative approaches for community detection of mental health problems in Chitwan, Nepal
2. Effectiveness of mental health services in primary care in Nepal: Results from PRIME studies
3. Community Informant Detection Tool: Detecting People with Mental Health Problems in the Community
4. Understanding barriers to help-seeking and developing innovative strategies for perinatal depression in Chitwan
5. Promoting maternal mental health through early detection

Press and media:

1. चितवनमा मानसिक स्वास्थ्य जाँच गराउने बढे
2. मानसिक स्वास्थ्य सेवा उपयोग बढाउन सिआईडिटि उपयुक्त
3. मानसिक रोगका कारण चालिस सेकेण्डमा एकजनाको मृत्यु
4. चितवनमा झन्डै डेढ लाखमा मानसिक समस्या
5. मानसिक स्वास्थ्यको उपचार गराउने बढे
6. प्राथमिक स्वास्थ्य संस्थामै मानसिक रोगको उपचार
7. स्थानीय स्वास्थ्य संस्थाबाट मानसिक उपचार सम्भव
8. मानसिक स्वास्थ्य सेवा देशैभरी
9. डिप्रेसनले लिन्छ ज्यान
10. मानसिक स्वास्थ्य सुधारमा प्राइम कार्यक्रम
11. मानसिक स्वास्थ्य सेवामा स्थानीय तहको चासो