REducing barriers to mental health task SHAring: stigma reduction in Primary carE (RESHAPE)

RESHAPE (Reducing Barriers to Mental Health Task Sharing: Stigma Reduction in Primary Care) is a 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/ ).

The global burden of disease attributable to depression rose 37% from 1990 to 2010. The future projected rise is greatest in low- and middle-income countries (LMIC). However, there is a gap of 1.2 million health workers needed to provide mental health services in LMIC. Task-sharing, the involvement of non-specialist health workers to deliver mental health services, is an essential aspect of reducing this gap. One of the barrier of developing this task-sharing is the negative attitudes and discriminatory behaviors among non-specialist health workers against persons with mental illness.

RESHAPE was built on another research project called PRIME where the primary health workers are trained on task-sharing i.e. mental health identification and treatment through WHO mental health Gap Action Programme (mhGAP). This project was aimed on understanding the feasibility and acceptability of a supplemental training module to improve attitudes toward and social engagement with persons with mental illness, with the goal of moving past traditional concepts of stigma and stigma-reduction interventions. This module was then added to a mental health Gap Action Programme (mhGAP) training to improve provider competence in evidence based practices (EBP), and reduce patient depression severity. A pilot cluster-RCT of social engagement training for primary care workers was also conducted to assess feasibility and acceptability of content, procedures, adverse event monitoring, and analytic approaches.

In Nepal, this project contributed to scalable training models that promote quality clinical services and minimize barriers to implementation stemming from biases and discrimination perpetuated by providers.

Target group: Primary health care workers, people living with mental illness (PWMI) and their caregivers

Implementation area: Chitwan district

Time frame: 2015 – 2019

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

Publications:

1. Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers
2. A service user co-facilitated intervention to reduce mental illness stigma among primary healthcare workers: Utilizing perspectives of family members and caregivers
3. Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal