Task Sharing for the Care of Severe Mental Disorders in a Low-income Country

Summary

Task sharing mental health care through integration of mental health into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. In Ethiopia, it is estimated that only around 10% of people with severe mental disorders (SMDs) ever receive evidence-based treatment for their condition, largely due to scarcity of specialist mental health services. A task-sharing model of mental health care in PHC would be more affordable and accessible to the majority of persons with SMD who do not currently receive evidence-based mental health care. Furthermore, task sharing mental health care with PHC is about to be scaled up in Ethiopia in line with the National Mental Health Strategy. However, the effectiveness of the task sharing model of mental health care for people with SMD has not been evaluated systematically in a low-income country. In this study we propose to investigate non-inferiority of a task sharing model of mental health care in PHC compared to a less accessible, but more specialist, psychiatric nurse-led model of care. The specialist model of care has been demonstrated to be acceptable and associated with improved clinical outcomes for persons with SMD engaged in the service in Ethiopia thus making this an appropriate comparison model against which to evaluate non-inferiority of the task sharing model.

Conditions

• Schizophrenia
• Bipolar Disorder
• Major Depressive Disorder
• Schizoaffective Disorder

Interventions

BEHAVIORAL

Integrated mental health in primary care

A task-shared model of collaborative mental health care integrated into the primary care setting.

BEHAVIORAL

Psychiatric nurse-led specialist care

A centralised, psychiatric nurse-led, hospital out-patient service with outreach from project outreach workers

Sponsors & Collaborators

• Addis Ababa University

  collaborator OTHER

• King's College London

  collaborator OTHER

• Johns Hopkins University

  collaborator OTHER

• Columbia University

  collaborator OTHER

• Armauer Hansen Research Institute, Ethiopia

  collaborator OTHER

• University of Cape Town

  lead OTHER

Principal Investigators

• Charlotte Hanlon, BM BS, PhD · Addis Ababa University and King's College London

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

25 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2015-03-31

Primary Completion

2017-05-16

Completion

2017-11-16

Countries

• Ethiopia

Study Locations