Bundled Intervention Integrating Mental Health Services in Nepal

Summary

Globally, access to mental healthcare is often non-existent in rural, resource-deprived communities despite the pervasive need for services, particularly in post-conflict and post-disaster settings. We are developing and piloting will develop and pilot a culturally appropriate training model for non-specialist providers (NSPs) to deliver high-quality mental health care over a period of 24 months in a primary care hospital in a rural district in Nepal. We will employ a mixed methods framework to evaluate change in skills, knowledge, and attitude in NSP's, identify key mechanisms for continuum of mental healthcare delivery, and efficacy and cost-effectiveness in care delivery through a government hospital, clinics, and a network of community health workers. This integrated approach will introduce a bundled intervention that includes: both an on-site care coordinator and off-site psychiatric supervisors based in Nepal's capital, Kathmandu, weekly case conferences, and surveys of NSP's and clinical supervisors every six months during the study period. To learn about the acceptability, feasibility and challenges in the program we will also conduct Focus Group Discussions among the PCPs. In the last one year of the research in Achham District we have seen increase in knowledge efficacy and skills among the NSPs and also improved mental health care services at Bayalpata Hospital. Our experience in Achham motivated us to develop a similar program for Charikot Primary Health Center in Dolakha District. Outcomes of this study will focus on efficacy of this model to appropriately identify, counsel, and treat patients with depression, psychosis, and post-traumatic stress disorder (PTSD) through an integrated rural mental healthcare delivery intervention as a model for rural healthcare delivery.

Conditions

• Mental Health

Interventions

OTHER

Bundled Intervention

The authors have designed continuing medical education curriculum to improve clinical capacity and competency about mental health for Nepali Primary Care Providers. Specifically: * On-site care coordinator and off-site psychiatric supervisors based in Nepal's capital, Kathmandu * Weekly case conferences * Surveys of clinicians and clinical supervisors in accordance with CME curriculum

Sponsors & Collaborators

• University of California, San Francisco

  collaborator OTHER

• Harvard Medical School Center for Global Health Delivery-Dubai

  collaborator UNKNOWN

• National Institute of Mental Health (NIMH)

  collaborator NIH

• Brigham and Women's Hospital

  collaborator OTHER

• Possible

  lead OTHER

Principal Investigators

• David Citrin, PhD, MPH · Possible

Study Design

Allocation

NA

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

15 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2016-02-06

Primary Completion

2019-07-30

Completion

2019-07-30

Countries

• Nepal