The research was based on a trial in Indonesia, where patients often do not get the treatment they need due to a shortage of practitioners. The team at the Cambridge Institute of Public Health say the findings are also relevant to the UK and any other country with a long waiting time for mental health appointments and a growing globalised clientele, as it opens up alternative pathways of care.
In many countries, there is a ‘treatment gap’ for mental health issues, caused in part by a confluence of the lack of mental health professionals and the social stigma attached to seeking help. While the median worldwide treatment gap for psychosis is 32% - meaning that almost in one three people with psychosis do not receive treatment - in low and middle-income countries it is estimated to be almost three times higher, above 90%.
Experts have argued that one way of bridging this gap would be to integrate mental health care into primary care, such as GP practices. Recent research confirmed that primary care clinics are the first port-of-call for most people with mental health problems. However, diagnosing mental health problems in primary care is difficult for several reasons, including time constraints during consultations, lack of mental health expertise and problems with referrals.
In 2008, the World Health Organisation (WHO) launched the WHO Mental Health Gap Action Programme to support countries in scaling up services for mental, neurological, and substance use disorders, with a free online Intervention Guide and Training Manual. In 2015, the Indonesian Ministry of Health introduced the programme to selected pairs of GPs and nurses at its network of community health centres, with the aim to rolling it out nationally.
Researchers at the Cambridge Institute of Public Health carried out a study to evaluate the effectiveness of this programme in Indonesia. 153 patients completed treatment at 14 primary care clinics that had received the WHO training, while 141 patients at 14 other clinics received treatment from specialist clinical psychologists co-located in primary care. The findings are published in PLOS ONE.
Image: Indonesian man
Credit: kilarov zaneit
Reproduced courtesy of the University of Cambridge