From 2012 to 2016, World Vision Uganda, in partnership with the Uganda Ministry of Health and WHO, implemented a pilot mhGAP project in three districts – Jinja, Kamuli and Kitgum – in the east and north of the country. The project’s goal was to improve the well-being of people affected by mental, neurological and substance use (MNS) disorders by reducing the treatment gap. Working through primary health-care services, access to support and treatment has risen dramatically.
Independent evaluation of the pilot indicates:
- Better community awareness has enabled 91% of people to recognize symptoms of MNS disorder
- Some 67% of people with mental health concerns have sought treatment
- mhGAP trained health workers regularly used mhGAP
- Service users reported increased mental well-being
The key intervention of group interpersonal therapy – psychological treatment recommended by mhGAP – has successfully reduced people’s symptoms of depression, anxiety and alcohol use, and facilitated them moving forward with their lives and livelihoods. The project also resulted in policy change, such as Jinja district increasing its annual mental health budget allocation.
Before the intervention I had a lot of headaches, I could not eat food well, I lost interest in the things I used to like, I used to think of killing myself and my four children in the River Pager … until the village health team member in our community conducted an awareness talk. Interpersonal therapy has saved my life and children! It has made such a big difference in my life; it’s much better than someone giving me money!
Person using mental health services
A short video and personal stories from those who benefited can be viewed at:
The project has demonstrated that integrating mental health services into primary health care is a low-cost, effective approach to ensuring care. Interventions like group interpersonal therapy, formation of active service user groups, stakeholder engagement, anti-stigma campaigns and advocacy for the protection of rights of service users proved important. World Vision, with Uganda’s Ministry of Health and WHO, is now actively seeking support for wider scale up of the programme
About Mental Health
About four out of five people in low- and middle-income countries who need services for mental, neurological and substance use conditions do not receive them. Even when available, the interventions often are neither evidence-based nor of high quality. WHO recently launched the Mental Health Gap Action Programme (mhGAP) for low- and middle-income countries with the objective of scaling up care for mental, neurological and substance use disorders. This mhGAP Intervention Guide (mhGAP-IG) has been developed to facilitate mhGAP-related delivery of evidence-based interventions in non-specialized health-care settings.
There is a widely shared but mistaken idea that all mental health interventions are sophisticated and can only be delivered by highly specialized staff. Research in recent years has demonstrated the feasibility of delivery of pharmacological and psychosocial interventions in non-specialized health-care settings. The present model guide is based on a review of all the science available in this area and presents the interventions recommended for use in low- and middle-income countries. The mhGAP-IG includes guidance on evidence-based interventions to identify and
manage a number of priority conditions. The priority conditions included are depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm / suicide and other significant emotional or medically unexplained complaints. These priority conditions were selected because they represent a large burden in terms of mortality, morbidity or disability, have high economic costs, and are associated with violations of human rights.
Although the mhGAP-IG is to be implemented primarily by non-specialists, specialists may also find it useful in their work. In addition, specialists have an essential and substantial role in training, support and supervision. The mhGAP-IG indicates where access to specialists is required for consultation or referral. Creative solutions need to be found when specialists are not available in the district. For example, if resources are scarce, additional mental health training for non-specialist health-care providers may be organized, so that they can perform some of these functions in the absence of specialists. Specialists would also benefit from training on public health aspects of the programme and service organization. Implementation of the mhGAP-IG ideally requires coordinated action by public health experts and managers, and dedicated specialists with a public health orientation