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Toolkit for the Integration of Mental Health into General Healthcare

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Step 1. Assess & Plan for Mental Health Integration

A rapid or comprehensive assessment is a process of systematically collecting and analyzing data around the country background and context, existing mental health policies, systems and resources as well as needs and barriers to care. This information is needed to plan mental health integration programs.

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WHY is this step needed?

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Information from an assessment is needed to make key decisions about program planning & design such as:

  • What existing government efforts and policies exist that we need to build on and be consistent with? Are there national mental health plans, policies, guidelines, legislation, and budgetary allocations available (e.g. are certain conditions prioritized to be treated at the PHC level)?
  • Who are the actors, academic institutions, or local groups currently working on mental health who need to be engaged (e.g. are others implementing a similar program)?
  • Which trainees and health facilities should we target for capacity building and what do we need to provide or advocate for (e.g. where are providers and what are their roles, what psychotropic medication is available?)
  • What are perceived needs and barriers to accessing mental health care among affected communities?

An assessment is a dynamic and often continual process and ensures that we design a program that is tailored to the local context, is consistent with government guidelines, builds on existing resources and meets identified needs.

Planning in accordance with national and regional programs and policies and acquiring an understanding of the needs and demands of the local community supports sustainability planning and community engagement from the start.

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HOW is this step done?

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  • Plan your assessment based on global tools (WHO/UNHCR assessment toolkit, IASC assessment guide and IASC ethical guidelines).
  • Conduct a desk top review of available information (e.g., data and reports from implementing agencies of mental health and psychosocial programming, peer reviewed publications, newspaper articles).
  • Collect data in the field (e.g. by integrating MHPSS into existing multi-sector assessments or conducting a specific MHPSS focused assessment) by utilizing a variety of assessment tools and techniques such as semi-structured interviews, direct observation, and focus group discussions with stakeholders including service providers, people affected by mental health problems, policy makers and community members.
  • Analyze and summarize data to obtain an understanding of the sociocultural context, mental health policies and legislation, mapping of mental health resources and services as well as mental health and psychosocial needs of the community.
  • Share what you have learned through discussion with key stakeholders, presentation at coordination meetings, and/or dissemination of your assessment report.
  • Use assessment information for planning including meetings and workshops that explore who to train, how to provide short term and longer term support & supervision, which stakeholders to involve, how to make drugs regularly available, coordination with government, establishing referral pathways, funding, etc.
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MINIMUM elements of assessment & planning

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Link to existing sources of information and identify the following critical information:

  • Country level analyses: Quick assessment of existing health systems and policies, and available resources, and efforts (e.g. based on WHO AIMS, AIMS country reports, and MH Atlas, discussion with key national stakeholders).
  • Community level analyses: Discussion (e.g. with key members of affected community, service providers, service users) about attitudes toward persons with mental disorders, help-seeking for mental health problems, ways of coping and community support, formal (e.g. health clinics) and informal (e.g. social supports, religious and traditional healers) resources and barriers to accessing services.
  • Health facilities assessments: Focus on understanding which levels of the health system mental health services exist (if any), to what extent staff are trained in providing mental health services, and which health clinics/settings would be optimal for MH integration (e.g. discussion with heads of health facility and potential trainees).
  • Mapping of existing programming, services and gaps, using the basic 4Ws table that outlines who is doing what, where and until when.
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COMPREHENSIVE additional elements of assessment & planning

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Identify additional information within each of the assessment categories:

  • Country level analyses: Conduct comprehensive desk top review (e.g. National Health Policy, National Mental Health Policy), meet with many actors to understand how mental health systems and services are already supported and funded.
  • Community level analyses: Assessment of key aspects (see minimum considerations for more information) through engaging diverse groups and sub-groups among affected populations as well as various service providers (formal and informal).
  • Health facilities assessments: Assess different health facilities (e.g. using MH PHC integration checklist) to explore staff skills, staff roles,, service provision, referral systems and processes, pharmacy and medication supply, health information system and clinic management.
  • Mapping of existing programming, services and gaps, using the more comprehensive IASC 4Ws mapping tool or IASC 4Ws online mapping tool available by logging onto mhpss.net as part of an inter-agency process moderated through coordination groups (e.g. cluster coordination, MHPSS Coordination Group).
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WHEN is this step done?

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At the time of planning your integrated mental health program:

  • A rapid assessment can be carried out during the initial stage of a humanitarian crisis over the course of multiple days1.
  • A more comprehensive assessment is generally carried out at any time over the course of weeks to months.

1 Number of days to complete an assessment ranges and is contingent on available expertise and local capacity to support the assessment, whether translation is needed, distance to and number of locations where assessment is taking place, and other factors.

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KEY CONSIDERATIONS

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  • Do carry out a desk review first to identify information gaps and inform data collection in the field.
  • Do involve mental health service users and carers at every stage of assessment, planning and development
  • Do coordinate with other agencies to find out about existing and planned assessments.
  • Do ensure MHPSS technical experts are involved from the beginning when designing assessments.
  • Do include local secondary level mental health care in your assessment and consider how it can be strengthened and how local mental health professionals can be engaged to support training, supervision, referral and consultations.
  • Do include assessing needs and resources of people with pre-existing and serious mental disorders, such as psychosis.
  • Do consider and include the diverse cross-section of the population in terms of age, gender, educational level, geographic location, etc.
  • Do use trained data collectors who speak the language of respondents.
  • Do ask questions that have practical implications for programming.
  • Do ensure the anonymity and protection of the data collected.
  • Do document or record consent and protect identifiable personal data when carrying out assessments.
  • Do not collect data with pre-conceived notions or expectations.
  • Do not conduct surveys on the prevalence of mental disorders (that is, psychiatric epidemiology).
    → Such surveys can be important for advocacy and academic value but are of limited practical value when designing a humanitarian response.
    * Note: If you have to make a quick estimate on the prevalence of mental disorders, you can use existing WHO projections for a general indication of mental disorders in crisis-affected populations (refer to UNHCR/WHO Assessment toolkit, tool 2).
    → Why: WHO has existing prevalence estimates of MH issues (e.g. see WHO UNHCR assessment toolkit, page 18); It is difficult to distinguish between normal psychological distress and mental disorders in humanitarian settings (which can lead to over-estimates), Studies with the right methods and expertise are lengthy, costly and resource intensive.
  • Do not create protection risks for vulnerable segments of the populations by visibly targeting them for assessments, target broad segments of affected populations and ensure privacy, consent and confidentiality when asking sensitive questions or speaking with specific population groups.
  • Do not ask potentially distressing questions (e.g. about stressful events, MH problems) without ensuring they are asked in a sensitive way, and that information about available follow-up support is provided.
  • Do not ask questions that may stigmatize people or endanger them.
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RESOURCES

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Category

  • Key Guidance Apply Key Guidance filter
  • Specific Tools & Materials Apply Specific Tools & Materials filter
  • Field Examples and Applications Apply Field Examples and Applications filter
  • Key Publications & Readings Apply Key Publications & Readings filter

Audience

  • Implementing agencies Apply Implementing agencies filter
  • Governments Apply Governments filter
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  • Toolkit Homepage
  • Step 1. Assess & Plan for Mental Health Integration.
  • Step 2. Build Capacity of General Healthcare Workers.
  • Step 3. Strengthen Mental Health Services & Systems.
  • Cross cutting component. Monitoring, Evaluation, Accountability & Learning.
  • Cross cutting component. Advocate, Coordinate and Network.
  • Cross cutting component. Sustain Mental Health Services.
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  • World Health Organization and UNHCR (2012) Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings

    Category: Key Guidance, General MHPSS Assessment Methods & Tools

    Audience: Implementing agencies, Governments, Donors

    For general comprehensive guidance on MHPSS assessments, as well as various tools for assessing MHPSS problems and resources.

    • PDF icon Access Toolkit in English
    • PDF icon Access Toolkit in Arabic
    • PDF icon Access Toolkit in French
    • PDF icon Access Toolkit in Russian
    • PDF icon Access Toolkit in Spanish
  • IASC MHPSS Reference Group (2012 Draft) Assessment Guide

    Category: Key Guidance, General MHPSS Assessment Methods & Tools

    Audience: Implementing agencies, Governments, Donors

    For brief and simple guidance based on the WHO UNHCR Assessment toolkit for rapid or very basic assessments. This covers the most important MHPSS questions for humanitarian emergency contexts.​

    • PDF icon Access here
  • WHO (2018) mhGAP Operations Manual

    Category: Key Guidance, Planning MH PHC Integration

    Audience: Implementing agencies, Governments, Donors

    Use the mhGAP Operations Manual for practical, step-by-step guidance for integrating mental and health services, with sections relevant to planning and assessment activities [See page 2 for how to plan for mhGAP within existing entry points, and page 8 for a specific case example of mental health service planning in Uganda: a situation analysis].

    • PDF icon Access here
  • IMC (2015) Guidance on Local Partner Selection in MH Integration Programming

    Category: Key Guidance, Planning MH PHC Integration

    Audience: Implementing agencies, Governments, Donors

    Use this simple stepped guidance with key considerations and steps for the selection of local partners in setting up MH integration programming.

    • File Access here
  • WHO (2012) Template for Desk Review of Pre-Existing Information Relevant to MHPSS in the Region/Country

    Category: Specific Tools & Materials, Key Templates, Checklists & Tools

    Audience: Implementing agencies, Governments, Donors

    Use this tool for understanding all the aspects of information that can be part of a desktop review.
       
    [Also part of WHO UNHCR Assessment toolkit- tool 9, pg. 60].
    • PDF icon Access Tool 9
    • PDF icon Access Tool 9 in French
    • PDF icon Access Tool 9 in Spanish
    • PDF icon Access Tool 9 in Arabic
    • PDF icon Access Tool 9 in Russian
  • WHO (2012) WHO Mental Health PHC Integration Checklist

    Category: Specific Tools & Materials, Key Templates, Checklists & Tools

    Audience: Implementing agencies, Governments, Donors

    Use this tool to assess to what extent mental health is integrated into Primary Health Care (PHC). 

    An adapted and extended version of the WHO mental health PHC integration checklist has been developed by IMC (2017), and is available for download here.

    [Also part of WHO UNHCR Assessment toolkit– tool 5, pg. 47].

    • PDF icon Access Tool 5
    • PDF icon Access Tool 5 in Arabic
    • PDF icon Access Tool 5 in French
    • PDF icon Access Tool 5 in Russian
    • PDF icon Access Tool 5 in Spanish
    • File Adapted version of the Tool 5 checklist developed by IMC (2017)
  • WHO (2011 Draft) IASC 4W MHPSS tool (Who is doing What, Where, When)

    Category: Specific Tools & Materials, Key Templates, Checklists & Tools

    Audience: Implementing agencies

    Use this tool to map mental health and psychosocial services in emergencies.
    - Simple version: a table in word format.
    - Comprehensive version:  a complete mapping of services using the excel sheet and reporting template.
     
    A manual is available, developed by the IASC MHPSS RG, that describes methods and activity codes in mapping. 

    An online version of the tool was developed by mhpss.net in consultation with the IASC MHPSS RG. Agencies can enter data and employ an automated analysis of gaps and key areas for coordination. Access the tool through the main mhpss.net site’s mappings page.

    [Also part of WHO UNHCR Assessment toolkit which includes detailed description; excel file is separate- tool 1, pg. 30]

    • PDF icon Access Tool 1
    • PDF icon Access Tool 1 in Arabic
    • PDF icon Access Tool 1 in French
    • PDF icon Access Tool 1 in Russian
    • PDF icon Access Tool 1 in Spanish
  • WHO (2012) WHO Participatory Assessment: Perceptions by General Community Members

    Category: Specific Tools & Materials, Key Templates, Checklists & Tools

    Audience: Implementing agencies

    Use this tool to explore local perspectives on problems and coping in a participatory manner, to provide information for MHPSS response, utilizing interviews with general community members.
     
    [Also part of WHO UNHCR Assessment toolkit– tool 10, pg. 63]
    • PDF icon Access Tool 10
    • PDF icon Access Tool 10 in Arabic
    • PDF icon Access Tool 10 in French
    • PDF icon Access Tool 10 in Russian
    • PDF icon Access Tool 10 in Spanish
  • WHO (2012) WHO Participatory Assessment: Perceptions by Community Members with In-Depth Knowledge of the Community

    Category: Specific Tools & Materials, Key Templates, Checklists & Tools

    Use this tool to learn about local perspectives on problems and coping in a participatory manner, to provide information for MHPSS response, utilizing (Individual or group) key informant interviews.

    [Also part of WHO UNHCR Assessment toolkit– tool 11, pg. 70]

    • PDF icon Access Tool 11
    • PDF icon Access Tool 11 in Arabic
    • PDF icon Access Tool 11 in French
    • PDF icon Access Tool 11 in Russian
    • PDF icon Access Tool 11 in Spanish
  • IMC (2017) MHPSS Basic Rapid Assessment

    Category: Specific Tools & Materials, Key Templates, Checklists & Tools

    Audience: Implementing agencies

    Use this brief questionnaire for a quick overview of mental health problems as a result of the current crisis/conflict, existing MHPSS services, and critical information about services, capacities, and needs of identified health facilities. 
     
    [Adapted from select tools from the WHO UNHCR Assessment toolkit].
    • File Access here

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This Toolkit is made possible by the generous support of the American people through the United States Agency for International Development (USAID).

The content are the responsibility of International Medical Corps and do not necessarily reflect the views of USAID or the United States Government.

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