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Toolkit for the Integration of Mental Health into General Healthcare

Step 2 icon

Step 2. Build Capacity of General Healthcare Workers

Capacity building includes theoretical and practical training, as well as ongoing technical support and supervision for general health workers such as doctors and nurses as well as community health workers. Additional MHPSS workers to be trained is dependent on the context and can include social workers, counsellors, psychosocial workers and volunteers.

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WHY is this step needed?

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Treatment coverage for people with mental disorders is increased significantly by offering accessible and affordable mental health services as part of general health care.

  • Building the knowledge and skills of facility and community level general health care providers and non-specialist MHPSS providers through training, supervision and mentorship over time helps ensure that trainees are confident and able to apply their skills to provide quality services.
  • Raising Awareness among health care providers and other trainees about mental health and their roles in mental health integration (e.g. access, combating stigma, affordability, etc.) makes such services more accessible and acceptable.
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HOW is this step done?

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  • Select up to 51 priority mental health priority conditions to focus on (based on situational analysis/national guidelines), in addition to covering general principles of care.
  • Identify targeted geographical regions and health facilities and select the number and types of trainees to include.
  • Develop the training curriculum content (based on WHO mhGAP materials and guidelines), and adapt it to the context (local, social, and cultural considerations) and to the capacity and roles of trainees.
  • Prioritize topics to emphasize better quality training on a smaller number of conditions vs training on all conditions. Training on additional conditions can be rolled out over phases as needed.
  • Develop a training and supervision schedule which allocates the needed time and resources for on the job supervision sessions, with follow up sessions and refresher trainings as needed, avoiding a one-off training with no supervision.
  • Engage local mental health professionals (where possible) in conducting training and providing longer term support, consultation and supervision (e.g. as co-trainers, to receive a training of trainers (TOT)) to ensure sustainable and quality mental health care.
  • Engage mental health care providers (e.g. international psychiatrist, national psychiatrist, psychiatric nurse) to provide training as well as ongoing supervision (e.g. on the job mentorship, case discussions).
  • Monitor and evaluate baseline and improvement in knowledge and skills to determine follow up and refresher training focus and content.

1 More than 5 mental health priority conditions may be chosen if in line and in accordance with national level discussions, policy and planning.

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MINIMUM elements of capacity building

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  • Provide training and supervision sessions to local health professionals over a minimum of 4 months to recognize and treat and refer persons with mental disorders.
  • Ideally, train on one mhGAP topic per day (2 maximum topics depending on assessment of foundational knowledge). If fewer training hours are restricted and few due to budget or logistical constraints or political/institutional considerations, consider reducing the number of priority conditions covered and include more supervision hours.
  • Provide supervision (e.g. on the job supervision, group and/or individual supervision sessions) following completion of foundation training for a minimum of 3 months (e.g. 3 sessions per trainee, 1 session per month).
  • Train community level non-specialists (e.g. community health workers, volunteers, psychosocial workers) to assist with case identification, follow up, community awareness raising and provide basic psychosocial support (e.g. Psychological First Aid (PFA)).
  • Use M&E tools to track knowledge (pre-post test), and skills (on the job supervision checklist) among trainees.
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COMPREHENSIVE additional elements of capacity building

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  • Carry out periodic evaluations (FGDs, interviews, questionnaires, supervision visits etc.) to assess remaining training gaps in knowledge and competencies, and develop follow up and refresher trainings.
  • Set up peer level supervision between PHC staff.
  • Develop additional supplemental materials (e.g. job aids).
  • Support national stakeholders and health facilities in developing resources and strategies to promote staff well-being.
  • Develop longer term strategy with national stakeholders to leverage role of national mental health professionals to provide training and ongoing supervision and support to general health workers and non-specialist MHPSS providers, and to to provide consultation or manage complex cases.
  • Collaborate with academic institutions and professional associations to integrate mental health into pre-service training and continuing education for health professionals.
  • Develop capacity of local non-specialist MHPSS providers (e.g. community health workers, social workers, psychosocial workers) in mental health case management, and evidence based scalable psychological interventions2 (e.g. cognitive behavior therapy, Problem Solving Plus (PM+) or interpersonal therapy (including group IPT)).

2 Use the manuals in the Psychological Interventions category resource below if you are developing an integration program with a component that teaches local non-specialist MHPSS providers to deliver evidence-based scalable psychological interventions for common mental disorders

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WHEN is this step done?

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After conducting the initial needs assessment and planning which would inform the selection of target facilities, trainees, geographical locations and training content as well as the identification of resources, partnerships, and local capacities to support in the short, medium, and longer term.

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KEY CONSIDERATIONS

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  • Do establish links and communication between trained healthcare providers and specialized mental health services (e.g. psychiatrist) for ongoing technical support and referral/back-referral of persons with severe and complex mental health problems.
  • Do identify supervisors before the training is conducted and define a timetable for supervision.
  • Do ensure careful consideration and assessment of training needs, existing structures and resources.
  • Do ensure training is within implementing agency’s capacity and based on current best practices and standards.
  • Do use results of pre/post training tests to inform key aspects of supervision sessions.
  • Do coordinate with the state health office or ministry of health on planning, implementing and longer term support, training, and supervision.
  • Do pay attention to staff well-being (e.g. work load, schedules, breaks, stress management sessions).
  • Do not decide on topics for training without consulting national guidelines and other relevant aspects of the needs assessment.
  • Do not set up stand-alone training without proper follow up, support and supervision.
  • Do not forget to monitor progress in knowledge and skills during training and supervision.
  • Do not overwhelm the health staff (e.g. training on too many modules at the same time, asking them to do much more than what they usually do on a day to day basis).
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RESOURCES

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Category

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

Audience

  • Implementing agencies Apply Implementing agencies filter
  • Governments Apply Governments filter
  • Donors Apply Donors filter

Language

  • English Apply English filter
  • French Apply French filter
  • Arabic Apply Arabic filter
  • Spanish Apply Spanish filter
  • Other Apply Other filter
  • 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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  • WHO (2017) WHO Training of Health Care Providers Training Manual (ToHP) for mhGAP-IG

    Category: Key Guidance, Training Guidance

    Audience: Implementing agencies

    Adapt this training manual to build capacity among local non-specialist health-care providers in the assessment and management of people with priority MNS conditions. The manual is part of a comprehensive training package for the implementation of the mhGAP Intervention Guide, version 2.0. for low resource settings.

    Access the ToHP manual by individual modules:

    Supplemental Resource: mhGAP Video Training Aids, supplemental videos for each section of the mhGAP can be found within video links.

    • PDF icon Access the comprehensive TOHP Manual
  • UNHCR and WHO (2015) mhGAP Humanitarian Intervention Guide (mhGAP-HIG)

    Category: Key Guidance, Training Guidance

    Audience: Implementing agencies, Governments, Donors

    In humanitarian emergencies where there are limited mental health resources. This guide extracts essential information from the full mhGAP-IG and includes additional elements for use in humanitarian emergency contexts.

    • PDF icon Access here
    • PDF icon Access in Arabic
    • PDF icon Access in French
    • PDF icon Access in Russian
    • PDF icon Access in Spanish
    • PDF icon Access in Ukranian
  • UNHCR and WHO (field test version) mhGAP-HIG Training Manual: Facilitator Guide

    Category: Key Guidance, Training Guidance

    Audience: Implementing agencies

    Facilitators can use this manual with step-by-step training modules of priority MNS conditions within the mhGAP-HIG.

    > If you’d like to share your feedback on use of this specific resource with WHO, please fill out this feedback form, and submit to the appropriate WHO focal person.

    • PDF icon Access field test version here
  • WHO (2016) mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings - Version 2.0

    Category: Key Guidance, Training Guidance

    Audience: Implementing agencies, Governments, Donors

    For comprehensive guidance on integrated management of priority MNS conditions using protocols for clinical decision-making. This mhGAP-IG Version 2.0 reflects updates to the initial 1.0 version, based on emerging literature and extensive feedback from the field to enhance the guide in its clarity and usability.

    e-mhGAP (Phone Application): Also available in a mobile application version for download on iOS and Android.

    • PDF icon Access here
    • PDF icon Access in Spanish
  • WHO (2013) Assessment and Management of Conditions Specifically Related to Stress: mhGAP Intervention Guide Module

    Category: Key Guidance, Training Guidance

    Audience: Implementing agencies

    For guidance on assessment and management advice related to acute stress, post-traumatic stress and grief in non-specialized health settings. This resource is an annex to the mhGAP-IG.

    [an mhGAP supplementary resource]

    • PDF icon Access here
    • PDF icon Access in Arabic
    • PDF icon Access in French
    • PDF icon Access in Russian
    • PDF icon Access in Spanish
    • PDF icon Access in Ukranian
  • WHO (2017) mhGAP-IG Training of Trainers and Supervisors Training Manual (ToTS)

    Category: Key Guidance, Training Guidance

    Audience: Implementing agencies

     Use this TOTS manual as a training resource for national mental health professionals to provide training and ongoing supervision and support to general health workers and non-specialist MHPSS providers. Includes training needs assessment, pre- and post-tests, competency checklist, feedback forms, and end of training evaluations.

    • PDF icon Access ToTS Manual
    • PDF icon Access the ToTS Slides
  • WHO (2018) mhGAP Operations Manual

    Category: Key Guidance, Implementation Guidance

    Audience: Implementing agencies

    Use the mhGAP Operations Manual for practical, step-by-step guidance for integrating mental health services into general health care, with sections relevant to capacity building activities [See page 15, and specifically Sections 2.1 and 2.2 for guidance on adapting resources and training].

    • PDF icon Access here
  • WHO (Coming Soon) Implementation Guide for Scalable Psychological Interventions

    Category: Key Guidance, Implementation Guidance

    Audience: Implementing agencies

    Field Test Version to be finalized and available in 2019 [Coming Soon].

  • WHO (2016) PROBLEM MANAGEMENT PLUS (PM+) Individual Psychological Help for Adults Impaired by Distress in Communities Exposed to Adversity

    Category: Psychological interventions

    Audience: Implementing agencies

    Use this manual (an mhGAP supplementary resource) to train MHPSS providers to support people with depression, anxiety and stress, regardless of whether or not exposure to adversity has caused these problems, using problem solving techniques.

    Theoretical basis: Adaptations of aspects of cognitive behavior therapy
    For use by: non-specialists including paraprofessionals, and other MHPSS providers.
    Target: Adults impaired by distress
    Field Testing: Feasibility and definitive randomized controlled trials were carried out in Nairobi in Kenya and Peshawar in Pakistan.

    Supplementary Material:

    • Training materials: [Coming Soon]
    • “Khoutweh-Khoutweh”: An e-mental health program developed in Lebanon, based on PM+, available in Arabic and English.
    • PDF icon Access here
    • PDF icon Access in Arabic
    • PDF icon Access in Urdu
    • PDF icon Access in Kenyan (mixed English/Swahili)
  • WHO (2015) Thinking Healthy: A Manual for Psychosocial Management of Perinatal Depression

    Category: Psychological interventions

    Audience: Implementing agencies

    Use this manual (an mhGAP supplementary resource) for programs where there are opportunities and a need for training community health workers on how to support mothers with depression.

    Theoretical Basis: Adaptation of cognitive behavioral techniques
    For use by: Community health workers
    Target: Mothers with depression

    Supplementary Material:
    Training materials: [Coming Soon]

    • PDF icon Access manual 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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