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GIZ (2017) Conference Report: Staff Care in Fragile Contexts: What Works and What Doesn’t?
Category: Specific Tools & Materials, Staff and Self Care
Audience: Implementing agencies
Access this summary of a 2-day working conference on “Staff care in fragile contexts: what works and what doesn’t?” that explores processes, barriers, and opportunities for staff care in line with global staff care principles, based on GIZ’s regional program “Psychosocial Support for Syrian and Iraqi Refugees and IDPs”
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MHPSS Capacities and Needs Assessment
Category: Field Examples & Applications, MHPSS Capacities & Needs Assessment
Audience: Implementing agencies, Governments, Donors
WHO MHPSS Assessment Toolkit (including capacity and training needs assessments conducted by formal institutions as well as IMC, in addition to interviews and individual discussions with MHPSS service providers).
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Sample Training Reports
Category: Field Examples & Applications, Sample Training Reports
Audience: Implementing agencies, Governments, Donors
Use/adapt IMC’s Sample Training Report Template to develop your own report.
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IMC Challenges & Solutions linked to Capacity Building within Mental Health Integration
Category: Field Examples & Applications, Challenges & Solutions
Audience: Implementing agencies
A summary of problem areas and example solutions drawn from key readings, publications, and field examples.
(This is a working document which is expected to be updated periodically based on feedback from toolkit users)
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Mental Health Training of Primary Health Care Workers
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
This article describes three cases of mental health training programs for primary health care workers in three different countries and shares the lessons learnt in each setting.
Full reference: Budosan, B. (2011). Mental health training of primary health care workers. Intervention, 9(2), 125–136.
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Improving Access to Community-Based Mental Health Care and Psychosocial Support within a Disaster Context
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
A semi-quantitative study that demonstrates the feasibility and effectiveness of one community-based integrated MHPSS intervention in one resource-poor developing country, post-disaster.
Full reference: Budosan, B., O’Hanlon, K. P., & Aziz, S. (2014). Improving access to community-based mental health care and psychosocial support within a disaster context. Disaster Health, 2(1), 25–34.
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The Integration of Mental Health into Primary Health Care in Lebanon
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
This paper describes an example project in Lebanon involving the design of a mental health PHC integration curriculum and training involving formative research, programme modifications, and close collaboration with the government and key stakeholders.
Full reference: Hijazi Z, Weissbecker I, & Chammay R (2011). The Integration of Mental Health into Primary Health Care in Lebanon, Intervention, 9(3), 265-278.
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Implementing mhGAP Training to Strengthen Existing Services for an Internally Displaced Population in Pakistan
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
This paper describes the successful implementation of the mhGAP to train primary care physicians in LMIC such as Pakistan, despite the challenges of a humanitarian crisis.
Full reference: Humayun, A., Haq, I., Khan, F. R., Azad, N., Khan, M. M., & Weissbecker, I. (2017). Implementing mhGAP training to strengthen existing services for an internally displaced population in Pakistan. Global Mental Health, 4.
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Building Capacity in Mental Health Interventions in Low Resource Countries: An Apprenticeship Model for Training Local Providers
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
This paper presents an apprenticeship model for lay counselor training and supervision in mental health treatments in LMIC, used in a range of mental health intervention studies conducted over the last decade in various low-resource settings. Describes elements of this approach, the underlying logic, and examples drawn from experiences working in 12 countries, with over 100 lay counselors.
Full reference: Murray, L. K., Dorsey, S., Bolton, P., Jordans, M. J., Rahman, A., Bass, J., & Verdeli, H. (2011). Building capacity in mental health interventions in low resource countries: An apprenticeship model for training local providers. International Journal of Mental Health Systems, 5(1), 30.
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Cognitive Behaviour Therapy-Based Intervention by Community Health Workers for Mothers with Depression and Their Infants in Rural Pakistan: A Cluster-Randomised Controlled Trial
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
This paper assesses the Thinking Healthy Program, a psychological intervention delivered by community-based primary health workers. Results show positive outcomes linked to its integration into health systems in resource-poor settings.
Full reference: Rahman, A., Malik, A., Sikander, S., Roberts, C., & Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. The Lancet, 372(9642), 902-909.

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.

WHY is this step needed?
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.

HOW is this step done?
- 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.

MINIMUM elements of capacity building
- 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.

COMPREHENSIVE additional elements of capacity building
- 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

WHEN is this step done?
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.

KEY CONSIDERATIONS
- 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).
