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IMC (2017) Case Management Clinical Form Package
Category: Specific Tools and Materials, Clinical Forms
Audience: Implementing agencies
Use this package to develop standardized mental health case management services in line with a mental health integration program services framework.
The package includes the following forms: a simplified MH case management care plan (designed by IMC), a biophysical assessment form, a discharge form, and a clinical audit sheet.
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WHO (draft) Epilepsy Patient Management Forms
Category: Specific Tools and Materials, Clinical Forms
Audience: Implementing agencies
Trained PHC providers can use this set of forms, with accompanying instructions, for persons with epilepsy (including consultation record and follow up form)
Available upon request from MHGAP-INFO@WHO.INT
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MHIN (2016) Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review
Category: Specific Tools and Materials, Clinical Forms
Audience: Implementing agencies
A summary of validated screening tools of common mental disorders for use in low and middle-income countries, based on a systematic review of 153 studies. Validated screening tools have been tested within the local context against a gold standard diagnostic interview administered by a medical professional.)
Screening tools strongly recommended in this document include:
Common Mental Disorder: SRQ-20 (general) and GHQ-12 (with physical illness)
Depressive Disorder only: HAD-S (general), PHQ-9 (with good literacy levels), EPDS (perinatal)
Anxiety Disorders only: HAD-A -
WHO (2012) Disability Assessment Schedule (DAS) 2.0
Category: Specific Tools and Materials, Patient Outcome Measures
Audience: Implementing agencies
Use this patient assessment measure to monitor treatment progress and enhance clinical decision-making. This questionnaire asks about difficulties due to health/mental health conditions. Instructions, scoring, and interpretation guidelines are provided.
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WHO (2005) 1-Item Functioning Scale
Category: Specific Tools and Materials, Patient Outcome Measures
Audience: Implementing agencies
Use this simple one item scale that assesses baseline and improvement in patient functioning within the primary health care setting.
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IMC (2017) Guide and Tools for Assessment of Functioning
Category: Specific Tools and Materials, Patient Outcome Measures
Audience: Implementing agencies
Use this simple guide that outlines methods for the development of a culturally appropriate measure of functioning using the Bolton method (Johns Hopkins University).
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Royal College of Psychiatrists.The Health of the Nations Outcome Scales (HONOS)
Category: Specific Tools and Materials, Patient Outcome Measures
Audience: Implementing agencies
For a more comprehensive outcome measure, use these scales that assess behavior, impairment, symptoms and social functioning. The scales are completed after routine clinical assessments.
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Supplementary Reading
Category: Specific Tools and Materials, Patient Outcome Measures
Audience: Implementing agencies, Governments, Donors
The WHO-5 Well-Being Index: A Systematic Review of the Literature
A systematic search for literature on the WHO-5 in PubMed and PsycINFO in accordance with the PRISMA Guidelines.
Access: here.Implementation of Health of the Nation Outcome Scale (HoNOS) in Outpatient Clinic, Sligo Mental Health Services: Feasibility and Agreement with Global Assessment of Functioning Scale
Prospective longitudinal study of psychiatric outpatients attending a clinic in Sligo. Patients were assessed using HoNOS and GAF by trained doctors during the consultation. Feedback from doctors using HoNOS during the research was taken as a measure for feasibility.
Access abstract: here. -
IMC (2017) Satisfaction Scale
Category: Specific Tools and Materials, Measures of Satisfaction
Audience: Implementing agencies
Use this satisfaction tool to measure satisfaction of persons receiving health, mental health and other services. Can be used as a measure to improve services within the areas of access to care, facility, staff care and communication skills, and confidentiality.
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IMC (2019) Mental Health Awareness and Psychoeducation Booklets
Category: Specific Tools and Materials, Psychoeducation Materials
Audience: Implementing agencies
Use these simple psychoeducation booklets that include signs and symptoms of mental, neurological, and behavioral disorders as well as sources of psychosocial distress, and challenges stereotypes to reduce stigma and encourage people to seek care.
The booklets cover various topics, including: depression, schizophrenia, attention-deficit/hyperactivity disorder, dementia, epilepsy, and post-traumatic stress disorder. They also contain information on suicide, torture, loss and grief, and psychosocial stressors and recommendations on how and where to seek support (Available in Arabic & English)
Toolkit for the Integration of Mental Health into General Healthcare
Step 3. Strengthen Mental Health Services & Systems
Strengthening of mental health services at facility and community levels provided by trained and supervised healthcare staff in addition to strengthening systems through improved coordination and referral between service providers, HMIS documentation, and psychotropic medication supply.
WHY is this step needed?
While staff capacity building is a critical component, it is not enough to establish a functioning system of community based mental health care. Various parts of the system need to work together to ensure that persons with mental health problems can be identified, appropriately managed and cared for, have access to psychotropic medications and can be referred to essential clinical or community services and followed up, as part of a functioning system. Strengthening these systems means that persons receive the care they need, and that integration can be sustained.
HOW is this step done?
Use your assessment/situational analysis to identify where your planned mental health program falls within the larger systems of health, mental health and community services as well as within humanitarian response efforts. Work with national, regional and local authorities as well as with health facility staff to strengthen MH services (e.g. identification, management, referral) and systems (e.g. space and time for services, mapping of service providers, HMIS, psychotropic medication). Ensure that trained staff and other service providers understand their role in the MH system.
MINIMUM elements of Strengthening Mental Health Services &...
Strengthening of mental health services provided by trained health staff (doctors, nurses and CHWs) consisting of:
- Identification, assessment and diagnosis (e.g. initial identification through CHWs, assessment by PHC providers).
- Management of mental disorders (e.g. psycho-education for patients and family members, psychosocial interventions, psychotropic medication- if needed).
- Follow-up (e.g. continued appointments, visits by CHWs, phone calls/text messages).
- Referral to other services including to more specialized mental health service providers.
Strengthening of mental health system through:
- Ensuring that trained staff understand their roles in MH service provision (e.g. outlining protocols, referral pathways, job descriptions).
- Ensuring there is designated and appropriate space (e.g. private space, locked files) and time (e.g. afternoons one day a week) for staff to see persons with MH problems.
- Adaptating Health Information Systems, in line with national systems, to collect data on persons with mental disorders identified in primary care.
- Supporting procurement of essential psychotropic medications in coordination with the government.
- Mapping of community services (e.g. protection, social services) and specialized MH service providers.
- Setting up processes for referral to and from MH PHC services.
- Establishing links and communication with local specialized MH services (e.g. psychiatrist) for referral of persons with severe mental health problems.
COMPREHENSIVE additional elements of Strengthening Mental...
Strengthening of mental health services through additional capacity building such as:
- Training of non-specialized staff (social workers, counselors, case managers, etc.) to provide evidence based psychological interventions with mechanisms for support, follow up and supervision by specialized mental health professionals.
- Peer to peer support activities with leadership from mental health service users.
- Setting up mechanisms for patient identification, basic support and follow up by mobilizing community health workers.
Strengthening of mental health system through:
- Supporting communication, care coordination and multi-disciplinary teamwork among various staff (e.g. health and social services, psychiatrists, psychologists and other MH professionals) to address multiple and complex needs of persons with mental illness and their families.
- Supporting Health Information Systems, in line with national systems, to collect and report data on persons with mental disorders treated at different levels of care (e.g. in primary care, mental health outpatient facilities, mental hospitals).
- Comprehensive Mapping of formal and informal service providers in the area (e.g. specialized MH services, protection services, community services, traditional healers).
- Supporting the availability and affordability of psychotropic medications including effective maintenance or establishment of sustainable supply chains (e.g. staff know when and how to order medication and feel empowered to advocate for availability of medication with government or other stakeholders).
- Setting up an effective monitoring and evaluation system for MH services and organizational level change.
- Setting up interagency referral workshops to establish clear referral pathways and guidelines among different service providers.
WHEN is this step done?
This is a continual process which requires ongoing monitoring, planning and active participation of all stakeholders from the beginning. The resources presented as Specific Tools and Materials should be used by those who have been trained as mental health care providers.
KEY CONSIDERATIONS
- Do ensure that investment in primary care is preceded by, or at least carried out in tandem with, development of community and secondary mental health services.
- Do invest in local human resources (displaced and host) to respond to MH needs.
- Do help ensure provision of a quiet and private space to meet with persons with mental health problems.
- Do address mental health needs at the appropriate level of care, while being aware of available up and down referral systems and pathways if needed.
- Do set up a system where trained health staff can connect with MH specialists for support and guidance, and for emergencies (e.g. responding to acute suicidal ideation).
- Do utilize CHWs and community leaders for outreach and connect with formal and informal service providers for referrals.
- Do respect the privacy and confidentiality of persons with MH problems.
- Do take into consideration that families/carers of people with mental disorders may also need support.
- Do discuss in training how to establish referral links with traditional healers and religious leaders who are often the first point of contact for persons with severe mental illness.
- Do not refer all persons to a specialized provider (e.g. psychiatrist or psychologist).
- Do not set up a parallel system of MH care.
- Do not forget that persons with mental health problems may have other complex needs that also need to be addressed (e.g. other general health conditions or injuries, protection concerns, housing issues).
- Do not assume people with mental illness will come to a health care facility on their own.
- Do not introduce expensive psychotropic medications that cannot be sustained in the long term and work in line with the ministry of health’s essential drug list.
- Do not allow medication supply to be interrupted.
- Do not contribute to an influx of referrals to already stretched services, without working to strengthen those existing services first.
