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WHO (2016) Handouts on Depression
Category: Specific Tools and Materials, Psychoeducation Materials
Audience: Implementing agencies
Use these handouts for providing people who are living with depression themselves or who know someone who is, with general information on the characteristics of depression and how depression can be prevented and treated:
Depression: What you should know
Living with someone with depression?
Worried that your child is depressed?
Worried about the future? Preventing depression during your teens and twenties
Wondering why your new baby is not making you happy?
Staying positive and preventing depression as you get older
Do you know someone who may be considering suicide?
Do you feel like life is not worth living? -
International Federation of Red Cross and Red Crescent Societies (web-page) MHPSS Emergency Handouts and Info Sheets
Category: Specific Tools and Materials, Psychoeducation Materials
Audience: Implementing agencies
For psychoeducation material on stress and coping, children’s stress and support, Psychological First Aid, working in stressful situations, and much more, access the IFRC MHPSS Emergency handouts and info sheets here.
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WHO (2014) Preventing Suicide: A Global Imperative
Category: Specific Tools and Materials, Prevention
Audience: Implementing agencies, Governments, Donors
Use this report as a tool to increase the awareness of the public health significance of suicide and suicide attempts, and to make suicide prevention a higher priority on the global public health agenda. The report is intended as a resource for policy-makers and other stakeholders.
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PAHO (2016) Prevention of Suicidal Behavior
Category: Specific Tools and Materials, Prevention
Audience: Implementing agencies, Governments, Donors
Access this practical tool for essential information regarding suicidal behavior and the main prevention strategies.
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IMC Challenges & Solutions linked to Strengthening Services and Mental Health Systems within Mental Health Integration
Category: Field Examples and 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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Scale Up of Services for Mental Health in Low-Income and Middle-Income Countries
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
An assessment of progress in scaling up mental health integration services worldwide using a systematic review of literature and a survey of key national stakeholders in mental health. Describes successful strategies for overcoming barriers to scaling up, such as the low priority accorded to mental health, scarcity of human and financial resources, and difficulties in changing poorly organized services.
Full reference: Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., ... & Saxena, S. (2011). Scale up of services for mental health in low-income and middle-income countries. The Lancet, 378(9802), 1592-1603.
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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 provides important input towards integrating mental health into primary health on the national policy level in Lebanon.
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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Special Series on Integrating Mental Health Care into Existing Systems of Health Care: During and After Complex Humanitarian Emergencies
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
An Intervention special issue which focuses on integrating mental health care into existing systems of health care: during and after complex humanitarian emergencies- with summaries of papers in various languages. Access here.
Full reference: Intervention Journal Special Series on Integrating mental health care into existing systems of health care: During and after complex humanitarian emergencies November 2011-Volume 9- Issue 3.
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Traditional Healers in South Africa: A Parallel Health Care System
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
A call to involve traditional healers in mental health programming and service provision, and to avoid setting up parallel service systems.
Full reference: Kale, R. (1995). Traditional healers in South Africa: A parallel health care system. BMJ: British Medical Journal, 310(6988), 1182.
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Mapping the Evidence on Pharmacological Interventions for Non-Affective Psychosis in Humanitarian Non-Specialised Settings: A UNHCR Clinical Guidance
Category: Key Publications & Readings
Audience: Implementing agencies, Governments, Donors
This paper provides clinical guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings in cases where pharmacological treatment of people with non-affective psychosis do not improve with mhGAP first-line antipsychotic treatments.
Full reference: Ostuzzi, G., Barbui, C., Hanlon, C., Chatterjee, S., Eaton, J., Jones, L., ... & Ventevogel, P. (2017) Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: A UNHCR clinical guidance. BMC medicine, 15(1), 197.
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.
