Step 3. Strengthen Mental Health Services & Systems

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.

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.

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.

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.

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.

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.

  • 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.


Use information from the initial assessment (step 1) and work with trainees targeted for capacity building (step 2) and facility and regional level supervisors to strengthen mental health services and systems. This is a continual process that includes addressing barriers to accessing care and strengthening systems for case identification, service provision by trained and supervised staff, referral pathways, and follow-up mechanisms, as well as ensuring availability of needed materials and supplies (e.g. psychotropic medication).