Step 3. Strengthen Mental Health Services & Systems

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.