The Neno mental health program delivers services through an integrated mental health clinic and mentorship of providers using an adapted Mentorship and Enhanced Supervision at Health Centers (MESH) Checklist. The mental health clinic is incorporated into Neno District’s broader Integrated Chronic Care Clinic (IC3) program, which utilizes two hospital-based teams supporting all health centers in the district. The district hospital team, which started providing mental health services in 2012, is supported by a psychiatric nurse and Mental Health Clinical Officer Mark Chalamanda. The community hospital team is supported by a mental health clinical officer, Thokozani Kholomana and started enrolling mental health patients in May 2017.
The model operates through the existing Integrated Chronic Care Clinic (IC3) platform in Neno District. IC3 is a primary care delivery platform which leverages the pre-existing HIV clinics to deliver care to all patients with chronic disease, be it HIV and/or non-communicable diseases (NCDs), serving a catchment area of over 165,000 Malawians2, 6-8.
The clinic primarily treats patients with psychosis, schizophrenia, epilepsy and mood disorders induced by HIV or epilepsy medications. The clinic also takes care of patients who have relapsed from lack of treatment or medication adherence issues5,9. Advanced mental health clinics are also held once a week at the hospital for more complex patients who need a higher level of care. Additionally, a visitation program started to reach patients who are reluctant to come to the health facility for medications or for patients with epilepsy that have compromised movement.
Training and Mentorship
The mental health clinical officers support the primary care delivery at all health centers through mentorship at IC3, traveling out to health centers with the multidisciplinary IC3 team on a regular basis. Mentorship is conducted using the MESH checklist at least twice per month per mentee and initial results show progress in the clinical teams’ skills. Moving forward, the Malawi program hopes to integrate depression screening into the IC3 clinic for patients with chronic conditions including HIV/AIDs.
To supplement the mentorship approach, APZU has conducted 3 mental health trainings to Neno health providers between April 2017 and February 2018. The training aimed to enhance the knowledge capacity of health providers on the management of common mental disorders and how to handle psychiatric emergencies. Content for the training sessions was created by the Malawi team with help from Psychiatrists at Boston. Certain materials were also adapted from PIH/Zanmi Lasante’s Mental Health program in Haiti. The participants who were trained are followed up monthly for mentorship by Mental Health Clinical Officers.