Since the end of conflict in 2009, Northern Sri Lanka has an increased need to rebuild the health system. Currently, there is a lack of human resources, as the amount of new healthcare professionals being trained is below that of the growing need in the region. The relative political, social, and economic stability in the region is favourable to training new healthcare workers and increasing the capacity of existing health work force. This project aims to improve the skills of existing primary care health work force by adding mental health care into primary care services (first port of call) across all districts of the province.
Content of the innovation
A cross-sectional study was completed at primary care level in 2016 to understand the prevalence and burden of mental health disorders in the Northern region of Sri Lanka. Here, the evidence gathered in the pilot is combined with locally created videos and training materials to adapt the mhGAP 2.0 intervention programme
to ensure it is locally relevant.
25 primary care facilities will receive training over the course of one week, in which primary care practitioners (PCP) and public health professionals (PHP) attend a three-day training involving role-plays, videos, and seminars using material developed by the World Health Organization. Once trained, they will be asked to use their training to diagnose, treat, and refer patients with possible mental health problems, and patients visit a psychiatrist to confirm their diagnosis and receive treatment as required. Additionally, community representatives (CR) such as religious leaders, traditional healers, and Ayurvedic practitioners from the areas near each primary care facility will be provided with a tailored version of the training intervention, and afterwards asked to help raise awareness, find local resources, and organise mental health promotional activities in their communities. PHP will be asked to engage in activities such as stigma reduction, enabling referrals, and supporting CR-led community engagement activities. There will be two refresher courses for PCP, PHP, and CR 3 and 6 months after the first training course. A psychiatrist will provide feedback to each facility to enhance the quality of clinical assessment.
Long-term aims of the innovation
It is envisaged that the training intervention using mhGAP-IG will increase rates of correct identification, treatment/management, and specialist referral rates by PCP. It is also envisaged that extending this training intervention to involve PHP in the region will improve the delivery of psycho-education and monitoring of mental health care delivery, and will increase referrals. In addition, the study explores the task-shifting of mental health care provision from health services to the community.
In the long-term, it is hoped that these trained PCP, PHP and CR will aid to:
- Reduce acute and long-term disease burden and service-provision costs
- Provide effective/accessible mental health care
- Help reduce mental health related stigma
- Enhance community awareness
- Support the improvement of psychosocial well-being among vulnerable/traumatized post-conflict populations in the area4