Research has shown that an effective means of implementing improvements to the quality of mental health services for common mental health problems, such as depression, is through interventions aimed at changes in primary healthcare practice (3-6). This study examines the feasibility of an approach that aimed to effect changes to primary care through a carefully coordinated and supported detection and intervention program designed specifically to enhance the quality of mental health services amongst primary healthcare practitioners. Similar approaches have been proven effective in other countries, providing a strong rationale for the study in Vietnam (6-8). The goal of this study was to test the feasibility of conducting a cluster randomized controlled trial of enhanced primary healthcare services for depression, with the long-term goal of having a transformative effect on the quality of mental health services in Vietnam.
The rationale for primary mental healthcare enhancements include the:
Commune health workers who work at the level of primary healthcare were the target of the study which aimed to achieve specific changes in their practice, including:
Vietnam has made substantive policy and legislative changes over the past few decades to replace institutional care with community-based mental health services. Consequently, this study intended to contribute to this system’s transformation, building the capacity of primary care providers to support better detection and treatment for common mental health problems. In order to lay the foundation for a full-randomized control trial, the feasibility study collected pilot data that would provide the evidence base for successful scale-up of the program.
The study undertook careful field-testing of materials and measures to contribute to the refinement of procedures and approaches that optimized the program’s success.
On completion of the study, investigators were able to establish that a full study of primary mental health care enhancement can be successfully undertaken and implemented in Vietnam. This includes materials and measures that have been tested for acceptability and validity. PHAD continues to build strong relationships and structures with key stakeholders in Vietnam, and this work has contributed to the full randomized trial and implementation study that is currently being implemented (Mental Health in Adults and Children: Frugal Innovations).