Mental health service delivery at IMB started through the Mentorship and Enhanced Supervision at Health Centers for Mental Health (MESH MH) model, implemented from 2014- 2016 via a seed grant from Grand Challenges Canada. MESH MH is a model adapted from the Mentoring and Enhanced Supervision at Health Centers Model (MESH), which was originally developed for HIV and other clinical areas2. MESH MH strengthens decentralized primary health care services at health centers through a combination of didactic training, ongoing clinical mentorship, and quality improvement activities3,6.
- Training: Health center nurses receive intensive training (40 hours) on identifying and managing four major neuropsychiatric disorders: schizophrenia, bipolar disorder, major depressive disorder, and epilepsy. Community health workers also receive sensitization and training on these disorders.
- Supervision: After the training, nurses receive regular supervision by trained Rwandan mental health nurse mentors. Mentors conduct regular supervision visits for clinical observation, case and documentation review, and brief didactic sessions, using a mental health supervision checklist. This checklist ensures standardization of activities and performance of key elements of psychiatric evaluation, diagnosis, and referral. Quality of care provided by health center nurses is defined by the successful completion of checklist items. During supervision visits, the nurse mentor also discusses system-based performance issues and “quality gaps” with the health center nurses and director to formulate specific plans to improve patient care, referral pathways, and coordination between services.
Over the course of MESH implementation, the MOH and PIH/IMB identified the need to strengthen the non-pharmacologic elements of existing services, specifically by integrating evidence-based psychotherapies for mental health disorders into the primary care system.
A pilot delivery of a psychotherapy intervention is being rolled out using the World Health Organization’s Problem Management + Protocol (PM+)1. PM+ has been shown to be effective in Kenya and Pakistan4,5, and IMB will be the first to adapt PM+ for Rwanda and to deliver the intervention in a ministry/NGO setting. Implementation and pilot testing begins in 2017.
Goals of the intervention include:
- Adapt PM+ Curriculum to the Rwandan context and train providers
- Pilot delivery at the health center level by nurses
- Train 1 nurse at each health center in Burera to deliver evidence-based psychotherapies to mental health patients
- Train other health care professionals in Burera district, including at Butaro District hospital, on the integration of psychotherapies
- Develop and implement a system for mentorship and supervision of nurses providing psychotherapy