Partners In Health, Cross-Site Mental Health Learning Collaborative (MHLC)

Innovation summary

The Cross-Site Mental Health Learning Collaborative (MHLC) is a trans-national consultation model which supports the development of highly innovative and sustainable mental health services as well as system strengthening efforts across Partners in Health programs in Haiti, Kazakhstan, Lesotho, Liberia, Malawi, Mexico, Navajo Nation, Peru, Rwanda and Sierra Leone. Focusing on delivering innovative psychotherapies in formats that can be taught, supervised and scaled, the MHLC provides a forum for implementers to develop a toolbox for treating mental conditions, share best practices across sites, and grow as leaders in the global mental health field. The MHLC is tethered by quality improvement techniques enabling practitioners to analyze current gaps in diagnosis and treatment of common mental disorders, co-design and co-implement contextually relevant solutions in their settings. The MHLC aligns with national and international efforts to strengthen non-specialist driven interventions to address common mental conditions.

Impact summary

Innovation details

With few sustainable, efficacious, and cost-effective mental health service delivery models being translated to services worldwide, the MHLC seeks to promote innovation, foster capacity building and professional development, and cross-site knowledge sharing to expand mental health care that moves treatment outside of institutions and into home and communities, meeting people where they live.

Promoting Innovation

With input from representatives from all 10 PIH sites, the PIH Mental Health program developed the Cross-Site Strategic Planning Matrix to Achieve Universal Health Coverage—a tool to expand service delivery and model effective implementation of mental health services at health center and community levels, depending on available local resources. In 2019, four sites (Haiti, Mexico, Liberia, and Rwanda) participated in Theory of Change and Quality Improvement workshops to further ground the matrix in local experience and generate momentum for strengthening health systems around expanding delivery of community-based care for common as well as severe mental conditions.

Knowledge Sharing and Capacity Building

Through cross-site learning, collaboration, and dissemination, the MHLC creates a platform for training and mentorship led by local implementing teams from across sites. Monthly cross-site calls provide an opportunity for mental health teams and collaborators to share best practices and collectively develop custom frameworks and tools to strengthen their delivery of mental health care. In addition, the MHLC continues to develop an online resource where site teams can share and adapt implementation tools, training materials, and clinical guidelines. Through virtual coordination calls and in-person trainings, this cross-national training model has evolved to encompass collaborations between PIH teams in Liberia and Sierra Leone for the implementation of Sierra Leone’s homeless mental health care program as well as the piloting of WHO’s Problem Management Plus (PM+) intervention in Mexico and Malawi with guidance from PIH teams in Peru and Rwanda respectively. Over the years, teams have created, adapted, and piloted new curricula for psychosocial rehabilitation, substance use, and healthcare worker trainings across sites. Team members travel across sites and continue to meet virtually to support and learn from one another.

Value chain workshops and e-learning course

Care delivery sites engaged in value chain workshops and created an e-learning course to promote and deepen the quality of mental health care. The PIH Mental Health value chain—a map of the care delivery system—describes key elements essential in the delivery of quality, high-value care for mental health patients. The primary goal of the course is to equip learners to recognize how to apply essential elements required for delivery of quality care for people with mental health conditions. After its official launch on the MHLC call on September 20th, our self-paced eLearning. Mental Health Value Chain course is now available on OnePIH’s Learning Portal hosted by Tovuti. The e-learning course can be accessed on the learning platform through the Partners In Health website here.

Key drivers

Knowledge Management and Capacity Building
There have been over 200 people involved in the MHLC between 2016-2022, with over 40 innovations shared and implemented across sites. To leverage best practices, site teams engage in peer-to-peer capacity building and curriculum adaptation

Challenges

Internet: The internet serves as a valuable platform for coordination, collaboration, and knowledge sharing between cross-site teams. As PIH sites often serve remote communities, internet connectivity can sometimes be a barrier to optimal communication.

Bandwidth of Frontline Service Providers: The MHLC is comprised of providers on the frontlines of mental health service delivery across PIH sites. For this reason, the Collaborative remains mindful of members’ available time, capacity, and the implications of travel when considering opportunities for collaboration and cross-national training.

Changing Needs: Each of our sites work is impacted by their local political climate. In situations of unrest, our colleagues are impacted and need to adjust to ensure the safety of their staff as a priority. The MHLC remains as a virtual platform for ongoing support recognizing the needs and wellbeing of our colleagues, in each of our sites

Continuation

PIH’s Cross-Site Mental Health Program is leveraging the existing MHLC to support service adaptation, communication, and strong coordination for nimble response to the COVID-19 crisis.

Partners

Partners In Health Sister Sites:

Collaborators

Harvard Medical School, Department of Global Health and Social Medicine
Brigham and Women’s Hospital Division of Global Health Equity
Massachusetts General Hospital Chester M. Pierce Division of Global Psychiatry
District and national Ministry of Health in each country

Funders

Abundance Foundation
HGHI Burke Fellowship
Many Voices Foundation
One by One
Grand Challenges Canada
Johnson & Johnson

Evaluation methods

Strengthening Data Collection Systems for Improved Mental Health Outcomes. The MHLC continually seeks to improve mental health outcomes measurement, data collection systems on routine care provision, and electronic medical records across sites. Sites have established key performance indicators to track common mental health conditions and developed clinical tools, forms, and protocols to guide program implementation and enhance data collection and analysis. These tools have already contributed to expanding key data and data visualizations available through PIH’s existing platform of Microsoft’s Power BI. As a result, clinicians across sites have increased access to patient-level data and an enhanced ability to track key performance outcomes. In addition, the MHLC continues to explore innovative digital health platforms to further strengthen community-based data collection systems across sites.

Quality Improvement Collaborative. The MHLC has initiated a quality improvement collaborative (QIC) to offer sites a platform in which they can learn from each other and explore opportunities to improve service delivery across the value chain for mental health care delivery. Working through this model sites including PIH Liberia and PIH Rwanda have already implemented quality improvement workshops and launched QI projects to increase their impact within the community and improve patient management and retention for PM+ programming respectively. The MHLC has developed a QI curriculum and toolkit to support these efforts and improve service delivery across sites.

Impact details

PIH’s MHLC has proven that high-quality mental health care can and should be available to all people, no matter where they live.
Since its genesis in 2016, the MHLC has supported the mental health care of more than 62,000 patients and conducted over 265,000 mental health visits across 11 global sites.