Health system strengthening in partnership with researchers, Ministries of Health and non-governmental organisations. The program implements and evaluates district level mental health care plans (MHCPs) at health organization, facility and community levels, initially in one district in each country, with a view to scaling up in other districts.
In Nepal, the MHCP consists of twelve packages, divided over community, health facility and organization platforms. The mhGAP Intervention Guide (IG) forms the core of the treatments provided at the health facility, in addition a number of community based interventions are incorporated in the plan (including community sensitization, counselling, home-based care and stigma reduction). The basic structure of the plan is further shaped by the outcomes of the formative study, primarily by the Theory of Change that outlines the key building blocks of the plan.
Furthermore, a strategy has been developed to increase community detection through proactive case-finding. The Community Informant Detection Tool (CIDT) was developed to identify people with probably mental health problem by matching on vignettes that are context sensitive. Evaluation of the CIDT is currently ongoing, with promising initial results.
Finally, we developed the ENhancing Assessment of Common Therapeutic factors (ENACT) scale to meet these needs. The ENACT scale is an 18-item assessment for common factors in psychological treatments, including task-sharing initiatives with non-specialists across cultural settings. ENACT can be used to evaluate therapy quality and association with patient outcomes, as well as for supervision and training purposes.