Innovation summary

This program established a special clinician primary care system, where the management of psychiatric disorders are run by family physicians. Physicians are able to carry out primary, secondary & tertiary prevention for both physical & mental issues, enabling people to live healthier lives.

  • Increased public awareness & reduction of the stigma of psychiatric disorders among younger and older populations
  • Creating the availability of & easy access to cost effective services is a significant achievement of the programme and facilitating team

Impact summary

  • Integrated the programme within 12 primary mental health care clinics out of 25 centers
  • Trained approximately 200 physicians in psychiatric integration within the primary health care system 

Innovation details

In Kuwait, number of psychiatric physicians is less than 84 in a country of nearly 4.5 million1. This statistic is especially concerning given that common mental health disorders such as depression, generalised anxiety disorders, panic disorders, obsessive-compulsive disorders (OCD), post-traumatic stress disorders and social anxiety disorders may affect up to 15% of the population at any one time. They vary considerably in their severity, but all these conditions can be associated with significant long-term disability. About 50% of all individuals with psychiatric illnesses never seek treatment due to factors related to the negative perception of mental disorders and stigma.

When people do seek help for mental disorders it's mostly from clinicians not trained in mental health. In Kuwait, the incidence of depression, anxiety disorders  and somatic symptoms disorders is 56%, 47% and 68% respectively among patients visiting primary care centres for general clinics2. That's why it is important to educate physicians in the primary health care system and increase their skills in the recognition of mental disorders. The goal is build capacity within physicians to provide appropriate treatment at the right time and address this gap between patients with psychiatric illnesses and the psychiatric health services in Kuwait.

Mental health and well-being is everybody’s business. It affects every family in Kuwait and it can only be improved if co-ordinated action is taken across all levels of the government services. To address the treatment gap, the Primary Health Care mental health team in the capital health district in Kuwait aimed to promote and improve the knowledge and skills of primary care physicians who worked with people in distress. The programme involved mental health promotion and prevention, with a focus on intervening early including:

  1. Creating primary mental health clinics run by family physicians with mental health training
  2. Continue education programs integrating psychiatric knowledge in primary care together with clinical training
  3. Develop and implement public Awareness Campaigns to increase public awareness regarding mental health conditions and reduce the stigma associated with people receiving care.
  4. Increase the access and availability of antidepressant and antipsychotic medications in primary care centres

Key drivers

  1. Establishment of a dedicated primary mental health team with regular meeting to encourage and motivate team members
  2. Effective cooperation with the Taqabal awareness campaign to do awareness lectures in high schools & universities

Challenges

Monitoring and Evaluation

  • Difficulty obtaining statistics from the central department of primary care in the Ministry of Health creating challenges in monitoring and evaluation

Human Resources and Retention

  • Insufficient number of clinical psychologists to facilitate work in primary clinics
  • The programme struggles with retaining doctors who dropped out after training in primary mental health programs. Although the programme trained 20-30 physicians each year since 2011 till 2019 approximately many of these left to carry out other administrative work or clinical duties.

Low in Policy Priority

  • Lack of manpower and support in the mental health committee and heads of primary care centres on  programme policy
  • Challenges with engaging and generating the support of Officials and decision makers in the Ministry of Health on the subject of mental health policies and interventions
  • Limited ethical policies and laws for the regulation and standard of mental health services and the rights of individuals who seek and are undergoing treatment and care
  • Challenges engaging with the IT Department in the Ministry of Health to reform and develop the electronic files on mental health. More relationship building is required to motivate the central department for primary care to update the medical electronic file in Primary Care

Continuation

Plans for continuation of the programme involves re-organising the primary mental health team and ensuring rigorous follow-up and assessment of the mental health education & training programs administered from 2011-2019

  1. Clinical Training for 5 family physicians for 4 weeks at the psychiatric hospital until each year, till December 2019.
  2. Creating a new policy regarding suicide prevention together with a public awareness campaign in Oct 2019

Partners

Funders

Evaluation methods

  1. Set new standards and protocols for equipping primary mental health clinics in new centres within the capital health district
  2. End of year evaluation of the performance of physicians working in primary mental health clinics in 11 centers within the Capital health district
  3. All physicians are evaluated after attending theoretical & clinical training by observations
  4. Statistical evaluation of psychiatric medical visits in the Primary mental health clinics and general clinics in all centers within capital health district

Cost of implementation

  1. Creating a local Kuwaiti guideline for the integration of psychiatric management in primary care cost 3,000 KD (~ GBP 7,911.75)
  2. Capacity-building activities for doctors from each health center; cost of each course was 1,000-1,500 KD (~GBP 2,637 - 3,955.5)
  3. Public awareness days celebrations 500-1,500 KD yearly (~GBP 1,317.58 -3,955.5)
    • YouTube awareness movie 3,000 KD (~GBP 7,911.75)
    • Other costs for dissemination and awareness 750-1000 KD (~ GBP 1,976.38 - 2,637)

Impact details

  • The programme started with only 3 Primary Mental health Clinics out of a total of 21 centers within the Capital health district.
    • In 2019 the programme has successfully integrated into 12 PRMH clinics out from 25 centers
  • Training doctors from each health center on the protocols of psychiatric integration in primary health system through 7 courses from 2011 -2019
    • Approximately 200 physicians trained from 2011
  • The Primary Mental Health Clinics also mark public awareness days yearly according to the WHO Mental health day’s themes.

References

  1. Sulaiman AK, Aseel OA et al (2016) Prevalence of psychiatric morbidity in the primary health clinic attendees in Kuwait​​, Journal of Affective Disorders; 195, 15–20
  2. Al-Otaibi, B., Al-Weqayyan et al (2007) Depressive symptoms among Kuwaiti population attending primary health care settings. Prevalence and influence of Sociodemographic factors. Med. Princ. Pract; 16, 384–388.
  3. Sulaiman AK , Aseel OA et al (2018) Mental and physical co-morbidity in an Arab primary health care setting​, BMC Psychiatry; 18:313 [Link]

Research

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