Innovation summary

Healthcare professionals in primary care settings such as physicians, nurses, and other workers are usually first port of call for health care since they are easily accessible by all population. Therefore, they are seen as the experts in providing holistic care for both physical and mental health. While mental healthcare concerns (primarily depression and anxiety) are seen in approximately 60% of presenting primary health patients, doctors are not always equipped and trained the best to detect and manage mental health conditions. This results in many missed opportunities for mental healthcare in primary health care services and has also been found to affect patients with chronic medical cases1.

The programme seeks to empower PHC physicians to appropriately detect and deal with MH conditions via a basic training for an innovative 5-steps patient interview approach and advance MH training courses in order to:

  1. Modify the patients’ interview approach from the traditional approach to the new one
  2. Increase the availability of antidepressant drugs in PHC centres

Impact summary

  • Covered 832 clinics in Saudi Arabia that is about 41% of PHC centres
  • Offered mental health services to approximately 44,850 patients in 134,215 PHC visits
  • Conducted 320 training courses targeting 5,243 healthcare professionals
  • Trained 1033 PHC doctors about mental health conditions

 “No success for the mental health services without successful primary mental health services in PHC centres” 

- Director General, Directorate General of Mental Health and Social Services in MOH

Innovation details

This programme aims to develop an effective and innovative patient interview approach for quick and easy diagnosis of and dealing with mental health conditions. Since 1995 to present, the Ministry of Health in the Kingdom Saudi Arabia has implemented the mhGAP integration program for integrating mental health services within primary health care (PHC) centers. The procedure includes a brief training workshop of 1 day for PHC doctors on the Innovative Patient Interview Approach (5 steps) to improve their knowledge and attitudes with regards to addressing mental health concerns in presenting patients within PHC2.

Aims and Objectives

  • Establish educational environment within PHC setting to provide both MH services & training for PHC staff 
  • Build bridge between PHC workers & MH specialists
  • Enhance community ‘MH awareness' to minimize stigma
  • Establish a PHC-based research center 

Key drivers

Best-practice model
  • The Kingdom of Saudi Arabia model for the integration of mental health services into primary health care was quotes as one of the best models in the WHO WONCA Report (2008)2 due to the Ministry’s effort in ensuring a comprehensive service was developed with a number of linked components.

Effective integration in care pathways

  • Both the community mental health centre and the primary health care setting provided a combination of psychotherapy and medication management with appropriate pathways for referral. 

Challenges

Drug availability

Unavailability of antidepressants in the PHC centres.

Expansion of programme

Expanding the model to different parts of the country has been a slow process.

Continuation

Enhance existing training approaches based on the new innovative patient interview (5-steps) approach.

Partners

  • Directorate General of Mental Health and Social Services in MOH (Saudi Arabia)

Funders

Evaluation methods

  • Screening tools for detecting depression and anxiety in PHC include the Patient Health Questionnaire-2 and the General Anxiety Disorder 2-item tool.
  • KPI for Provinces’ performance through detection rates, measuring the extent to which they provided treatment and psychotherapy and issued referrals to community mental health services or more specialized care in hospitals
  • KPI for PHC doctors’ knowledge of mental health disorders through pre- and post- tests in training sessions

Cost of implementation

Addressing mental health conditions plays a key role in the control of chronic diseases. While the programme has not evaluated an official cost analysis, integrating mental health services within primary health care is saving the health economic through improving the chronic diseases control such as diabetes and hypertension. Moreover, it enhances patients’ satisfaction and resulted in a decline in frequent medical services’ visits.

Impact details

This programme had coverage of 832 clinics in Saudi Arabia which is about 41% of PHC centres and offered mental health services to approximately 44,850 patients in 134,215 PHC visits.

The programme also conducted 320 training courses targeting 5,243 healthcare professionals and trained 1033 PHC doctors about mental health conditions.

References

  1. Greenhalgh T. WHO/WONCA report–Integrating Mental Health in Primary Care: A Global Perspective. London journal of primary care. 2009;2(1):81.
  2. Al-Khathami, A. (2007) Effect of MH Training Program on PHC Physicians' Skills, EP, KSA, Middle East J. FM, 5(4): 22-24.
  3. Integrating mental health into primary care: A global perspective WHO and World Organization of Family Doctors (Wonca) 2008.
  4. Al-Khathami, A. et al. A Primary Mental Health Program in Eastern Province, Saudi Arabia, 2003-2013. Journal of Mental Health in Family Medicine, 2013;10:203-2010

Multimedia

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Country

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