In partnership with the District Mental Health Program in Kashmir, the World Health Organization’s mhGAP framework – developed with the aims of training and capacity building to deliver services with mental, neurological, and substance use disorders in low and middle income countries – is being implemented to train health professionals from diverse specialties to reduce the treatment gap found in Kashmir and eventually decentralize the current mental health system.
The overall objectives of the mhGAP Implementation in Kashmir implemented via Kashmir’s District Mental Health program are to:
- Deliver a standardized mhGAP training to prescribers and non-prescribers working in primary care settings in Kashmir
- Increase participants’ confidence and skills in the assessment, diagnosis and management of the priority conditions prioritized by mhGAP
- Increase participants’ skills in a range of training techniques, facilitators and supervision skills, identifying a pool of local mhGAP champions
- Raise the profile of mental healthcare among primary care workers
The mhGAP Implementation in Kashmir works alongside the District Mental Health Program to use a decentralized community based approach to the problem by:
- Training the mental health team at the identified nodal institutes within the state
- Increasing awareness about mental health problems and effective health seeking patterns
- Providing adequate services to promote early detection and treatment of mental illness in the community itself with both outpatient and indoor treatment and appropriate follow up measures
- Collecting data and experience for future planning, research and improving service provision
Further it seeks to take the mhGAP training program one step further by evaluating the training. This element is an innovative feature, one that other mhGAP programs do not usually include.
3 Phases of Training in Kashmir
To date there have been 3 phases of training in Kashmir as part of this innovation, supported by the Director of Health Kashmir:
Preliminary Primary Care Training (September 2013)
A two-week preliminary primary care training was conducted for 120 health professionals from all over Kashmir in September 2013. The training was delivered by a team of UK, Kashmiri and Dutch psychiatrists and psychologists who were recruited from the Royal College of Psychiatrists Volunteering and International Psychiatry Special Interest Group.
Secondary Care Training (August 2014)
The second phase was coordinated by the secondary care level to link primary and secondary levels of care effectively. This phase included new participants from secondary care and from the private sector. The training specifically focused on the child development modules of the mhGAP.
Pilot Program in Ganderbal District (August 2014)
Following a series of meetings over 2013-2014, a steering group was formed for development and implementation of the pilot project in the Ganderbal district. This steering group was essential in preparing an extensive background sketch for the implementation of the pilot.
Training was repeated in August 2014 and focused on primary care physicians in Ganderbal district. The meeting was held with the Chief Medical Officer, the Block Medical Officer and medical officers of the Ganderbal district to establish a robust supervision, monitoring and evaluation system over the following year as per supervision and monitoring framework. The BMO and MO were identified as supervisors.
The objectives of the pilot training program were:
- To train all GPs in the Ganderbal district of Kashmir (India) in mhGAP implementation guide tool
- To implement the mhGAP based integrated mental health primary care service in Ganderbal
- To implement a supervision framework for 1 year for GPs in Ganderbal
The main image is a submission by Masood Hussain, a renowned Kashmiri artist. It depicts a praying woman's face and hands peeping through a lattice window - a symbolic image intertwined with the success of the project.
Ganderbal, Jammu & Kashmir