Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: systematic review

The involvement of mental health service users and their caregivers in health system policy and planning, service monitoring and research can contribute to mental health system strengthening, but as yet there have been very few efforts to do so in low- and middle-income countries (LMICs). Methods This systematic review examined the evidence and experience of service user and caregiver involvement in mental health system strengthening, as well as models of best practice for evaluation of capacity-building activities that facilitate their greater participation. Both the peer-reviewed and the grey literature were included in the review, which were identified through database searches (MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, SciELO, Google Scholar and Cochrane), as well as hand-searching of reference lists and the internet, and a snowballing process of contacting experts active in the area. This review included any kind of study design that described or evaluated service user, family or caregiver (though not community) involvement in LMICs (including service users with intellectual disabilities, dementia, or child and adolescent mental health problems) and that were relevant to mental health system strengthening across five categories. Data were extracted and summarised as a narrative review. Results Twenty papers matched the inclusion criteria. Overall, the review found that although there were examples of service user and caregiver involvement in mental health system strengthening in numerous countries, there was a lack of high-quality research and a weak evidence base for the work that was being conducted across countries. However, there was some emerging research on the development of policies and strategies, including advocacy work, and to a lesser extent the development of services, service monitoring and evaluation, with most service user involvement having taken place within advocacy and service delivery. Research was scarce within the other health system strengthening areas. Conclusions Further research on service user and caregiver involvement in mental health system strengthening in LMICs is recommended, in particular research that includes more rigorous evaluation. A series of specific recommendations are provided based on the review

Problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence:A randomised, controlled feasibility trial in rural Ethiopia

Evidence for the feasibility of brief psychological interventions for pregnant women experiencing intimate partner violence (IPV) in rural, low-income country settings is scarce. In rural Ethiopia, the prevalence of antenatal depressive symptoms and lifetime IPV are 29% and 61%, respectively. We aimed to assess the feasibility and related implementation outcomes of brief problem-solving therapy (PST) adapted for pregnant women experiencing IPV (PST-IPV) in rural Ethiopia, and of a randomised, controlled feasibility study design. We recruited 52 pregnant women experiencing depressive symptoms and past-year IPV from two antenatal care (ANC) services. Consenting women were randomised to PST-IPV (n = 25), 'standard' PST (not adapted for women experiencing IPV; n = 12) or enhanced usual care (information about sources of support; n = 15). Masked data collectors conducted outcome assessments nine weeks post-enrolment. Addis Ababa University (#032/19/CDT) and King's College London (#HR-18/19-9230) approved the study. Fidelity to randomisation was impeded by strong cultural norms about what constituted IPV. However, recruitment was feasible (recruitment rate: 1.5 per day; 37% of women screened were eligible). The intervention and trial were acceptable to women (4% declined initial screening, none declined to participate, and 76% attended all four sessions of either active intervention). PST-IPV was acceptable to ANC providers: none dropped out. Sessions lasting up to a mean 52 minutes raised questions about the appropriateness of the model to this context. Competence assessments recommended supplementary communication skills training. Fidelity assessments indicated high adherence, quality, and responsiveness but assessing risks and social networks, and discussing confidentiality needed improvement. Adjustments to optimise a future, fully powered, randomised controlled trial include staggering recruitment in line with therapist availability, more training on the types of IPV and how to discuss them, automating randomisation, a supervision cascade model, and conducting post-intervention outcome assessments immediately and three months postpartum. Registration: Pan African Clinical Trials Registry #PACTR202002513482084 (13/12/2019): https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9601

Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review

Background Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs. Methods We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review. Results Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors. Conclusions This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches

Wes Anderson’s The Grand Budapest Hotel:psychiatry in the movies

I never lost my childhood awe of the author's creative power to craft characters from pure imagination. Perhaps this is why I chose psychiatry: the personalities and experiences of each patient remain far more vivid than anything I could think up. Wes Anderson, often lauded for his novel approach to film-making, challenges the perceived originality of creative genius in his latest film, The Grand Budapest Hotel. Speaking of his success as the fictional Republic of Zubrowka's national hero, Tom Wilkinson's ‘The Author’ confesses at the outset that his much-loved classic is pinched from mundane reality.</jats:p

Global health partnership for student peer-to-peer psychiatry e-learning:Lessons learned

BACKGROUND: Global ‘twinning’ relationships between healthcare organizations and institutions in low and high-resource settings have created growing opportunities for e-health partnerships which capitalize upon expanding information technology resources worldwide. E-learning approaches to medical education are increasingly popular but remain under-investigated, whilst a new emphasis on global health teaching has coincided with university budget cuts in many high income countries. RESULTS: King’s Somaliland Partnership (KSP) is a paired institutional partnership health link, supported by Tropical Health and Education Trust (THET), which works to strengthen the healthcare system and improve access to care through mutual exchange of skills, knowledge and experience between Somaliland and King’s Health Partners, UK. Aqoon, meaning knowledge in Somali, is a peer-to-peer global mental health e-learning partnership between medical students at King’s College London (KCL) and Hargeisa and Amoud Universities, Somaliland. It aims to extend the benefits of KSP’s cross-cultural and global mental health education work to medical students and has reported positive results, including improved attitudes towards psychiatry in Somaliland students. CONCLUSIONS: The process of devising, piloting, evaluating, refining, implementing, re-evaluating and again refining the Aqoon model has identified important barriers to successful partnership. This article describes lessons learned during this process, sharing principles and recommendations for readers wishing to expand their own global health link beyond qualified clinicians, to the healthcare professionals of the future. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12992-016-0221-5) contains supplementary material, which is available to authorized users