Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries
Open accessAbstract
BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
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A relative lack of networks between providers made implementation more difficult.
“but a relative lack of these types of networks made implementation more difficult [78].”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [78]
The Discussion section on feasibility of psychosocial care says a lack of collaborative frameworks between health services and traditional or religious healers may limit one approach to delivering care. This supports a potential implementation difficulty, but it is narrower and more tentative than a general claim that a lack of networks between providers made implementation more difficult. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSeveral of the papers assessed health system preparedness for integrated care, in general finding low levels of preparedness.
“Several of the papers assessed this issue, in general finding low levels of preparedness 50 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [50]
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“A comprehensive overview of each district is provided elsewhere [29].”
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“17”
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“Such barriers include negative community attitudes that stigmatize women with mental ill health, inadequate infrastructure such as health facilities that are far and difficult to reach, social and economic disadvantage among women, including poverty, and personal or psychological barriers [18–20].”
BackgroundSelf-citationHanlon, C., Fekadu, A., Jordans, M. J. D., Kigozi, F. N., Petersen, I., Shidhaye, R. R., Honikman, S., Lund, C., Prince, M. J., Raja, S., et al. (2015) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.114.153767 · Cited by 96 · see citing works
Self-citationSelamu, M., Thornicroft, G., Fekadu, A., & Hanlon, C. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2370-5 · Cited by 89 · see citing works
“implemented in the Sodo district of the Gurage zone, which neighbours the Silte zone [32, 33].”
MethodSelf-citationAsher, L., Fekadu, A., Hanlon, C., Mideksa, G., Eaton, J., Patel, V., & Silva, M. J. D. (2015) · PLoS ONE · doi:10.1371/journal.pone.0143572 · Cited by 88 · see citing works
“Health care costs are largely out-of-pocket with a free waiver available for the very poorest [38].”
BackgroundSelf-citationLehoux, P., Roncarolo, F., da Silva, H. P., Boivin, A., Denis, J., & Hébert, R. (2018) · International Journal of Health Policy and Management · doi:10.15171/ijhpm.2018.110 · Cited by 91 · see citing works
Seward, N., Hanlon, C., Abdulahi, A., Abrams, Z., Alem, A., Araya, R., Bachmann, M., Bogale, B., Brima, N., Chibanda, D., et al. (2021) · doi:10.1101/2021.01.06.20248468 · Cited by 84 · see citing works
“Work packages 1–3, 6 and 7 conduct situation analyses of primary health facilities using an adapted version of the situation analysis tool developed by Programme for Improving Mental Health Care (PRIME) [19].”
MethodInfluentialSelf-citationSarikhani, Y., Bastani, P., Rafiee, M., Kavosi, Z., & Ravangard, R. (2020) · Community Mental Health Journal · doi:10.1007/s10597-020-00619-2 · Cited by 92 · see citing works
Shidhaye, R. R., Shrivastava, S., Murhar, V., Samudre, S., Ahuja, S., Ramaswamy, R., & Patel, V. (2015) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.114.153700 · Cited by 79 · see citing works
Self-citationMayston, R., Alem, A., Habtamu, A., Shibre, T., Fekadu, A., & Hanlon, C. (2015) · Health Policy and Planning · doi:10.1093/heapol/czv072 · Cited by 77 · see citing works
“This debate taps into ongoing questions about the limitations of tasksharing and the extent to which non-specialist workers in primary care may be expected to integrate mental health into their role whilst delivering high quality care to people with SMD (Hanlon et al. 2014; Lund et al. 2012).”
BackgroundSelf-citationKpobi, L. N. A., Swartz, L. M., & Ofori-Atta, A. L. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-2887-2 · Cited by 75 · see citing works
“A number of studies have reported the process of implementing new MHISs in different countries, including the various challenges that were experienced in each of these [5, 10, 11].”
BackgroundBeyond the Biomedical: Community Resources for Mental Health Care in Rural Ethiopia
Selamu, M., Asher, L., Hanlon, C., Medhin, G., Hailemariam, M., Patel, V., Thornicroft, G., & Fekadu, A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0126666 · Cited by 73 · see citing works
“We propose that existing resources could potentially support the following aspects of the MHCP in Sodo district: 1.”
BackgroundMethodInfluentialSelf-citationHailemichael, Y., Hanlon, C., Tirfessa, K., Docrat, S., Alem, A., Medhin, G., Lund, C., Chisholm, D., Fekadu, A., & Mariam, D. H. (2019) · BMC Public Health · doi:10.1186/s12889-019-7239-6 · Cited by 74 · see citing works
Self-citationChisholm, D., Heslin, M., Docrat, S., Nanda, S., Shidhaye, R., Upadhaya, N., Jordans, M., Abdulmalik, J., Olayiwola, S., Gureje, O., et al. (2017) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796016000408 · Cited by 65 · see citing works
Self-citationStakeholder analysis of the Programme for Improving Mental health carE (PRIME): baseline findings
Makan, A. J., Fekadu, A., Murhar, V., Luitel, N. P., Kathree, T., Ssebunya, J., & Lund, C. (2015) · International Journal of Mental Health Systems · doi:10.1186/s13033-015-0020-z · Cited by 72 · see citing works
Self-citationMurray, L. K., & Jordans, M. J. D. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0938-y · Cited by 72 · see citing works
“In the last decade, substantial advances have been made in global mental health (for some reviews see [4, 12–14]).”
BackgroundSelf-citationHanlon, C., Alem, A., Medhin, G., Shibre, T., Ejigu, D. A., Negussie, H., Dewey, M. E., Wissow, L. S., Prince, M. J., Susser, E., et al. (2016) · Trials · doi:10.1186/s13063-016-1191-x · Cited by 68 · see citing works
“Adaptation of the task-sharing model for the study setting was informed by extensive formative work and community consultation in the study site [40] and from findings arising from a sister project implementing integrated mental health care in a neighbouring district [43, 44].”
MethodSelf-citationThe Emerging Global Health Crisis: Noncommunicable Diseases in Low- and Middle-Income CountriesPreprint
Daniels, M. E., Donilon, T. E., & Bollyky, T. J. (2016) · SSRN Electronic Journal · doi:10.2139/ssrn.2685111 · Cited by 68 · see citing works
Involvement of people with schizophrenia in decision-making in rural Ethiopia: a qualitative study
Souraya, S., Hanlon, C., & Asher, L. (2018) · Globalization and Health · doi:10.1186/s12992-018-0403-4 · Cited by 68 · see citing works
“Sodo district is a rural area located 100 km south of Addis Ababa, the capital of Ethiopia, which is characterized by a lack of infrastructure in terms of electricity and sanitation, and a low population literacy level (45%) [46, 47].”
BackgroundSelf-citationAbayneh, S., Lempp, H. K., Alem, A., Kohrt, B. A., Fekadu, A., & Hanlon, C. (2020) · International Journal of Mental Health Systems · doi:10.1186/s13033-020-00383-6 · Cited by 71 · see citing works
Self-citationKoschorke, M., Oexle, N., Ouali, U., Cherian, A. V., Deepika, V., Mendon, G. B., Gurung, D., Kondrátová, L., Müller, M., Lanfredi, M., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0258729 · Cited by 72 · see citing works
“The questionnaires for the documentary analysis were based on an existing case study methodology outlined for mental health projects in LMIC [23] as well as a situational analysis tool developed for a large international program of mental health interventions in primary care [24].”
MethodSelf-citationHealth system governance to support scale up of mental health care in Ethiopia: a qualitative study
Hanlon, C., Eshetu, T., Alemayehu, D., Fekadu, A., Semrau, M., Thornicroft, G., Kigozi, F. N., Marais, D. L., Petersen, I., & Alem, A. (2017) · International Journal of Mental Health Systems · doi:10.1186/s13033-017-0144-4 · Cited by 66 · see citing works
“The district has a population of approximately 160,000 people and is almost 90% rural and predominantly Orthodox Christian in religion [28].”
BackgroundMethodInfluentialSelf-citationNalwadda, O., Rathod, S. D., Nakku, J. E. M., Lund, C., Prince, M. J., & Kigozi, F. N. (2018) · International Journal of Mental Health Systems · doi:10.1186/s13033-018-0191-5 · Cited by 64 · see citing works
“Full details of the country sites are presented elsewhere [21].”
BackgroundSelf-citationParcesepe, A. M., Bernard, C., Agler, R. A., Ross, J., Yotebieng, M., Bass, J., Kwobah, E. K., Adedimeji, A., Goulet, J. L., & Althoff, K. N. (2018) · Journal of Virus Eradication · doi:10.1016/s2055-6640(20)30341-1 · Cited by 63 · see citing works
“Although screening and treatment for mental health conditions are limited in many healthcare settings in SSA and globally [86], the integration of mental health care into Hiv testing and care settings must be a priority.”
BackgroundRecognition of depression by primary care clinicians in rural Ethiopia
Fekadu, A., Medhin, G., Selamu, M., Giorgis, T. W., Lund, C., Alem, A., Prince, M., & Hanlon, C. (2017) · BMC Family Practice · doi:10.1186/s12875-017-0628-y · Cited by 61 · see citing works
“As part of the PRogramme for Improving Mental health carE (PRIME), which aims to support integration of mental healthcare in five low and middle income countries [31], we conducted a study to determine the detection rate of depression in the eight primary care facilities that provide care to a population of over 160,0…”
BackgroundMethodSelf-citationGirma, E., Ketema, B., Mulatu, T., Kohrt, B. A., Wahid, S. S., Heim, E., Gronholm, P. C., Hanlon, C., & Thornicroft, G. (2022) · International Journal of Mental Health Systems · doi:10.1186/s13033-022-00540-z · Cited by 62 · see citing works
Self-citationChisholm, D., Burman-Roy, S., Fekadu, A., Kathree, T., Kizza, D., Luitel, N. P., Petersen, I., Shidhaye, R. R., Silva, M. J. D., & Lund, C. (2015) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.114.153866 · Cited by 63 · see citing works
Self-citationTrani, J., Ballard, E., Bakhshi, P., & Hovmand, P. S. (2016) · Conflict and Health · doi:10.1186/s13031-016-0089-2 · Cited by 64 · see citing works
“Other studies have shown elsewhere the need for specialized mental health professionals to drive the process of developing and integrating mental healthcare as part of the primary healthcare system [64, 65].”
Hanlon, C., Medhin, G., Selamu, M., Birhane, R., Dewey, M. E., Tirfessa, K., Garman, E. C., Asher, L., Thornicroft, G., Patel, V., et al. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796019000398 · Cited by 62 · see citing works
“Sodohas an estimated population of around160 000people (Hanlon et al., 2014).”
BackgroundSelf-citationTeferra, S., Medhin, G., Selamu, M., Bhana, A., Hanlon, C., & Fekadu, A. (2016) · BMC Public Health · doi:10.1186/s12889-016-2911-6 · Cited by 64 · see citing works
Self-citationAbayneh, S., Lempp, H. K., & Hanlon, C. (2020) · Research Involvement and Engagement · doi:10.1186/s40900-019-0175-x · Cited by 59 · see citing works
Self-citationTopp, S. M., Abimbola, S., Joshi, R., & Negin, J. (2018) · Health Policy and Planning · doi:10.1093/heapol/czx169 · Cited by 60 · see citing works
“…et al. 2012 Liambila et al. 2009 Chaudhary et al. 2005 Shelley et al. 2014 Kouam et al. 2014 Green et al. 2010 Sarnquist et al. 2014 Wright et al. 2014 Hanlon et al. 2014 Li et al. 2012 Kalyango et al. 2012 Smit et al. 2012 Schaan et al. 2012 Awadhi et al. 2012 Winestone et al. 2012…”
BackgroundInfluentialRathod, S. D., Roberts, T., Medhin, G., Murhar, V., Samudre, S., Luitel, N. P., Selohilwe, O., Ssebunnya, J., Jordans, M. J. D., Bhana, A., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-023421 · Cited by 58 · see citing works
Self-citationCluver, L. D., Sherr, L., Toska, E., Zhou, S., Mellins, C.-A., Omigbodun, O., Li, X., Bojo, S., Thurman, T., Ameyan, W., et al. (2022) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(22)00101-8 · Cited by 58 · see citing works
Self-citationDevelopment of a district mental healthcare plan in Uganda
Kigozi, F. N., Kizza, D., Nakku, J. E. M., Ssebunnya, J., Ndyanabangi, S., Nakiganda, B., Lund, C., & Patel, V. (2015) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.114.153742 · Cited by 56 · see citing works
Self-citationA guide to systems-level, participatory, theory-informed implementation research in global health
Seward, N., Hanlon, C., Hinrichs, S., Lund, C., Murdoch, J., Salisbury, T. T., Verhey, R., Shidhaye, R. R., Thornicroft, G., Araya, R., et al. (2021) · BMJ Global Health · doi:10.1136/bmjgh-2021-005365 · Cited by 51 · see citing works
Self-citationBrooke‐Sumner, C., Lund, C., & Petersen, I. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0042-1 · Cited by 54 · see citing works
Self-citationAsher, L., Silva, M. J. D., Hanlon, C., Weiss, H. A., Birhane, R., Ejigu, D. A., Medhin, G., Patel, V., & Fekadu, A. (2016) · Trials · doi:10.1186/s13063-016-1427-9 · Cited by 51 · see citing works
“The work included a literature review, situational analysis [43, 44], an intervention development workshop, participatory meetings, qualitative interviews with a range of stakeholders, including people with schizophrenia, their caregivers, psychiatrists and community leaders, and collaboration with an existing CBR pro…”
BackgroundSelf-citationA qualitative study of methamphetamine initiation in Cape Town, South Africa
Hobkirk, A. L., Watt, M. H., MYERS, B. J., Skinner, D. G., & Meade, C. S. (2015) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2015.10.006 · Cited by 52 · see citing works
“In a situational analysis of mental health services in multiple LMIC sites involved in the PRIME study (Lund et al., 2012), the South African site located in the North West Province had a number of advantages compared to other sites (Hanlon et al., 2014).”
InfluentialLund, C., Docrat, S., Abdulmalik, J., Alem, A., Fekadu, A., Gureje, O., Gurung, D., Hailemariam, D., Hailemichael, Y., Hanlon, C., et al. (2019) · BJPsych Open · doi:10.1192/bjo.2019.20 · Cited by 44 · see citing works
Self-citationMental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania
Ambikile, J. S., & Iseselo, M. K. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1271-9 · Cited by 51 · see citing works
“This corroborates findings from low income countries which show that many health service organization requirements for mental health care are absent [10, 18].”
BackgroundResultInfluentialUpadhaya, N., Jordans, M. J. D., Abdulmalik, J. O., Ahuja, S., Alem, A., Hanlon, C., Kigozi, F. N., Kizza, D., Lund, C., Semrau, M., et al. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0094-2 · Cited by 50 · see citing works
“The capacity to track changes in treatment coverage and quality of care is essential for monitoring the impact of mental health programs [22].”
Self-citationLovero, K. L., Lammie, S. L., van Zyl, A., Paul, S. N., Ngwepe, P., Mootz, J. J., Carlson, C., Sweetland, A. C., Shelton, R. C., Wainberg, M. L., et al. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-3912-9 · Cited by 49 · see citing works
Hailemichael, Y., Hanlon, C., Tirfessa, K., Docrat, S., Alem, A., Medhin, G., Fekadu, A., Lund, C., Chisholm, D., & Mariam, D. H. (2019) · International Journal for Equity in Health · doi:10.1186/s12939-019-1020-4 · Cited by 52 · see citing works
Self-citationJordans, M. J. D., Chisholm, D., Semrau, M., Upadhaya, N., Abdulmalik, J. O., Ahuja, S., Alem, A., Hanlon, C., Kigozi, F. N., Mugisha, J., et al. (2016) · Health Policy and Planning · doi:10.1093/heapol/czw040 · Cited by 49 · see citing works
Self-citationGarman, E. C., Rathod, S. D., Hanlon, C., Prince, M. J., Fekadu, A., Kigozi, F. N., Jordans, M. J. D., Luitel, N. P., Medhin, G., Murhar, V., et al. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1642-x · Cited by 48 · see citing works
“graphical, social and cultural profile [14].”
Self-citationChase, L., & Sapkota, R. P. (2017) · Transcultural Psychiatry · doi:10.1177/1363461517703023 · Cited by 50 · see citing works
“In global mental health research currently being carried out in Nepal, informal care systems are not routinely factored into assessments of mental health needs and resources; although efforts have been made to document the ‘‘community context’’ of global mental health interventions, these have identified more formaliz…”
BackgroundHailemariam, M., Fekadu, A., Medhin, G., Prince, M., & Hanlon, C. (2019) · International Journal of Mental Health Systems · doi:10.1186/s13033-019-0332-5 · Cited by 44 · see citing works
Self-citationMartin, P., Murray, L. K., Darnell, D., & Dorsey, S. (2018) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12270 · Cited by 53 · see citing works
“In LMIC, options for addressing the mental health treatment gap must be those that are effective, but also sustainable and affordable (Hanlon et al., 2014).”
Fekadu, A., Medhin, G., Selamu, M., Shiferaw, T., Hailemariam, M., Rathod, S. D., Jordans, M. J. D., Teferra, S., Lund, C., Breuer, E., et al. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0784-y · Cited by 46 · see citing works
Self-citationService user involvement for mental health system strengthening in India: a qualitative study
Samudre, S., Shidhaye, R. R., Ahuja, S., Nanda, S., Khan, A., Evans-Lacko, S. E., & Hanlon, C. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0981-8 · Cited by 44 · see citing works
“mental health program has been functioning through collaboration between the DMHP and the PRogram for Improving Mental health carE (PRIME) since 2011 [10, 20].”
MethodSelf-citationSubba, P., Luitel, N. P., Kohrt, B. A., & Jordans, M. J. D. (2017) · Conflict and Health · doi:10.1186/s13031-017-0132-y · Cited by 46 · see citing works
“Although specialized mental health services from psychiatrists were available in Chitwan through tertiary level health facilities, mental health services were non-existent in the community-based health facilities prior to PRIME implementation [9].”
BackgroundSelf-citationGyimah, F. T., & Dako‐Gyeke, P. (2019) · Globalization and Health · doi:10.1186/s12992-019-0459-9 · Cited by 43 · see citing works
Hailemichael, Y., Mariam, D. H., Tirfessa, K., Docrat, S., Alem, A., Medhin, G., Lund, C., Chisholm, D., Fekadu, A., & Hanlon, C. (2019) · International Journal of Mental Health Systems · doi:10.1186/s13033-019-0294-7 · Cited by 45 · see citing works
Self-citationCulture and mental health in Nepal: an interdisciplinary scoping review
Chase, L., Sapkota, R. P., Crafa, D., & Kirmayer, L. J. (2018) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2018.27 · Cited by 44 · see citing works
“Nepal became an implementation site for several high-profile global mental health projects (Hanlon et al. 2014; Mendenhall et al. 2014; Kohrt et al. 2015; Jordans et al. 2016).”
BackgroundAgyapong, V. I. O., Osei, A. O., Farren, C. K., & McAuliffe, É. (2015) · Global Health Action · doi:10.3402/gha.v8.28955 · Cited by 42 · see citing works
“In a situational analysis of the challenges and opportunities at the district level of five LAMICs implementing integrated mental health care, it was reported that across all sites, community mental health literacy was low and there were no models of multisectoral working or collaborations with traditional or religiou…”
BackgroundAngdembe, M., Kohrt, B. A., Jordans, M., Rimal, D., & Luitel, N. P. (2017) · International Journal of Mental Health Systems · doi:10.1186/s13033-017-0176-9 · Cited by 39 · see citing works
“Many studies have recommended that formation of self-help groups, along with the family support is the major component in the process of integrating mental health services for severe mental disorders in PHC levels and community settings [44, 61].”
BackgroundSelf-citationMental health in primary health care in a rural district of Cambodia: a situational analysis
Olofsson, S., Sebastiån, M. S., & Jegannathan, B. (2018) · International Journal of Mental Health Systems · doi:10.1186/s13033-018-0185-3 · Cited by 42 · see citing works
“In this study, key themes from the original PRIME study were the frame for the qualitative interviews and for the structure of this article [25].”
MethodWeobong, B., Ae-Ngibise, K. A., Sakyi, L., & Lund, C. (2023) · PLoS ONE · doi:10.1371/journal.pone.0285324 · Cited by 41 · see citing works
“Details of the tool are provided elsewhere in the main report by Hanlon and colleagues [16], but in summary the tool comprises six sections with 156 items.”
MethodResultInfluentialSelf-citationDewidar, O., John, J., Baqar, A., Madani, M. T., Saad, A., Riddle, A. Y., Ota, E., Kung’u, J. K., Arabi, M., Raut, M. K., et al. (2023) · Campbell Systematic Reviews · doi:10.1002/cl2.1361 · Cited by 38 · see citing works
Jordans, M. J. D., Aldridge, L. R., Luitel, N. P., Baingana, F. K., & Kohrt, B. A. (2017) · International Journal of Mental Health Systems · doi:10.1186/s13033-017-0177-8 · Cited by 38 · see citing works
“Background In most low- and middle income countries (LMIC) decentralized mental health services often range from inadequate to nonexistent [1], which is particularly concerning in light of the high burden of disease associated with mental illness globally [2].”
BackgroundMethodSelf-citationMental health services in Cambodia, challenges and opportunities in a post-conflict setting
Jegannathan, B., Kullgren, G., & Deva, P. (2014) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2014.12.006 · Cited by 37 · see citing works
“The evidence for efficacy of mental health programs that are integrated at primary health care setting in LMICs is reassuring (Hanlon et al., 2014), and this may be a golden opportunity to”
Backgroundvan Rensburg, B. J., Kotzé, C., Moxley, K., Subramaney, U., Zingela, Z., & Seedat, S. (2021) · Health Policy and Planning · doi:10.1093/heapol/czab144 · Cited by 37 · see citing works
Shidhaye, R. R., Raja, A., Shrivastava, S., Murhar, V., Ramaswamy, R., & Patel, V. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9893-1 · Cited by 37 · see citing works
“…of the PRIME project, a new situation analysis tool (downloadable from http://www.prime.uct. ac.za/index.php/research/tools.html) was developed (Hanlon et al. 2014) as existing methods and tools for appraising mental health systems and services in LMICs did not meet the needs of PRIME either…”
BackgroundMethodInfluentialSelf-citationFurst, M. A., Gandré, C., Romero López-Alberca, C., & Salvador-Carulla, L. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4005-5 · Cited by 45 · see citing works
Mental health literacy among primary healthcare workers in South Africa and Zambia
Korhonen, J., Axelin, A., Stein, D. J., Seedat, S., Mwape, L., Jansen, R., Groen, G., Grobler, G. P., Jörns‐Presentati, A., Katajisto, J., et al. (2022) · Brain and Behavior · doi:10.1002/brb3.2807 · Cited by 34 · see citing works
“PHC workers require specific professional training on the identification and management of mental health problems (Hanlon et al., 2014; Kapungwe et al., 2011; Marais & Peterson, 2015; Mwape et al., 2010).”
BackgroundMurphy, A., Chikovani, I., Uchaneishvili, M., Makhashvili, N., & Roberts, B. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3113-y · Cited by 31 · see citing works
Dadi, A. F., Miller, E. R., Azale, T., & Mwanri, L. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00466-y · Cited by 35 · see citing works
Community Mental Health Competencies: A New Vision for Global Mental Health
Burgess, R. A., & Mathias, K. R. (2017) · Palgrave Macmillan UK eBooks · doi:10.1057/978-1-137-39510-8_11 · Cited by 33 · see citing works
“For example, a recent study exploring the foundations for integrated mental health care in five low-income countries (Hanlon et al., 2014) asserts the importance of ‘community’ interventions such as adherence support, screening, and community-based psychosocial prevention.”
BackgroundDocrat, S., Besada, D., Cleary, S., & Lund, C. (2020) · Health Economics Review · doi:10.1186/s13561-020-00268-x · Cited by 32 · see citing works
Self-citation
- Authors
- Hanlon, C., Luitel, N. P., Kathree, T., Murhar, V., Shrivasta, S., Medhin, G., Ssebunnya, J., Fekadu, A., Shidhaye, R., Petersen, I., Jordans, M., Kigozi, F., Thornicroft, G., Patel, V., Tomlinson, M., Lund, C., Breuer, E., De Silva, M., & Prince, M.
- Affiliations
- King's College London (GB)
- University of KwaZulu-Natal (ZA)
- Sangath (IN)
- Addis Ababa University (ET)
- Butabika Hospital (UG)
- Public Health Foundation of India (IN)
- London School of Hygiene & Tropical Medicine (GB)
- University of Cape Town (ZA)
- Corresponding author
- Hanlon, Charlotte
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-02-18
- Volume
- 9
- Issue
- 2
- Pages
- e88437
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3928234
- OpenAlex
- W2151272134
- Cited by
- 339
- References
- 46
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 26 · 2023: 18 · 2022: 33 · 2021: 24 · 2020: 61 · 2019: 27 · 2018: 32 · 2017: 24 · 2016: 23 · 2015: 26 · 2014: 9
- FWCI
- 40.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- SUNScholar (Stellenbosch University) (submittedVersion, public-domain)
- Greater South Information System
- Funders
- Wellcome Trust (084674, 100714)
- Government of the United Kingdom
- National Institute for Health and Care Research (NF-SI-0611-10053)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- integrated mental health care, primary care integration, health system preparedness, mental health literacy, community health workers, mental health professionals, intersectoral collaboration, low- and middle-income countries, district health planning
- MeSH terms
- Community Health Workers, Community Mental Health Services, Cross-Sectional Studies, Developing Countries, Ethiopia, Health Services Accessibility, Humans, India, Nepal, Poverty, Primary Health Care, Public Health, South Africa, Tuberculosis, Uganda, Program Evaluation, HIV Infections
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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