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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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![Figure 1 Requirements for integrating mental health into primary health care [14]–[17].](/paper-figures/de0e97da5958491285622b9ec34da5ac/challenges-and-opportunities-for-implementing-integrated-mental-health-care-a-figure-1.jpg)
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“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]
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“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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No health without mental health
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Self-citationThe world health report 2001 - Mental health: new understanding, new hope
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Self-citationThornicroft, G., Brohan, E., Rose, D. S., Sartorius, N., & Leese, M. (2009) · The Lancet · doi:10.1016/s0140-6736(08)61817-6 · Cited by 1,189
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Self-citationMendenhall, E., De Silva, M. J., Hanlon, C., Petersen, I., Shidhaye, R., Jordans, M., Luitel, N., Ssebunnya, J., Fekadu, A., Patel, V., et al. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.07.057 · Cited by 355
“The present study reports on the results of qualitative research from one district in all five countries exploring stakeholder views on the acceptability and feasibility of task sharing for mental health care delivery at the pre-implementation stage, the results of which were used to inform the development of district…”
BackgroundMethodInfluentialSelf-citationKohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M. S., Jordans, M. J. D., Mutamba, B. B., Nadkarni, A., Pedersen, G. A., Singla, D. R., & Patel, V. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15061279 · Cited by 381
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Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
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