Bundled Intervention Integrating Mental Health Services in Nepal

Possible

Status: Unknown

Conditions: Mental Health

Treatments: Other: Bundled Intervention

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02376062

MHCMEnyaya

Details and patient eligibility

About

Globally, access to mental healthcare is often non-existent in rural, resource-deprived communities despite the pervasive need for services, particularly in post-conflict and post-disaster settings. We are developing and piloting will develop and pilot a culturally appropriate training model for non-specialist providers (NSPs) to deliver high-quality mental health care over a period of 24 months in a primary care hospital in a rural district in Nepal. We will employ a mixed methods framework to evaluate change in skills, knowledge, and attitude in NSP's, identify key mechanisms for continuum of mental healthcare delivery, and efficacy and cost-effectiveness in care delivery through a government hospital, clinics, and a network of community health workers. This integrated approach will introduce a bundled intervention that includes: both an on-site care coordinator and off-site psychiatric supervisors based in Nepal's capital, Kathmandu, weekly case conferences, and surveys of NSP's and clinical supervisors every six months during the study period. To learn about the acceptability, feasibility and challenges in the program we will also conduct Focus Group Discussions among the PCPs. In the last one year of the research in Achham District we have seen increase in knowledge efficacy and skills among the NSPs and also improved mental health care services at Bayalpata Hospital. Our experience in Achham motivated us to develop a similar program for Charikot Primary Health Center in Dolakha District. Outcomes of this study will focus on efficacy of this model to appropriately identify, counsel, and treat patients with depression, psychosis, and post-traumatic stress disorder (PTSD) through an integrated rural mental healthcare delivery intervention as a model for rural healthcare delivery.

Enrollment: 225 estimated patients

Sex: All

Ages: 15+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Primary Care Provider (MBBS-level physician or Health Assistant)
• Current staff at healthcare facility in Achham, Bajura, or Doti Districts.

Exclusion criteria

• N/A

Trial design

Primary purpose: Health Services Research

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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225 participants in 1 patient group

Bundled Intervention

Experimental group

Description:

* On-site care coordinator and off-site psychiatric supervisors based in Nepal's capital, Kathmandu * Weekly case conferences * Surveys of clinicians and clinical supervisors in accordance with CME curriculum

Treatment:

Other: Bundled Intervention