New project to PRIME mental health services

By all measures, £6 million is a lot of money. But when stacked up against the ambitions of the new PRogramme for Improving Mental health carE (PRIME) - to illustrate just how mental healthcare services in five resource-poor countries can be delivered - it may appear but a drop in the ocean.

The problem: Mental health institutions, like this one in New Delhi in India, has long suffered from poor investment. (Picture courtesy of WHO/P.Virot)	Team spirit: Forming part of the new PRIME project at UCT will be (left to right) Dr Simone Honikman, Sharon Kleintjes, Vuyiseka Dubula, Sally Field, Assoc Prof Crick Lund, Sara Cooper and Thandi van Heyningen.

The funding, awarded to the UCT-based Centre for Public Mental Health by the Department for International Development (DfID) in the UK government, will go towards setting up a series of 'demonstration sites' in the primary-study countries - Ethiopia, India, South Africa and Uganda - and in one "fragile state", Nepal.

"Mental health is often a neglected issue in public health, often with under-funded services," explains Associate Professor Crick Lund, PRIME CEO. "So there's an international move, led by the WHO [World Health Organisation] and others, to try and build the capacity of primary health care clinics and primary health care practitioners to deliver basic mental health services at primary health care level."

Lund will lead PRIME as a project from the Centre for Public Mental Health in the Department of Psychiatry and Mental Health at UCT, working with a host of partners and collaborators across the five countries and elsewhere.

Over the six years of the programme, research teams in these countries will work with doctors, nurses, health ministries, academic institutions and civil society organisations to set up these demonstration sites. There they will attempt to implement a set of clinical guidelines drawn up by the WHO, known as the mental health Gap Action Programme, aka mhGAP.

mhGAP is designed as a set of practical clinical guidelines that enable general health practitioners (doctors and nurses) to deliver mental health services at primary health care level. In line with those guidelines, PRIME will target three priority mental disorders, namely depression (particularly maternal depression), alcohol use and schizophrenia, which make up a large proportion of the burden of mental disorders globally.

The work will involve training the primary healthcare workers in these guidelines, assessing how well the guidelines are applied and implemented, and then assessing the impact on patients' mental health, social functioning and economic livelihoods.

There's a lot of lost ground to make up, suggests PRIME research director, Professor Vikram Patel of the London School of Hygiene & Tropical Medicine in the UK, and Sangath, a mental health NGO in India. For too long it was assumed that mental health was not a developing country issue, the upshot of which was that little money was invested in mental health services.

PRIME will allow a country like India, says Patel, to "establish affordable, equitable and feasible models of scaling up what we know works to help improve the quality of life of people affected by mental disorders and, in so doing, show that we can address mental health problems even in very resource poor health systems".

At the end of the six years, says Lund, PRIME will have produced the kinds of information that will show policymakers how to integrate mental health services into primary health care, and what kinds of resources would be required to scale up these services.

"I think it will not only address public health questions, but also development questions, regarding the impact of these services on social and economic outcomes."