Integration, Progressive Decentralization, and Community Mental Health Planning
Integration, progressive decentralization, and community health are key elements for ensuring sustainable mental health care delivery. This theme encompasses efforts to integrate mental health services into all levels of the health system including strengthening partnerships with community health teams, and integration of mental health across clinical areas such as tuberculosis, HIV, and non-communicable diseases (NCDs). Furthermore, it provides examples of how PIH sites have built partnerships with local Ministries of Health, leveraging PIH models as pilots for national decentralization of mental health services.
Integration with NCDs
The development of PIH Malawi’s mental health program began in 2016 and focuses on integrating mental health into PIH Malawi’s Integrated Chronic Care Clinic (IC3). Depression case-finding and treatment are also being integrated into HIV services, primary care, and maternal care.
Voices of NCDI Poverty
Voices of NCDI Poverty is a platform that shares stories and experiences of people living with NCDs and injuries in settings of extreme poverty. It is a joint project of The Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion(NCDI Poverty Commission) and the NCD Synergies Program at Partners In Health.
Given community health workers' (CHW) ability to bridge the gap between health care resources and patients who need them, they play an integral role in health systems across the globe. However, CHWs are often overwhelmed with too many tasks and not enough support. This happens because health systems are often stretched thin when trying to provide more and more services, but with the same or even less funding. To address this problem, this algorithm uses 7 key questions to walk through 5 important steps for program implementers and policymakers to understand how to plan for including mental health services into care delivery. By clearly mapping out the expected time and resources needed to accomplish priority tasks, the CHWs will be better positioned to successfully complete their work. The algorithm helps with planning for hiring, training, and supervision of these CHWs who will be including mental health services in their work.
Decentralization of Mental Health Care in Rwanda
Patients are progressively being seen more at health centers as compared to district hospitals. This enables them to access care closer to their homes and travel less, which is particularly important during the COVID-19 pandemic.
In collaboration with the MOH, IMB has delivered mental health care in Rwanda since 2009 through a health center nurse training model called MESH Mental Health (Mentoring and Enhanced Supervision at Health facilities for Mental Health), which provides affordable, community-based care in the public primary health care system, increasing the use of trained non-specialists through the mentorship program. Government psychiatric nurses travel regularly to health centers to provide mentorship and supervision, supporting general nurses to care for patients with severe mental disorders, and CHWs across the district are also involved.