January 15, 2010
Implementation Science for the Mental Health Gap Action Program
Pamela Y. Collins, M.D., M.P.H.
Associate Director, Office for Special Populations, and Director, Office of Global Mental Health
Office of the NIMH Director
To conduct comparative research on the implementation and scale-up of evidence-based mental health interventions in low- and middle-income settings.
Worldwide, community-based epidemiological studies estimate that the lifetime prevalence of mental disorders in adults ranges from 12.2 percent to 48.6 percent, accounting for approximately 30 percent of the total burden of non-communicable diseases. In Sub-Saharan Africa, the disability-adjusted life years attributable to psychiatric conditions surpass the proportion attributable to nutritional deficiencies, tuberculosis, or maternal complications from childbirth. Yet, insufficient attention and resources address the diagnosis, treatment, and care of people with mental disorders in low- and middle-income countries (LMICs).
This initiative aims to support research on the implementation of evidenced-based care for designated mental disorders developed through the World Health Organization’s (WHO) Mental Health Gap Action Programme (mhGAP). The mhGAP initiative aims to deliver an integrated package of evidence-based treatment interventions, taking into account existing and possible barriers for scaling up care. The interventions focus on eight high–disease-burden and high-cost conditions, including depression, schizophrenia and other psychotic disorders, suicide, and mental disorders in children. This program of multidisciplinary research on implementation of effective interventions and comparative studies in multi-country settings stands to make a significant impact on the treatment and course of mental disorders in LMICs.
The intent of the initiative is to 1) develop protocols for a situational analysis, based on data from the WHO-Assessment Instrument for Mental Health Systems (WHO-AIMS) study, for implementation of mhGAP; 2) conduct a situational analysis of the mental health system in 3-5 selected LMICs; 3) based on the situational analyses, develop protocols for implementation research on mhGAP; and 4) conduct an evaluation of the implementation process in selected LMICs.
Scientific areas of interest include:
- Understanding the social and policy environments that facilitate scale-up of mental health interventions, particularly in low- and middle-income countries;
- Studying cultural barriers and facilitators of scale-up;
- Assessment of the acceptability and social validity of individual and combined packages of care across settings as well as across populations at risk of exclusion from services
- Refinement of methods to assess the efficacy of multilevel intervention implementation.
Research findings will also have implications for mental health services research in varied settings across the United States and its territories.