Impact of integrated district level mental health care on clinical and social outcomes of people with severe mental illness in rural Ethiopia: an intervention cohort study

Charlotte Hanlon, Girmay Medhin, Medhin Selamu, Rahel Birhane, Michael Dewey, Kebede Tirfessa, Emily Garman, Laura Asher, Graham Thornicroft, Vikram Patel, Christopher Lund, Martin Prince, Abebaw Fekadu

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21 Citations (Scopus)
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Abstract

Aim
There is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia.

Methods
In the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint.

Results
Almost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35–0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13–0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly.

Conclusions
An integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.
Original languageEnglish
Article numbere45
Pages (from-to)1-10
JournalEpidemiology and Psychiatric Sciences
Early online date13 Aug 2019
DOIs
Publication statusPublished - 2020

Keywords

  • Bipolar disorder
  • community mental health
  • global mental health
  • psychotic disorder
  • schizophrenia
  • task-sharing

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