Ryan G K, Nwefoh E, Aguocha C, Ode P O, Okpoju S O, Ocheche P, Woyengikuro A, Abdulmalik J, Eaton J
1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.
2Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.
Int J Ment Health Syst. 2020 Feb 21;14:10. doi: 10.1186/s13033-020-00344-z. eCollection 2020.
71% of countries in the World Health Organisation's (WHO's) African Region have a stand-alone mental health policy or plan, but only 14% have fully implemented it. In Nigeria, integration of mental health into primary care has been a stumbling block to the implementation of the 1991 National Mental Health Policy, 2013 Policy on Mental Health Services Delivery and the National Mental, Neurological and Substance Use Programme and Action Plan. A partnership between public and private not-for-profits in Benue State, the Comprehensive Community Mental Health Programme (CCMHP) has successfully integrated mental health into primary care in alignment with the national mental health policy and the WHO's mental health Gap Action Programme Intervention Guide (mhGAP-IG). There is a need to document such examples in order to inform policy implementation in Nigeria and other low- and middle-income countries (LMICs).
We followed the Case Study Methodology to Monitor and Evaluate Community Mental Health Programmes in LMICs. Four field visits were conducted between 2013 and 2017 to document the first phase of activities of CCMHP, covering the period of January 2011 through June 2016.
In its first phase, CCMHP trained 19 community psychiatric nurses and 48 community health extension workers in mhGAP-IG, establishing 45 new mental health clinics in primary care facilities across Benue, a state more populous than many countries. As a result, 13,785 clients (55% male, 45% female) were enrolled in mental health services either in primary care or in one of two pre-existing community-based rehabilitation facilities. Most are adults over age 18 (82.75%), and present to services with epilepsy (52.38%) or psychosis (38.41%).
The case of CCMHP demonstrates it is possible to rapidly scale-up mental health services in line with national mental health policy using the mhGAP-IG, even in a challenging, low-resource setting. Multi-sectoral partnerships may help to overcome some of the barriers to successful integration of mental health into general healthcare by capitalising on the resources and expertise of both state and non-state actors. However, a difficult political context could threaten the sustainability of the programme if funder requirements force a rapid transition to full government ownership.
世界卫生组织（WHO）非洲区域71%的国家拥有独立的精神卫生政策或计划，但只有14%的国家已全面实施。在尼日利亚，将精神卫生纳入初级保健一直是1991年《国家精神卫生政策》、2013年《精神卫生服务提供政策》以及《国家精神、神经和物质使用计划及行动计划》实施过程中的一个绊脚石。在贝努埃州，公立和私立非营利组织之间建立了伙伴关系，即综合社区精神卫生项目（CCMHP），该项目已成功地按照国家精神卫生政策和WHO的精神卫生差距行动项目干预指南（mhGAP-IG）将精神卫生纳入初级保健。有必要记录此类案例，以便为尼日利亚和其他低收入和中等收入国家（LMICs）的政策实施提供参考。
我们采用案例研究方法来监测和评估LMICs中的社区精神卫生项目。在2013年至2017年期间进行了四次实地考察，以记录CCMHP第一阶段的活动，涵盖2011年1月至2016年6月期间。
在第一阶段，CCMHP对19名社区精神科护士和48名社区卫生推广工作者进行了mhGAP-IG培训，在贝努埃州各地的初级保健机构中新建了45家精神卫生诊所，贝努埃州的人口比许多国家都多。结果，13785名服务对象（55%为男性，45%为女性）在初级保健机构或两家现有的社区康复机构之一中登记接受精神卫生服务。大多数是18岁以上的成年人（82.75%），就诊时患有癫痫（52.38%）或精神病（38.41%）。
CCMHP的案例表明，即使在具有挑战性的低资源环境中，使用mhGAP-IG也有可能按照国家精神卫生政策迅速扩大精神卫生服务规模。多部门伙伴关系可能有助于通过利用国家和非国家行为体的资源和专业知识，克服将精神卫生成功纳入一般医疗保健的一些障碍。然而，如果资助者的要求迫使该项目迅速过渡到完全由政府主导，艰难的政治环境可能会威胁到该项目的可持续性。
