Ubaid Mohammad, Jadba Ghada, Mughari Hala, Tabash Hana, Yaghi Mohammad, Aljaish Amal, Shahin Umar
Rafah Health Center, UNRWA Gaza Field Office, Gaza Strip, occupied Palestinian territory.
Gaza Field Health Program, UNRWA Gaza Field Office, Gaza Strip, occupied Palestinian territory.
Lancet. 2021 Jul;398 Suppl 1:S51. doi: 10.1016/S0140-6736(21)01537-3.
Integration of mental health and psychosocial support (MHPSS) into primary health care in the Gaza Strip involves the delivery of mental health services within the essential service package provided by UNRWA, as recommended by WHO to fill the treatment gap. In early 2016, a successful pilot demonstrated that the integration is achievable in limited resource settings, and resulted in the adoption of a stepped care model to screen, identify, support, and treat patients. This study aimed to evaluate the MHPSS integration process and outcomes at UNRWA health centres in the Gaza Strip.
We used a descriptive analytical study design, with quantitative and qualitative data collected from records, and individual feedback from patients and health care providers (HCPs). The study was performed in the 22 UNRWA health centres of the Gaza Strip and all participants agreed to participate either verbally or by written consent. Approval was also obtained from the UNRWA Health Program Gaza Field Office.
The integration process started with the comprehensive training of 460 medical and nursing HCPs, in accordance with the Mental Health Gap Action Programme (mhGAP) Intervention Guide. On completion of training, the HCPs put into practice their learning, under close supervision for the first month and with only technical support thereafter. During the period of technical support, MHPSS activities, referral pathways, and proper reporting were ensured and standardised in all health centres. Overall, the integration process achieved success in training, implementation, and supervision. The success of training was assessed with an evaluation form and participants' feedback, the success of implementation by the numbers of people who benefitted, their response to the intervention, and their feedback, and the success of supervision by the standardisation of the process and the technical validity of the intervention. By the end of September, 2018, 80 857 high-risk patients were screened using the General Health Questionnaire 12 (GHQ-12) and 9·0% (7327) were identified as requiring intervention and support, and were assisted using the UNRWA stepped care approach. Of the individuals who were assisted, 30·2% (2212 of 7327) showed significant improvement and 38·9% (2849) were identified as having mental health issues according to the mhGAP. In the same period, 1020 patients benefited from 113 support groups, with excellent effects on their physical and mental health as assessed with qualitative data, patients' testimonies and, in some cases, laboratory investigations. The challenges that were faced were due to manual documentation and reporting, sociopolitical uncertainty, an increase in the number and needs of patients, and the imposed burden on HCPs. In addition, during implementation many individuals who were screened and identified required an urgent response: individuals who were suicidal and individuals whose mental health had been affected by the Great March of Return.
The integration showed remarkable success in a short time as a result of the collective effort of all participants. However, there are challenges to overcome, and observation, further evaluation, and refinement of the process are needed to stabilise and sustain the integration of MHPSS services into primary health care for maximum benefit.
WHO, and UNRWA resources.
按照世界卫生组织的建议，将精神卫生和心理社会支持（MHPSS）纳入加沙地带的初级卫生保健，意味着在近东救济工程处提供的基本服务包中提供精神卫生服务，以填补治疗缺口。2016年初一项成功的试点表明在资源有限的环境中这种整合是可行的，并促成采用了一种阶梯式照护模式来筛查、识别、支持和治疗患者。本研究旨在评估加沙地带近东救济工程处卫生中心的MHPSS整合过程及结果。
我们采用描述性分析研究设计，从记录以及患者和卫生保健提供者（HCP）的个人反馈中收集定量和定性数据。研究在加沙地带的22个近东救济工程处卫生中心开展，所有参与者均口头或书面同意参与。同时也获得了近东救济工程处加沙地带卫生项目办公室的批准。
整合过程始于根据《精神卫生差距行动规划》（mhGAP）干预指南对460名医疗和护理HCP进行全面培训。培训结束后，HCP们将所学付诸实践，第一个月在密切监督下进行，之后仅接受技术支持。在技术支持期间，所有卫生中心的MHPSS活动、转诊途径和正确报告均得到确保并实现标准化。总体而言，整合过程在培训、实施和监督方面均取得成功。培训的成功通过评估表和参与者反馈进行评估，实施的成功通过受益人数、他们对干预的反应及其反馈来衡量，监督的成功通过过程的标准化和干预的技术有效性来判断。到2018年9月底，使用一般健康问卷12项版（GHQ - 12）对80857名高危患者进行了筛查，其中9.0%（7327名）被确定需要干预和支持，并采用近东救济工程处的阶梯式照护方法予以协助。在得到协助的个体中，30.2%（7327名中的2212名）有显著改善，根据mhGAP，38.9%（2849名）被确定有精神卫生问题。同期，1020名患者受益于113个支持小组，根据定性数据、患者证言以及在某些情况下的实验室检查评估，对他们的身心健康产生了良好效果。面临的挑战包括手工记录和报告、社会政治不确定性、患者数量和需求增加以及给HCP带来的负担。此外，在实施过程中，许多经筛查和识别的个体需要紧急应对：有自杀倾向的个体以及心理健康受到“回归大游行”影响的个体。
由于所有参与者的共同努力，整合在短时间内取得了显著成功。然而，仍有挑战需要克服，需要进行观察、进一步评估并完善该过程，以稳定并持续将MHPSS服务纳入初级卫生保健，从而实现最大效益。
世界卫生组织和近东救济工程处资源。
