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Improving mental health interventions in LMICs

A group of participants take part in a mental health awareness workshop led by the NIHR Global Health Research Group on Psychosis Outcomes

A group of participants take part in a mental health awareness workshop led by the NIHR Global Health Research Group on Psychosis Outcomes

Published: 10 October 2023

The global impact of mental disorders

10 October is World Mental Health Day, a day dedicated to raising awareness of mental health, and leading positive change for everyone’s mental health. According to the World Health Organization (WHO), 1 in 8 people globally live with a mental health disorder. There is a great need for better mental health care, especially in low and middle income countries (LMICs).

Research is needed to develop and evaluate promising new approaches. Here, we highlight some of the innovative projects that NIHR’s global health research programme funds in LMICs.

Developing intervention tools to promote treatment and referral

Digital tools and apps are being increasingly used in mental health and care services. The NIHR Global Health Research Group on Psychosis Outcomes has been testing innovative digital support to help reduce the burden of psychotic disorders in India.

The Group helped design and test two mobile phone apps. These help patients to manage their treatment plans. Following the trial, app users reported improvements in symptoms of their mental illness. The apps also gave users more timely and efficient access to treatment information.

The Group worked with TrustCircle, a mental health care start-up in Chennai. They facilitated mental health screening for 15,000 students. Their research contributed to the development of the mental health screening tool ‘SCARF-TrustCircle’. This app provides information on referral services to children and young people.

In a pilot test with 13,000 students, the SCARF-TrustCircle app accurately detected early signs of mental disorders. The study showed significant improvements in mental health literacy at 2 and 6 months from launch.

As part of this trial, the Group and TrustCircle engaged with schools and colleges. Together, they raised awareness about mental health among teachers and students. This strengthened local capacity to recognise symptoms of psychotic disorders.

The project’s director, Professor Swaran Singh, said: “The NIHR-funded WIC (Warwick India Canada) Programme is a flagship project that aims to introduce the paradigm of early intervention in psychosis in resource poor settings such as India.

“The project demonstrated good outcomes in services where early intervention was implemented, piloted the use of mobile technologies to provide continuity of care for ‘difficult to treat’ patients with schizophrenia, and highlighted enormous unmet mental health need for school and university students.”

Improving mental health among survivors of violence

The NIHR Global Health Research Group on a package of care for the mental health of survivors of violence in South Asia worked in India, Sri Lanka and Afghanistan. It developed interventions to improve the mental health of survivors of violence against women, modern slavery, and civil conflict. The team worked with survivors and mental health care providers to assess their needs and service gaps. They could then identify the most effective methods of intervention.

The Group collaborated with the Society for Nutrition, Education and Health Action (SNEHA) in Mumbai. Together, they developed a web-based interface called ‘Garima’. This helped guide care practitioners working with survivors of violence. Users of ‘Garima’ have praised its practical application and localised perspective. It has been translated into Hindi and Marathi and can be accessed in remote locations.

The Group produced a workbook for clinicians working with survivors of domestic violence in Sri Lanka. They also published a mental health support service manual for women in Afghanistan. In both countries, this has encouraged open communication and strengthened local intervention capacity.

Professor Delanjathan Devakumar, the project’s director, said: “Women survivors of domestic violence and modern slavery in South Asia face substantial harms to their mental health, but their advocates lack guidance on how they might support their wellbeing and address common mental disorders.”

Understanding the impact of community mental health care

Community-based mental health care can be more accessible and acceptable than institutional services. The NIHR Global Health Research Group on Developing Psycho-Social Interventions for Severe Mental Illness tested different approaches. These built on existing community-based resources in Bosnia-Herzegovina, Colombia and Uganda.

The Group looked specifically at three kinds of interventions.

  • Digital intervention, the DIALOG+ app helps people take an active role in their own treatment, and encourages individuals to seek support within communities
  • Volunteers, engaging with people living with mental illness
  • Family and friends, supporting those around them affected by mental illness

For each of these interventions, people reported improved quality of life and reduced symptoms.

Professor Stefan Priebe of Queen Mary University of London led the partnership. He said: "In LMICs, there are often insufficient financial and human resources available to provide specialised mental health care. This is why we set out to explore and test resource-oriented approaches that support patients to draw from existing resources that are readily available through relationships and communities.

"The positive results from our trials showed the three interventions to be effective providing substantial benefits to patients. This included improving quality of life, reducing symptoms and in some instances reducing future re-hospitalisation rates. Participants responded positively towards all interventions and described the positive impact they had on their lives."

The Group ran training workshops and seminars to strengthen local research capacity. The training included both researchers and mental health care professionals. Participants could then develop and test interventions in their local communities.

Looking ahead - NIHR’s continued commitment to mental health

Building off of the work of this partnership, the PIECES project is encouraging conversations about mental illness in India and Pakistan. Using educational performances, the project is addressing the stigma around mental health within local communities.

NIHR continues to fund themed and researcher-led programmes on mental health. We also partner with other funders, such as the Being initiative. Led by Grand Challenges Canada, this focuses on the mental health and wellbeing of young people in LMICs.

Dr Inesa Thomsen, Head of International and Open Research Policy at the Department of Health and Social Care said: “Mental health is a critical challenge worldwide, and investing in high-quality locally relevant research is vital to finding and implementing sustainable solutions.

“Being is taking a coordinated and strategic approach, engaging with people with lived experience, healthcare professionals and policy makers to improve access to services and support. Working together as funders, we can help address the shifting global burden of disease and support the development of responsive health systems.”

Read more about this work in our previous feature - Improving young people’s mental health worldwide

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