The need for a validated standardized screening tool at facility level as well as strengthening of the mental health component of the ward-based primary health care outreach teams (WBPHCOTS) to facilitate detection of mental health problems at a community level as well as tracing of non-adherent patients have been identified through the ongoing continuous quality improvement process as well as national, provincial and district Department of Health collaborators.
As a result we developed and validated a Brief Mental Health (BMH) screening tool that has since been published in the South African Medical Journal (Bhana et al, 2019).
- The BMH assesses for positive symptoms of common mental disorders (depression, anxiety and substance abuse) and it was developed against a nurse-initiated assessment using the Adult Primary Care (APC) Manual. Having completed the validation of the Brief Mental Health (BMH) screening tool our findings show that the tool is effective in screening for common mental disorders. We have also worked closely with the KZN DoH to investigate how best the tool should be used at facility level to inform a standard operating procedure for the tool.
- Following the continuous quality improvement process that we have engaged with to strengthen the system to enable integrated care, we were requested by the KwaZulu-Natal provincial Department of Health to add a community layer to the package as well as a facility-based screening tool (that we validated in 2018) to strengthen demand for services. We have thus been working on the following:
- A Community Mental Health Education and Detection (CMED) tool that will assist the existing ward-based PHC outreach teams (WPHCBOTS) comprised of community health workers (CHWs) to identify chronic care patients with comorbid mental health disorders on their household visits. The feasibility and validity of this tool will be established before it is introduced into routine care. Adding a community layer should contribute to increased demand for mental health care services.
- Strengthening processes to enable timely follow-up of chronic patients lost to care and patient re-engagement, especially of chronic patients with HIV and/or TB with comorbid CMDs and tracking of health improvement via routine data such as blood pressure in hypertensive patients, viral load suppression rates in HIV patients and sputum conversion rates in TB patients.
- We will start our second cohort in 2020 where we will assess whether the strengthened MhINT intervention (that incorporates screening at a PHC facility level using the BMH, as well as a community package that comprises strengthened processes for retention in care of chronic patients with comorbid CMDs) as well as other lessons emerging from the first phase of evaluation results in improved uptake and outcomes of the MhINT integration package.
Broader provincial scale-up:
The MhINT model for integrated primary mental health care has been adopted by the King Cetswayo district in KwaZulu-Natal and currently being scaled up by the Department of Health in this district.