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Evaluation of capacity-building strategies for mental health system strengthening in low- and middle-income countries for service users and caregivers, policymakers and planners, and researchers

  • Sara Evans-Lacko (a1), Charlotte Hanlon (a2), Atalay Alem (a3), Jose Luis Ayuso-Mateos (a4), Dan Chisholm (a5), Oye Gureje (a6), Mark Jordans (a7), Fred Kigozi (a8), Heidi Lempp (a9), Crick Lund (a10), Inge Petersen (a11), Rahul Shidhaye (a12), Graham Thornicroft (a13) and Maya Semrau (a14)...

Abstract

Background

Strengthening of mental health systems in low- and middle-income countries (LMICs) requires the involvement of appropriately skilled and committed individuals from a range of stakeholder groups. Currently, few evidence-based capacity-building activities and materials are available to enable and sustain comprehensive improvements.

Aims

Within the Emerald project, the goal of this study was to evaluate capacity-building activities for three target groups: (a) service users with mental health conditions and their caregivers; (b) policymakers and planners; and (c) mental health researchers.

Method

We developed and tailored three short courses (between 1 and 5 days long). We then implemented and evaluated these short courses on 24 different occasions. We assessed satisfaction among 527 course participants as well as pre–post changes in knowledge in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, Uganda). Changes in research capacity of partner Emerald institutions was also assessed through monitoring of academic outputs of participating researchers and students and via anonymous surveys.

Results

Short courses were associated with high levels of satisfaction and led to improvements in knowledge across target groups. In relation to institutional capacity building, all partner institutions reported improvements in research capacity for most aspects of mental health system strengthening and global mental health, and many of these positive changes were attributed to the Emerald programme. In terms of outputs, eight PhD students submitted a total of 10 papers relating to their PhD work (range 0–4) and were involved in 14 grant applications, of which 43% (n = 6) were successful.

Conclusions

The Emerald project has shown that building capacity of key stakeholders in mental health system strengthening is possible. However, the starting point and appropriate strategies for this may vary across different countries, depending on the local context, needs and resources.

Declaration of interest

S.E.L. received consulting fees from Lundbeck.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Maya Semrau, Global Health and Infection Department, Medical Research Building, Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PS, UK. Email: m.semrau@bsms.ac.uk

References

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1Mills, A. Health policy and systems research: defining the terrain; identifying the methods. Health Policy Plan 2012; 27: 17.
2Samudre, S, Shidhaye, R, Ahuja, S, Nanda, S, Khan, A, Evans-Lacko, S, et al. Service user involvement for mental health system strengthening in India: a qualitative study. BMC Psychiatry 2016; 16: 269.
3Abayneh, S, Lempp, H, Alem, A, Alemayehu, D, Eshetu, T, Lund, C, et al. Service user involvement in mental health system strengthening in a rural African setting: qualitative study. BMC Psychiatry 2017; 17: 187.
4Gurung, D, Upadhyaya, N, Magar, J, Giri, NP, Hanlon, C, Jordans, MJD. Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors. Int J Ment Health Syst 2017; 11: 30.
5Schneider, M, Sorsdahl, K, Mayston, R, Ahrens, J, Chibanda, D, Fekadu, A, et al. Developing mental health research in sub-Saharan Africa: capacity building in the AFFIRM project. Glob Ment Heal 2016; 3: e33.
6Keynejad, R, Semrau, M, Toynbee, M, Evans-Lacko, S, Lund, C, Gureje, O, et al. Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review. BMC Health Serv Res 2016; 16: 601.
7Semrau, M, Lempp, H, Keynejad, R, Evans-Lacko, S, Mugisha, J, Raja, S, et al. Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: systematic review. BMC Health Serv Res 2016; 16: 79.
8Semrau, M, Evans-Lacko, S, Alem, A, Ayuso-Mateos, JL, Chisholm, D, Gureje, O, et al. Strengthening mental health systems in low- and middle-income countries: the Emerald programme. BMC Med 2015; 13: 79.
9Hanlon, C, Semrau, M, Alem, A, Abayneh, S, Abdulmalik, J, Docrat, S, et al. Evaluating capacity-building for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners and researchers. Epidemiol Psychiatr Sci 2018; 27; 310.
10Semrau, M, Alem, A, Abdulmalik, J, Docrat, S, Evans-Lacko, S, Gureje, O, et al. Developing capacity-building activities for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners, and researchers. Epidemiol Psychiatr Sci 2018; 27: 1121.
11Lempp, H, Abayneh, S, Gurung, D, Kola, L, Abdulmalik, J, Evans-Lacko, S, et al. Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study. Epidemiol Psychiatr Sci 2018; 27: 2939.

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Evaluation of capacity-building strategies for mental health system strengthening in low- and middle-income countries for service users and caregivers, policymakers and planners, and researchers

  • Sara Evans-Lacko (a1), Charlotte Hanlon (a2), Atalay Alem (a3), Jose Luis Ayuso-Mateos (a4), Dan Chisholm (a5), Oye Gureje (a6), Mark Jordans (a7), Fred Kigozi (a8), Heidi Lempp (a9), Crick Lund (a10), Inge Petersen (a11), Rahul Shidhaye (a12), Graham Thornicroft (a13) and Maya Semrau (a14)...
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