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Mental Health Beyond Facilities ( mhBeF ) GMH 0091-04 :

Mental Health Beyond Facilities ( mhBeF ) GMH 0091-04 :. PI: Florence Baingana ( Makerere University School of Public Health, Uganda Co-PI: Sonia Chehil , Dalhousie University, Canada Co-Investigators : Mark Jordans , TPO-Nepal, Patrick Onyango-Mangen , TPO-Uganda,

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Mental Health Beyond Facilities ( mhBeF ) GMH 0091-04 :

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  1. Mental Health Beyond Facilities (mhBeF) GMH 0091-04: PI: Florence Baingana (Makerere University School of Public Health, Uganda Co-PI: Sonia Chehil, Dalhousie University, Canada Co-Investigators: Mark Jordans, TPO-Nepal, Patrick Onyango-Mangen, TPO-Uganda, Juliet Nakku, Butabika Hospital, Uganda, Janice Cooper and Brandon Kort, The Carter Center, Liberia.

  2. Developing the ToC GMH 0091-04: mhBeF Lira Dissemination

  3. Overview • Objectives of the Meeting • Background to the Project • Project objectives and Conceptual Framework • Achievements so far • Lessons learned • Challenges GMH 0091-04: mhBeF Lira Dissemination

  4. Objectives of the Meeting • To share details of the Project • To disseminate the formative research results • To share achievements of the Project in the first Year • To share planned activities for Year 2 GMH 0091-04: mhBeF Lira Dissemination

  5. Background • Global Burden of mental disorders • GBD 27% of YLD, 14% of DALY • World Economic Forum • Conflicts, HIV and AIDS, poverty, lead to high burden in LMIC. • Data from Uganda, Kinyanda, Tugumisirize, MakSPH SHSSP II • Gap between burden and the cost-effective interventions GMH 0091-04: mhBeF Lira Dissemination

  6. Background • Weak Community Mental health systems in most of the developing world • Community MHS weakest component of MHS in Uganda (MakSPH/SHSSP II 2010) • High levels of stigma, make it difficult for people with mental disorders to go to school or to get jobs/get gainfully employed. GMH 0091-04: mhBeF Lira Dissemination

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  8. CONCEPTUAL FRAMEWORK Intervention IntermediateOutcomes Ultimate Outcomes Capacity Building for clinical care 1. Observed clinical skills evaluation at each care level 2. Quality of documentation 3. Inter-rater reliability of diagnoses and evidence based treatment according diagnosis and national services 4. Patient service use and symptom burden Objective 1 Develop CCMHS Package Objective 2 Train for the delivery of the CCMHS Package Objective 3 Delivery of the CCMHS Package Objective 4 Evaluation of effectiveness of the CCBMH Package IMPROVED FUNCTIONING 1. Improved individual functioning (EQ5D,GAF) 2. Improved Household Economic Status (monthly income) Empowerment of PSGs 1. Providers: Reduction in clinical expressed stigma 2. Community: Reduction in expressed stigma 3. Consumers: Reduction in self- , anticipated- , and experienced-stigma 4. Policy makers: New legislation, policy, and funding Stigma Reduction Cross-National Monitoring & Evaluation Innovation Cross-National Training & Stigma-Reduction Design

  9. Study Sites Uganda • Erute South HSD (Study site) • Erute North HSD (some health units) Control site Nepal • Pyutan District Liberia • 5 Districts of Sinoe County GMH 0091-04: mhBeF Lira Dissemination

  10. Presentation 2 GMH 0091-04: mhBeF Lira Dissemination

  11. Achievements • Inception workshop held in Kampala February 2013 with all project partners. • Formative research carried out in all three countries • Drafts of CCMHS Package manual completed • IT Consultants hired GMH 0091-04: mhBeF Lira Dissemination

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  14. Way Forward • Working to get IRB clearance by the end of October 2013, latest mid November 2013. • Do the baseline assessment of the health system maybe end of November or early December • Train all cadres second week of January 2014 • Annual meeting in Liberia February 2014 • Roll out services as soon as training is complete, so end of January 2014 • T0 of the cohort will begin as soon as HCW begin to see clients. GMH 0091-04: mhBeF Lira Dissemination

  15. Challenges • Working across 3 countries, we have to move at the pace of everyone else. • Different skills levels and resources in the three countries • Procurement processes of Makerere University can sometimes cause delays. GMH 0091-04: mhBeF Lira Dissemination

  16. What works well • Cooperation of all partners, within Uganda and in each of the countries • Cooperation between all the project staff in countries and between countries • Enthusiasm for the work that they are doing by all staff in all countries • Extreme interest by all the consultants, eg Biostatistician, IT and for the Manual. GMH 0091-04: mhBeF Lira Dissemination

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