03638nas a2200265 4500000000100000008004100001260004400042653005700086653001800143653003000161653003300191100001400224700001300238700001100251700002100262700001200283700001200295700001500307700001300322245007800335856007700413490000700490520286100497022001403358 2021 d bSpringer Science and Business Media LLC 10 aPublic Health, Environmental and Occupational Health 10 aHealth Policy 10 aPhychiatric Mental Health 10 aPsychiatry and Mental health 1 aQureshi O 1 aEndale T 1 aRyan G 1 aMiguel-Esponda G 1 aIyer SN 1 aEaton J 1 aDe Silva M 1 aMurphy J 00 aBarriers and drivers to service delivery in global mental health projects uhttps://ijmhs.biomedcentral.com/track/pdf/10.1186/s13033-020-00427-x.pdf 0 v15 3 aAbstract
Background
Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery.
Methods
This is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada’s (GCC’s) Global Mental Health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVivo 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness.
Results
Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake.
Conclusions
The study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.
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