Innovation in mental health services: psychotherapy via a call centre MSF Scientific Days 2016 Néstor Rubiano1, Ligia Paola García1, María Cristóbal2, Jaime Pedraza1, Carmen Martínez-Viciana2   MSF, Bogotá, Colombia1; MSF, Barcelona, Spain2 Presenter: Nestor Rubiano Deputy Medical Coordinator Colombia (msfe-bogota-psyco@barcelona.msf.org)

Background & Context

Cauca Pacífico-Buenaventura MSF IN COLOMBIA Cauca Pacífico-Buenaventura Urban area, Buenaventura Urban area, Buenaventura Nariño Cauca Cordillera MSF-OCBA is present in Colombia since 1994 Right now - we are present in 3 regions through 3 projects, all of them with 80% of their activities related to Mental Health and Psychosocial (MHPS) services : Cauca Cordillera Valle del Cauca (Buenaventura) Nariño deparments In addition, an emergency team continiously work within the mission. Humanitarian needs and gaps: People affected by conflict Other situations of violence (increased mental health morbidity, sexual violence, displacement, confinement, etc) Natural disasters Huge gap between mental health needs and services Problems of access to medical services

Buenaventura 42.5% of the population are internally displaced and 48% are victims of armed conflict 41.07 homicide cases rate per 100,000 inhabitants Most inhabitants of the dense urban areas are directly or indirectly exposed to violence (conflict-related, sexual, other) Movement restrictions imposed by violence constrains access to health care 90% of Buenaventura`s population are Afro Colombians of whom 60% live under the poverty line Colombia's main port Many armed groups fight to control cocaine routes, illegal commercial trade, etc MSF is in Buenaventura because of: violence, volatile context, difficulties with access to health care, and forced displacement

Buenaventura and MSF services Current MSF operations include: Mental health and psychosocial support (including psychiatric care) Sexual violence integrated care

Tele-counselling (via a call centre) and face-to-face sessions Innovative strategy Enhance access to mental health services by providing ways to receive psychological support that ensure privacy and confidentiality, and enable 24/7 service availability via a multidisciplinary team Tele-counselling (via a call centre) and face-to-face sessions Through combined tools/methods provides a window of opportunity that would otherwise not be available Model with potential to be adapted to other similar contexts. The model is innovative both in terms of MSF operations as well as in the intervention context

Target population People with emotional symptoms related to exposure to armed violence Comprehensive care for victims of sexual violence Comprehensive care for people with acute psychiatric symptoms

Aim of analysis Assess outcomes of patients in this innovative model Assess increase in access to care

Methods

Methods We analysed data from the whole of 2015 to measure increase in access for the selected target population comparing admissions to the programme before and after the implementation of the call centre Patients’ data collected from September to December 2015 was used for the descriptive analysis of main clinical findings and treatment outcomes after the implementation of the model This retrospective study met the criteria of the MSF Ethics Review Board for exemption from ethics review

Results

Calls 3137 (43%) of the 7451 attended calls were considered valid and classified as follows: Target population first time (23.3%, n=732) Target follow ups (36.7%, n=1.153) Other service requested (12.1%, n=380) Non-target calls (27.7%, n=872)

Treatment PATIENTS Identified through call centre 565 Call 378 (67%) Only call 195 (51.5%) Referral to face to face 183 (48.5%) Face to Face 187 (33%) Of the 732 target callers, 565 were admitted as clients and received mental health services through different modalities

Gender - Age Gender Distribution Age

Diagnosis The top five diagnoses were: 1. Depression 36% (203) 2. Other anxiety disorders 15.5% (86) 3. Relational problems, abuse, and neglect 10.2% (58) 4. Adjustment disorder 6% (34) 5. Post-traumatic stress disorder (PTSD) 6% (33)

Clinical outcomes of 372 closed cases*: overall Reasons for ending treatment Condition at exit *Cases closed by end December 2015 372 cases closed by December 2015:

Clinical outcomes of 372 closed cases: by treatment modality 258 clients had been treated through the call centre 114 had been referred and treated only face-to-face Of the 128 clients unable to be traced: 81.2% (104) had been treated through the call centre 18.7% (24) had been treated only face-to-face The overall improvement rate for call centre clients was 27.5% (71/258) versus 68.4% (78/114) for exclusively face-to-face clients

Admissions After inauguration of the call centre, 685 new patients were admitted to the programme; 82.4% (565) identified via the call centre The monthly average of new programme admissions has increased by 186%* since inauguration of the call centre * SD(27.91), 95%CI ±(2.09)

Conclusions

Increased access The strategy increased the programme’s overall access to the target population The call centre is a complementary option to provide mental health support, as well as a way to identify potential beneficiaries for more traditional face to face services

Clinical findings Overall clinical outcomes were negatively affected by the high dropout rate that led to an important number of clients whose condition was impossible to be determined at closure, especially in those cases directly managed through the call centre

Recommendations This model could be considered by MSF in contexts where access to face-to-face services is hindered by security constraints It should be restricted to settings where phone conversations are proven to be safe and confidential We need to better understand the reasons behind the dropout rate and develop strategies aimed at maximizing adherence