Mental Health Beyond Facilities (mhBeF) GMH : 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.

Developing the ToC September 2013GMH : mhBeF Lira Dissemination2

Overview Objectives of the Meeting Background to the Project Project objectives and Conceptual Framework Achievements so far Lessons learned Challenges September 2013GMH : mhBeF Lira Dissemination3

Objectives of the Meeting 1.To share details of the Project 2.To disseminate the formative research results 3.To share achievements of the Project in the first Year 4.To share planned activities for Year 2 September 2013GMH : mhBeF Lira Dissemination4

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 September 2013GMH : mhBeF Lira Dissemination5

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. September 2013GMH : mhBeF Lira Dissemination6

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Intermediate Outcomes Intervention Ultimate Outcomes Capacity Building for clinical care Stigma Reduction IMPROVED FUNCTIONING 1. Improved individual functioning (EQ5D,GAF) 2. Improved Household Economic Status (monthly income) 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 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 Cross-National Monitoring & Evaluation Innovation Cross-National Training & Stigma-Reduction Design CONCEPTUAL FRAMEWORK 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 Empowerment of PSGs

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 September 2013GMH : mhBeF Lira Dissemination9

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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 September 2013GMH : mhBeF Lira Dissemination11

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Way Forward Working to get IRB clearance by the end of October 2013, latest mid November 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. September 2013GMH : mhBeF Lira Dissemination14

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. September 2013GMH : mhBeF Lira Dissemination15

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. September 2013GMH : mhBeF Lira Dissemination16

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