1. 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

2. Background & Context

3. 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

4. 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

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

6. 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

7. 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

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

9. Methods

10. 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

11. Results

12. 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)

13. 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

14. Gender - Age
Gender Distribution
Age

15. 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)

16. 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:

17. 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

18. 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)

19. Conclusions

20. 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

21. 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

22. 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