According to WHO Mental Health Atlas 2014, more than 45% of the world population lives in a country with less than one psychiatrist for every 100,000 people, and there are even fewer neurologists.
Relying solely on specialists to provide services for people affected by mental, neurological, and substance use (MNS) disorders would prevent millions of people from accessing the services they need.
the Mental Health Gap Action Programme (mhGAP) was developed to scale up care for MNS disorders.
The mhGAP approach consists of interventions for prevention and management of priority MNS conditions, identified based on evidence about the effectiveness and feasibility of scaling up these interventions in low- and middle-income countries.
Priority conditions were identified based on the criteria that they represented:
a high burden (in terms of mortality, morbidity, and disability)
resulted in high economic costs
associated with violations of human rights.
What are the priority conditions?
depression, psychoses, self-harm/suicide, epilepsy, dementia, disorders due to substance use, and mental and behavioral disorders in children and adolescents.
The mhGAP-Intervention Guide (mhGAP-IG) is a resource to facilitate the delivery of the mhGAP evidence-based guidelines in non-specialized health care settings.
The mhGAP-IG Version 1.0 has been used at the country level
The mhGAP-IG Version 1.0 has been used most commonly:
as a key tool in the phased approach to scale-up mental health services on a regional, national, and sub-national level
as a capacity-building tool for a wide range of health professionals and para-professionals;
as a reference guide for developing and updating undergraduate and post-graduate curricula for health professionals.
The extensive feedback from a range of end-users, including non-specialist health care providers and people with MNS disorders across all WHO regions, were incorporated in the updated 2015 mhGAP guidelines, including new opportunities afforded by an e-version (or internet-based or mobile (m-) versions).
mhGAP-IG 2.0 updates
Content update in various sections based on new evidence, feedback, and recommendations from mhGAP users
Use of a vertical algorithm model, allowing for a streamlined and simplified clinical assessment
Inclusion of new algorithm for follow-up in all modules
Inclusion of two new modules: (a) Essential care and practice (which is an update for the chapter on General Principles of Care in version 1.0) and (b) Implementation module
A revised module for Psychoses (integrating both psychosis and bipolar disorder)
Child and Adolescent Mental and Behavioral Disorders (covering Developmental, Behavioral and Emotional Disorders)
Disorders due to Substance Use (including both disorders due to alcohol and disorders due to drug use)
The target user group of mhGAP-IG is non- specialized healthcare providers working at first- and second-level healthcare facilities.
The target user group of mhGAP-IG include primary care doctors, nurses, and other members of the healthcare workforce.
mhGAP-IG 2.0 is designed to be implemented primarily by non-specialists
mhGAP-IG 2.0 indicates where access to specialists is required for consultation or referral to improve utilization of scarce resources.
Training in using mhGAP-IG is best done as part of a systems approach involving health planners, managers, and policymakers so that the interventions proposed are supported by necessary infrastructure/resources
mhGAP-IG training also needs to be incorporated in an ongoing manner with mechanisms to ensure adequate support, supervision, and refresher training for the healthcare providers.
The mhGAP-IG is a model guide, and it must be adapted to the unique national or local situation.
The mhGAP-IG 2.0 begins with “Essential Care and Practice,” a set of good clinical practices and general guidelines for healthcare providers' interactions with people seeking mental health care.
The mhGAP-IG includes a “Master Chart,” which provides information on common presentations of the priority conditions.
Master Chart - which provides information on common presentations of the priority conditions, guides the clinician to the relevant modules.
most serious conditions - should be managed first.
mhGAP-IG 2.0 has a new addition to the Master Chart – Emergency Presentations of Priority MNS Conditions
Emergency Presentations of Priority MNS Conditions - section to help identify emergency situations and direction to management guidelines.
The modules, organized by individual priority conditions, are a tool for clinical decision-making and management.
The modules, organized by individual priority conditions, are a tool for clinical decision-making and management.
Each of the modules consists of three sections: assessment, management, and follow-up.
The mhGAP Version 2 has several sections including sections on: MEM
essential care and practice
master chart
modules covering the priority MNS conditions.
Essential Care and Practice - this module outlines the principles of essential care for all people seeking health care, including those with MNS conditions and their carers
The first section of ECP covers the general principles of clinical care.
First section of ECP - it aims to promote respect for the privacy of people seeking care for MNS conditions, foster good relationships between health care providers, service users, and their carers, and ensure care is provided in a non-judgmental, non-stigmatizing, and supportive manner.
The second section of ECP - covers the essentials of mental health clinical practice.
Section 2 of ECP - It aims to present healthcare providers with an overview of the assessment and management of MNS conditions in non-specialized settings.
Section 2: Essentials of Mental Health Clinical Practice
– Assess physical health
– Conduct a MNS assessment
– Manage MNS conditions
Section 1: General Principles UP– Use effective communication skills
– Promote respect and dignity
Master Chart - This section provides an overview of priority MNS conditions.
Master chart - guides the clinician to the relevant modules.
mhGAP-IG 2.0 also includes Emergency Presentations of Priority MNS Conditions to help in identifying emergency situations and direction to management guidelines.
DEPRESSION (DEP) MLPL
Multiple persistent physical symptoms with no clear cause
Low energy, fatigue, sleep problems
Persistent sadness or depressed mood, anxiety
Loss of interest or pleasure in activities that are normally pleasurable
Multiple persistent physical symptoms with no clear cause