Evaluation of the integration of mental health services into the primary and community healthcare system in Nepal

Globally, there is a huge gap between the number of people who need mental health care and those who receive it. In recent years, a large body of evidence has been generated indicating the effectiveness of the task-shifting approach where mental health services are delivered by primary and community health care providers. In the task-sharing approach, mental health specialists are involved in designing and managing mental health services, building clinical capacity of the primary health care providers, and providing supervision and quality assurance. The World Health Organization (WHO) advocates integration of mental health services into the primary health care system as a practical and effective means to lower the treatment gap on mental health care. In this direction, WHO has developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) to help to facilitate the effective integration of mental health services into the primary health care system, particularly in low-and-middle income countries. Although integration of mental health services into primary health care has been widely advocated, this has not been systematically evaluated in a real-world setting. This dissertation presents studies conducted to generate new evidence in implementation and evaluation of mental health services in the primary and community health care system in Nepal.