PROGRAVIDA was a randomised controlled trial testing the efficacy of a psychological intervention for depressed pregnant women in Sao Paulo, Brazil. This primary care intervention is based on problem-solving techniques and delivered at home by auxiliary nurses. 680 women were randomised to the intervention or usual care and almost 90% completed follow up assessments 3 months after the intervention phase was completed. Recovery rates in the intervention group were 15% higher than in the control group, as measured by the Patient Health Questionnaire (PHQ-9).

Contact Person / Email
ricardo.araya@lshtm.ac.uk

The Centre for Global Mental Health operates a full range of capacity building projects, including in-country training of human resources for mental health care and international research capacity building hubs. On this page we provide a sample of the kinds of projects we are working on in this regard.

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Care for People with Schizophrenia in India (COPSI) was a randomised controlled trial evaluating the clinical and cost effectiveness of collaborative, community based care for people with chronic schizophrenia in three sites in India. The intervention was specifically designed to promote collaboration between the person with schizophrenia, their caregivers, and the treatment team (the psychiatrist and the community health worker) to deliver a flexible, individualised and needs-based intervention. All community health workers were systematically trained over 6 weeks and assessed for adequate competence using a specially-developed intervention manual.

Contact Person / Email
graham.thornicroft@kcl.ac.uk

C-MaMiE is a population-based cohort of 1,065 pregnant women was recruited from the predominantly rural demographic surveillance site in Butajira, south central Ethiopia. The women have been followed up ever since to examine the impact of maternal mental health problems on child growth, physical and mental health, development, educational attainment and survival.

Contact Person / Email
charlotte.hanlon@kcl.ac.uk

Co-Production of a Therapeutic Skills Training Programme for Carers, Relatives and Friends with Psychosis is a qualitative study that aims to explore the views of people with psychosis as well as clinicians and carers in regards to wellbeing and recovery outcomes that are considered important and should be prioritised by a carer-focused therapeutic skills training programme.

CGMH Contact: 

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Arlinda.Cerga-Pashoja@lshtm.ac.uk

Common Mental Disorders and their association with Resilience Among Internally Displaced people (COMRAID) is a cross-sectional survey conducted in northern Sri Lanka between 2010 and 2013 that investigated forced migration exposure, mental health and resilience in a Muslim minority ethnic group displaced from the province since 1991 and returning since the civil war ended in 2009.

CGMH Contact: 

Contact Person / Email
chesmal.siriwardhana@kcl.ac.uk

The DON study is a cohort study of pregnant and postnatal women ever that measures risk factors for postnatal depression relate to adverse maternal and/or child birth outcomes, whereas those of antenatal depression are sociodemographic and pregnancy-specific. Both antenatal and postnatal depression were found to have deleterious effects on maternal health, child health and child survival.

Contact Person / Email
benedict.weobong@lshtm.ac.uk

ECOHOST is a project researched patterns of mental disorders and associated community-level factors among people affected by armed conflicts in the Republic of Georgia. A cross-sectional household survey was conducted involving 3,600 respondents, along with structured observations of their communities. Findings have been published on PTSD and common mental disorder comorbidity, harmful alcohol use, tobacco use and nicotine addiction, mental health service utilisation, somatic distress, and coping strategies. The project was funded by the Wellcome Trust and conducted in collaboration with CGMH, Curatio International and Global Initiative on Psychiatry – Tbilisi.

Contact Person / Email
bayard.roberts@lshtm.ac.uk

EMERALD is a five-year programme (2012-17) to improve mental health outcomes in six low- and middle-income countries (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). It aims to strengthen mental health system performance by identifying key barriers to the effective delivery of mental health services and offering solutions for improvement. There is a strong focus on capacity-building of researchers, policy-makers and planners to implement system improvements for mental health care services, and on working towards greater involvement of service users and caregivers.

Contact Person / Email
graham.thornicroft@kcl.ac.uk

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The Centre for Global Mental Health’s significant policy impact continues to inform and accelerate the growing commitment to developing, evaluating and scaling up global mental health promotion, prevention and treatment interventions worldwide. 

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E-COMPARED is a 4-year project (2013-17) funded by the European Commission which is conducting comparative effectiveness research in UK mental health services on the effectiveness of internet-based treatment for depression. E-COMPARED is multidisciplinary (psychology, HTA, ICT, care) and its members are frontrunners in internet-based treatment for common mental health disorders in Europe.

Contact Person / Email
ricardo.araya@lshtm.ac.uk

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EXPONATE: EXPanding care fOr periNATal women with dEpression is a large randomised controlled trial assessing the cost-effectiveness of a clinical management programme for perinatal depression in Ibadan, Nigeria. The programme is delivered by non-physician primary care providers (mostly community health workers), who receive support and supervision from nurses and general doctors through mobile phones. Women are recruited during pregnancy and follow-up continues after delivery. Children of depressed mothers are assessed 12 months after delivery to measure health indicators as well as cognitive development.

Contact Person / Email
ricardo.araya@lshtm.ac.uk

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Improving access to care designs interventions based on the best global and local evidence, systematically test them to ensure feasibility of delivery by lay health workers and acceptability by patients and families, and evaluate effectiveness and cost-effectiveness through randomised controlled trials. They embed their interventions within routine health care platforms and work closely with local stakeholders to scale up services. 

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The INTREPID research programme aims to better understand cross-cultural variation in the incidence and outcome of schizophrenia.

• Phase 1 aims to develop robust, comparable methods for the study of schizophrenia and other psychoses’ epidemiology, phenomenology, aetiology and outcomes in diverse settings. This is being conducted (2011-2014) in defined catchment areas in three countries: Chengalpet Taluk (near Chennai), India; Ibadan South East and Ona Ara, Ibadan, Nigeria; and Tunapuna-Piarco, Trinidad.
• Phase 2 will implement these methods in a multi-country study of psychoses.

Contact Person / Email
craig.morgan@kcl.ac.uk

The Mental Health Innovation Network (MHIN: mhinnovation.net) is a knowledge exchange hub for a global community of mental health stakeholders, including researchers, practitioners, service users, donors, and policy makers, working together to share innovative resources and ideas to promote mental health and support scale-up of mental health services. MHIN hosts a growing database of over 150 innovative projects from around the world, as well as a repository of resources ranging from training manuals for specific interventions to the latest systematic reviews. The site also features a community area where our 3000+ members can network through blogs, podcasts, webinars, and discussion forums.

CGMH Contact: mhin@lshtm.ac.uk

Contact Person / Email
mhin@lshtm.ac.uk

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PRIME is a consortium of research institutions and Ministries of Health in five countries in Asia and Africa (India, Nepal, Ethiopia, South Africa & Uganda). The goal of PRIME is to generate world-class research evidence on the implementation and scale up of treatment programmes for priority mental disorders in primary and maternal health care in low resource settings. In July 2013, the Department of Health in South Africa adopted its new national Mental Health Policy and Action plan, for which PRIME provided inputs through the national technical advisory committee for mental health. In Nepal, PRIME training has been incorporated into the National Health Training Center curriculum. In Uganda, work continues with the Ministry of Health and World Vision Australia to scale up mental health services in two additional districts. PRIME has been asked to contribute to state level planning for mental health in Madya Pradesh, India.

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Rehabilitation Intervention for people with Schizophrenia in Ethiopia (The RISE project) involved the development and evaluation of a community-based rehabilitation (CBR) intervention for people with schizophrenia in Ethiopia. This Wellcome Trust funded project had three phases: an intervention development phase, a 12-month pilot and a 12-month cluster randomized trial. A theory of change approach was used to structure the work through each phase.The RISE trial aimed to determine the impact of CBR in addition to facility based care, compared to facility based care alone, on disability in people with schizophrenia. CBR was delivered by trained non-specialist workers and involved both:

• Home-based support: psychoeducation, family intervention, support returning to work and community activities) and
• Community mobilization: awareness raising and targeted mobilization of community resources

Contact Person / Email
laura.asher@lshtm.ac.uk

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TaSCS is a randomised controlled trial run by the Addis Ababa University Department of Psychiatry and funded by NIMH. This trial is evaluating whether mental health care delivered by trained and supervised primary health care workers is as good as that delivered by centralised, hospital-based, psychiatric nurse-led care. The intervention group is receiving treatment at community-based clinics close to their homes, while the control group receives ongoing care from a centralised clinic staffed by psychiatric nurses and based in a more urban area.

Contact Person / Email
charlotte.hanlon@kcl.ac.uk

The 10/66 Dementia Research Group is a collective of researchers carrying out population-based research into dementia, non-communicable diseases and ageing in low and middle income countries. The collaboration brings together 30 research groups in 20 countries across Asia, Latin America and the Caribbean. 10/66 aims to provide a detailed evidence-base to inform the development and implementation of policies for improving the health and social welfare of older people, particularly those with dementia and their carers. The team works closely with national, regional and international policymakers to formulate research plans and to interpret and disseminate knowledge from the 10/66 studies.

Contact Person / Email
martin.prince@kcl.ac.uk

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The Zimbabwean Friendship Bench Project is a stepped care approach to depression (commonly expressed as ‘thinking too much’ or ‘Kufungisisa’ in the Shona language) and other common mental disorders in primary care. The Friendship Bench uses a brief psychological approach based on problem-solving therapy and carried out by lay health workers with supervision by higher cadres. The team has recently completed the formative phase of a cluster randomised controlled trial. Initial results from the pilot trial demonstrate decreased symptoms of common mental disorders after 3 sessions of problem-solving therapy, as measured by a locally validated screening tool. The full RCT began in August 2014 and consists of 12 intervention clusters and 12 enhanced usual care.

Contact Person / Email
melanie.abas@kcl.ac.uk

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The INTREPID research programme aims to better understand cross-cultural variation in the incidence and outcome of schizophrenia.

• Phase 1 aims to develop robust, comparable methods for the study of schizophrenia and other psychoses’ epidemiology, phenomenology, aetiology and outcomes in diverse settings. This is being conducted (2011-2014) in defined catchment areas in three countries: Chengalpet Taluk (near Chennai), India; Ibadan South East and Ona Ara, Ibadan, Nigeria; and Tunapuna-Piarco, Trinidad.
• Phase 2 will implement these methods in a multi-country study of psychoses.

Contact Person / Email
craig.morgan@kcl.ac.uk

The Manas trial is to date the largest trial of a mental health intervention in any low or middle income country. It was a cluster randomised controlled trial of a stepped care intervention for common mental disorders (CMD) delivered by lay health workers. A range of psychosocial treatments were provided including: 

• Psychoeducation
• Specific psychological treatments
• Yoga
• Proactive monitoring of adherence and
• Apecialist support. 

24 primary health care facilities in Goa, India, were randomised to receive enhanced usual care (control) or stepped care. The primary research question was whether the addition of the Health Counsellor (who delivers all the psychosocial treatments) provides a cost-effective intervention in comparison to simply providing the PHC doctor with diagnostic information and access to antidepressants. Results showed that the intervention led to cost-effective improvements in recovery from CMD among patients attending public health facilities. Manas has also produced a set of manuals for health workers, physicians and counsellors addressing the concepts of stress and depression, the various treatments for depression, and delivery of these treatments in the Manas program.

Contact Person / Email
vikram.patel@lshtm.ac.uk

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The SEF HOME Project is a needs assessment of street homeless people with mental illness. Over 90% had experienced some form of mental or substance use disorder, with around 40% assessed to have psychosis. Unmet needs were extensive. Multi-sectoral stakeholders were engaged in developing a feasible plan for implementation.

Contact Person / Email
abe.wassie@kcl.ac.uk

ImpleMentaLL is a European collaboration of 13 countries that aims to develop, apply, and evaluate tailored implementation strategies of on-going eHealth implementation initiatives. 

Contact Person / Email
Arlinda.Cerga-Pashoja@lshtm.ac.uk

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Generating Knowledge: Understanding the Burden of Mental Disorders include large community surveys to estimate the prevalence and social determinants of mental disorders in diverse settings. They interview local stakeholders to understand the experiences and community perceptions of mental health and illness, and use this insight to develop and validate diagnostic methods for different languages and cultural contexts. 

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Child and adolescent mental health department aims to:

• Strengthen advocacy, effective leadership and governance for child and adolescent mental health
• Provide comprehensive, integrated and responsive mental health and social care services in community-based settings for early recognition and evidence-based management of childhood mental disorders
• Implement strategies for promotion of psychosocial well-being, prevention of mental disorders and promotion of human rights of young people with mental disorders
• Strengthen information systems, evidence and research.

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WHO’s comprehensive mental health action plan focuses international attention on a long-neglected problem and is firmly rooted in the principles of human rights. The action plan calls for changes. It calls for a change in the attitudes that perpetuate stigma and discrimination that have isolated people since ancient times, and it calls for an expansion of services in order to promote greater efficiency in the use of resources. The four major objectives of the action plan are to:

• Strengthen effective leadership and governance for mental health.
• Provide comprehensive, integrated and responsive mental health and social care services in community-based settings.
• Implement strategies for promotion and prevention in mental health.
• Strengthen information systems, evidence and research for mental health.

Each of the four objectives is accompanied by one or two specific targets, which provide the basis for measurable collective action and achievement by Member States towards global goals. A set of core indicators relating to these targets as well as other actions have been developed and are being collected via the Mental Health Atlas project on a periodic basis.

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Mental Health and Psychosocial Support in Emergencies Department emphasizes that the number of persons exposed to extreme stressors is large and that exposure to extreme stressors is a risk factor for mental health and social problems. The Department’s work on mental health in emergencies focuses mostly on resource-poor countries, where most populations exposed to natural disasters and war live.

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Mental Health Atlas Project of the Department of Mental Health and Substance Abuse is designed to collect, compile and disseminate data on mental health resources in the world. These resources are necessary to provide services and care for people with mental disorders. Resources include mental health:

• Policies
• Plans
• Financing
• Care delivery
• Human resources
• Medicines and
• Information systems.

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Evidence and Research team (MER) at WHO is deeply committed to closing the gap between what is needed and what is currently available to reduce the burden of mental disorders worldwide and to promote mental health. The MER team transforms this objective into action through the following core projects that aim to increase the information and evidence base on mental health. Core projects include

• Mental Health Atlas Project : collecting and disseminating data on mental health resources such as policies, plans, financing, care delivery, human resources, medicines, and information systems in the world. The project started in 2001 and the data was updated in 2005, 2011 and 2014.
• The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) is a tool for collecting essential information on the mental health system of a country or region. The goal of collecting this information is to improve mental health systems and to provide a baseline for monitoring the change.
• Mental Health in Emergencies: work on mental health in emergencies is any population exposed to extreme stressors, such as refugees, internally displaced persons, disaster survivors, and terrorism, or war-exposed populations.

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mhGAP Training Manuals support implementation of the mhGAP Intervention Guide for mental, neurological and substance use (MNS) disorders in non-specialized health settings, version 2.0. As part of the Mental Health Gap Action Programme, WHO has developed training manuals (Training of trainers and supervisors training manual and Training of health-care providers training manual) to support implementation of the mhGAP Intervention Guide for mental, neurological and substance use (MNS) disorders in non-specialized health settings, version 2.0. These manuals can be used to build capacity among non-specialist health-care providers in the assessment and management of people with priority MNS conditions in low resource settings.

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Out of the Shadows: Making Mental Health a Global Development Priority is the expected economic, health and social returns from investing in mental health services. Participants will hear how countries of all income levels have successfully scaled up mental health services, often using innovative approaches. Particular focus will be given to the mental health challenges that result from mass migration and sustained conflict, and how they can be overcome. The event aims to kick-start an increase in investments in mental health.

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The mental health Gap Intervention Guide provides guidelines about identification and management of mental disorders by non-specialized mental health providers including in pregnant and postpartum mothers. Maternal mental health is a department of WHO who aim to: 

• Reinforce advocacy and provide global leadership for the mental health of the mothers
• Provide support to the member states on evidence based, cost effective, and human rights oriented mental health and social care services in community-based settings for early identification and management of maternal mental disorders;
• Provide strategies for promotion of psychosocial well-being, prevention and promotion of mental disorders of mothers during pregnancy and after delivery
• Support the integration of the programmes with maternal and child health initiatives, reproductive health programmes and mainstream them with gender sensitive, and equity and human rights oriented strategies of WHO;
• Strengthen information systems, evidence and research relevant to mental health of mothers.

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The WHO Caregiver Skills Training programme is an open-access programme for families of children with developmental delays or disorders, including autism, which could be implemented in low-resource settings by non-specialists. The programme uses a family-centred approach and is designed to be delivered by non specialists (nurses, community-based workers or peer caregivers) as part of a network of health and social services for children and families. The WHO CST consists of nine group sessions and three individual home visits, focused on training the caregiver on how to use everyday play and home activities and routines as opportunities for learning and development. The sessions specifically address communication, engagement, daily living skills, challenging behaviour and caregiver coping strategies.

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The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) is a tool for collecting essential information on the mental health system of a country or region. The goal of collecting this information is to improve mental health systems and to provide a baseline for monitoring the change. Data for WHO-AIMS are collected by a team led by a focal point within the country and are, in most cases, approved by the Ministry of Health. However, since WHO is not directly responsible for the data collection, WHO cannot independently verify the accuracy of any of the data presented in these reports.

Contact Person / Email
funkm@who.int

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The WHO Mental Health Gap Action Programme (mhGAP) aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income. The programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives– even where resources are scarce.

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WHO’s Preventing suicide: a community engagement toolkit is a step-by-step guide for people who would like to initiate suicide prevention activities in their community. It includes advice and practical tools to help with goal setting, stakeholder mapping and development of an action plan as well as details of successful initiatives in Canada, India, Kenya, Nepal, Trinidad and Tobago and the USA.

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