PRIME

Programme for Improving Mental Health Care
A Research Programme Consortium for integration of mental health in primary care

Brief
PRIME aims to generate knowledge which can be used to improve access to care for priority mental disorders (depression, alcohol abuse and psychoses) in primary and maternal health care contexts in low resource settings.

PRIME will be implemented in selected communities in five countries: Ethiopia, India, South Africa, Uganda and Nepal. In India, the program will be carried out in Madhya Pradesh, in a collaboration involving Sangath, Indian Institute of Public Health – Hyderabad and the Government of Madhya Pradesh.

The India programme will be implemented in close collaboration with all the other countries, and in particular with our collaborators in Nepal.

Objectives:
PRIME will achieve its purpose by addressing its objectives in three overlapping phases:

  1. In the Inception phase (Year 1) we will develop an integrated mental health care plan comprising packages of mental health care for delivery in primary health care and maternal health care.
  2. In the Implementation phase (Years 2-4) we will evaluate the feasibility, acceptability and impact of the packages of care in primary health care and maternal health care.
  3. In the Scaling Up phase (Years 5-6) we will evaluate the scaling up of these packages of care at the level of districts.

Overview
A situation analysis report is being finalised alongside on-going formative research work. The team is analysing data from interviews and focus group discussions, and conducting framework analyses. A revised mental healthcare plan and packages were presented to a senior PRIME team.

The team has completed data collection under a community-level detection survey and has begun pilot implementation of mental health care plan packages in the district’s Bilkisganj community health centre and Bamulya primary health centre. Accredited Social Health Activists (ASHAs), medical officers and paramedical staff are receiving pilot training, while the team also conducts community mobilisation programmes and sensitisation workshops.

During the first year, PRIME involved three related activities to define the integrated mental health care plan. Synthesis of evidence and systematic reviews determined which are the most feasible, acceptable and cost-effective components of mental health care, and the optimal ways in which these can be delivered within primary health care.

Formative studies with decision makers helped select components considered to be the most feasible, acceptable and affordable for scaling up. Modeling the components of packages of mental health care were used to design an integrated mental health care plan.

Expected impact
Over the six years, we anticipate the following key outcomes of PRIME.

  • Increased acknowledgement and uptake of knowledge generated by PRIME to influence policy and practice not only in the five countries, but also by other developing countries and international development agencies and donors to support actions to improve access to primary and maternal mental health care
  • Improved mental health, social and economic outcomes for the populations in which the PRIME programme will be carried out and in other populations in which mental health services have been strengthened, based on the outputs generated by PRIME
  • Sustainable capacity in the institutions in the participating countries to develop, undertake, and disseminate the mental health services research to implement and scale up mental health services
  • Sustainable partnerships for future collaborations between the international partners and, in each country, between academic partners, MoH and non-governmental organisations (NGOs)

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