title: Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action programme intervention guide.
abstract: BACKGROUND
  The World Mental Health Surveys conducted by the World Health Organization (WHO) have shown that huge treatment gaps for severe mental disorders exist in both developed and developing countries. This gap is greatest in low and middle income countries (LMICs). Efforts to scale up mental health services in LMICs have to contend with the paucity of mental health professionals and health facilities providing specialist services for mental, neurological and substance use (MNS) disorders. A pragmatic solution is to improve access to care through the facilities that exist closest to the community, via a task-shifting strategy. This study describes a pilot implementation program to integrate mental health services into primary health care in Nigeria.
  
  
  METHODS
  The program was implemented over 18 months in 8 selected local government areas (LGAs) in Osun state of Nigeria, using the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), which had been contextualized for the local setting. A well supervised cascade training model was utilized, with Master Trainers providing training for the Facilitators, who in turn conducted several rounds of training for front-line primary health care workers. The first set of trainings by the Facilitators was supervised and mentored by the Master Trainers and refresher trainings were provided after 9 months.
  
  
  RESULTS
  A total of 198 primary care workers, from 68 primary care clinics, drawn from 8 LGAs with a combined population of 966,714 were trained in the detection and management of four MNS conditions: moderate to severe major depression, psychosis, epilepsy, and alcohol use disorders, using the mhGAP-IG. Following training, there was a marked improvement in the knowledge and skills of the health workers and there was also a significant increase in the numbers of persons identified and treated for MNS disorders, and in the number of referrals. Even though substantial retention of gained knowledge was observed nine months after the initial training, some level of decay had occurred supporting the need for a refresher training.
  
  
  CONCLUSIONS
  It is feasible to scale up mental health services in primary care settings in Nigeria, using the mhGAP-IG and a well-supervised cascade-training model. This format of training is pragmatic, cost-effective and holds promise, especially in settings where there are few specialists.
authors.affiliation: WHO Collaborating Centre for Research and Training in Mental Health and Neuroscience, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria. ogureje@comui.edu.ng.
authors.forename: Oye
authors.initials: O
authors.lastname: Gureje
authors.affiliation: Department of Psychiatry, University of Ibadan, Nigeria, Ibadan, Nigeria. jfutprints@yahoo.com.
authors.forename: Jibril
authors.initials: J
authors.lastname: Abdulmalik
authors.affiliation: World Health Organization, Nigeria Country Office, Osogbo, Nigeria. lola_kola2004@yahoo.com.
authors.forename: Lola
authors.initials: L
authors.lastname: Kola
authors.affiliation: Nigeria Country Office, World Health Organization, Abuja, Nigeria. musaem@who.int.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Musa
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. yasamym@who.int.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Yasamy
authors.affiliation: Department of Psychiatry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria. kiskyboy@yahoo.com.
authors.forename: Kazeem
authors.initials: K
authors.lastname: Adebayo
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D003865:Major Depressive Disorder / Q000191:economics; D003906:Developing Countries; D005260:Female; D006282:Health Personnel / Q000191:economics; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D009549:Nigeria; D010865:Pilot Projects; D011203:Poverty / Q000191:economics; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000191:economics; D019966:Substance-Related Disorders