title: Planning and evaluating mental health services in low- and middle-income countries using theory of change.
abstract: BACKGROUND
  There is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in low-resource settings.
  
  
  OBJECTIVE
  To describe how theory of change (ToC) was used to plan the development and evaluation of MHCPs as part of the PRogramme for Improving Mental health carE (PRIME).
  
  
  METHODS
  ToC development occurred in three stages: (a) development of a cross-country ToC by 15 PRIME consortium members; (b) development of country-specific ToCs in 13 workshops with a median of 15 (interquartile range 13-22) stakeholders per workshop; and (c) review and refinement of the cross-country ToC by 18 PRIME consortium members.
  
  
  RESULTS
  One cross-country and five district ToCs were developed that outlined the steps required to improve outcomes for people with mental disorders in PRIME districts.
  
  
  CONCLUSIONS
  ToC is a valuable participatory method that can be used to develop MHCPs and plan their evaluation.
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK erica.breuer@uct.ac.za.
authors.forename: Erica
authors.initials: E
authors.lastname: Breuer
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: De Silva
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Rahul
authors.initials: R
authors.lastname: Shidaye
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Inge
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: Nakku
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Mark J D
authors.initials: MJ
authors.lastname: Jordans
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.affiliation: Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Mary J. De Silva, BA, MSc, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Rahul Shidaye, MBBS, MD, Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Inge Petersen, BSc, BSc(Hons), MSc, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa; Juliet Nakku, MBChB, MMed, Butabika National Mental Hospital, Kampala, Uganda; Mark J. D. Jordans, MSc, PhD, HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
mesh_terms: D003906:Developing Countries; D006801:Humans; D007182:Income; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D010347:Patient Care Planning / Q000592:standards*; D015397:Program Evaluation / Q000592:standards*