Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project.

BACKGROUND: Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems. METHODS: This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use. RESULTS: This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia. NEXT STEPS: This project may inform models of care that can extend to other regions of Latin America or other LMICs.

Technology-based mental healthcare models: A systematic review of the literature.

INTRODUCTION: This systematic review summarises the existing evidence on the implementation of technology-based mental healthcare models in the primary care setting. METHODS: A systematic search was conducted (MEDLINE, Embase, CENTRAL) in August 2019 and studies were selected according to predefined eligibility criteria. The main outcomes were clinical effectiveness, adherence to primary treatment and cost of implementation. SELECTION CRITERIA: Studies with an experimental or quasi-experimental design that evaluated the implementation of technology-based mental healthcare models were included. RESULTS: Five articles met the inclusion criteria. The models included technological devices such as tablets, cellphones and computers, with programs and mobile apps that supported decision-making in the care pathway. These decisions took place at different times, from the universal screening phase to the follow-up of patients with specific conditions. In general, the studies showed a decrease in the reported symptoms. However, there was great heterogeneity in both the health conditions and the outcomes, which hindered a quantitative synthesis. The assessment of risk of bias showed low quality of evidence. CONCLUSION: There is not enough evidence to support the implementation of a technology-based mental healthcare model. High quality studies that focus on implementation and effectiveness outcomes are needed to evaluate the impact of technology-based mental healthcare models in the primary care setting.

Characterizing the perceived stigma towards mental health in the early implementation of an integrated services model in primary care in Colombia. A qualitative analysis.

BACKGROUND: Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma. OBJECTIVES: Characterise the perceived stigma towards mental health among the stakeholders involved in the early implementation of the DIADA project [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)]. Explore whether the implementation of this model can decrease stigma. Describe the impact of the implementation on the lives of patients and medical practice. MATERIALS AND METHODS: Eighteen stakeholders (7 patients, 5 physicians and 6 administrative staff) were interviewed and a secondary data analysis of 24 interview transcripts was conducted using a rapid analysis technique. RESULTS: The main effects of stigma towards mental health disorders included refusing medical attention, ignoring illness, shame and labelling. Half of the stakeholders reported that the implementation of mental health care in primary care could decrease stigma. All of the stakeholders said that the implementation had a positive impact. CONCLUSIONS: The perceived stigma was characterised as social and aesthetic in nature. Communication and awareness about mental health is improving, which could facilitate access to mental health treatment and strengthen the doctor-patient relationship. Culture is important for understanding stigma towards mental health in the population studied.