Advancing the 5×5 approach to NCDs: including mental health in primary care

A drama activity during the training

PCI recently carried out a training of trainers on mental health care to Libyan doctors as part of a broader DfID-funded/WHO led project on primary care.

There has long been a push to include mental health care as part of Non-Communicable Disease (NCD) care provided at primary care level. At the UN High Level Meeting on NCDs last year, mental health conditions were finally officially recognised as one of the five components of the UN’s new ‘5-by-5’ approach to NCDs. This reflects the increased demand we at PCI have been seeing on building capacity to address this at primary care level and although we have often included elements of mental health in our work on NCDs, we are now looking at the issue in a more focused way. Hear from Senior Clinical Advisor Dr Mamsallah Faal-Omisore on PCI’s first training specifically dedicated to mental health.

“From the training we did in Tunis we wanted to have a cohort of primary care doctors confident and able to cascade knowledge and skills in primary mental health care to their colleagues. We also, just as importantly, wanted to support discussion around, and agreement between, the participants on what aspects of mental health care can and should be provided in primary care, and when referral is necessary.

The training covered diagnosis and management of common mental health conditions encountered in primary care. Case scenarios were used to strengthen knowledge, introduce the use of some validated patient assessment tools, adapt guidance to the Libyan context and agree referral criteria. Participants also practised communication skills through role play. Family, social, spiritual and cultural issues in mental health were explored in small group discussions and during the preparation and acting out of three dramas.

The majority of the participants were doctors working in primary health care centres in the project’s pilot sites. There were also two specialist psychiatrists, Family Physician specialists from the Libyan Board from Tripoli and Ministry of Health staff. Having this mix of participants was useful for understanding how mental health can be delivered in practice.

A recurring theme in discussions was how mental health issues are like looking at an iceberg: unusual behaviour is what is seen on the surface of the water, and the task of the physician is to gradually find out about the patient’s hidden thoughts and feelings.

The feedback on the training was very positive and it was noted that most of the attendees who worked in primary care had had very little mental health training. There is clear demand for mental health training at primary care level.

‘What this workshop has taught me is that as a psychiatrist I am always focusing narrowly on diagnosis and then treatment – but you Family Medicine doctors have a much wider perspective on what is happening to the patient and the family.’

At the end of the workshop, it was agreed that the participants would organise cascade training in all of the pilot sites.  The PCI team aim to provide remote mentoring (though skype, email and Viber) as the newly trained Libyan facilitators in turn train their colleagues.

As myself and colleagues considered the learning and next steps from this training we were reminded of why we are doing this by one of the participants: ‘When I am asked what specific areas in my work will improve as a result of this training, I think maybe it is not an ‘area’ that will improve but rather I hope people will improve’.”