Remember me
PERSONAL REFLECTION
Year : 2023 | Volume
: 21
| Issue : 1 | Page : 70-71
A Brief Reflection on Paper Titled “Mental Health Training of Primary Health Care Workers: Case Reports from Sri Lanka, Pakistan, and Jordan”
Boris Budosan
Consultant Psychiatrist, Vocarsko Naselje 22, 10000 Zagreb, Croatia, EU
Correspondence Address:
MD Boris Budosan
Vocarsko Naselje 22, 10000 Zagreb
Croatia, EU
Source of Support: None, Conflict of Interest: None
DOI: 10.410310.4103/intv.intv_1_23
Reading the paper more than a decade after publishing it in the journal Intervention in 2011 brought back memories of the fieldwork done in Sri Lanka, Pakistan and Jordan. The objective of this paper was to share the lessons learnt about the integration of mental health into primary healthcare in three settings. I remember that already in 2011, I shared the paper with all the relevant stakeholders whom I mentioned in the acknowledgement section of the paper. The feedback from all of them who responded was generally positive. It means that they read the paper and that they were in agreement with its content and findings.
After all these years, I would still support the main findings of the paper. They agree with my current knowledge and past reading experiences, mostly the WHO publications on the integration of mental health into primary healthcare. Namely, mental health training for primary healthcare workers is just one of the factors necessary for the successful integration of mental healthcare into primary healthcare. If I would add anything to this message now, it would definitively be needed for a genuine political will of relevant local actors to integrate mental health into primary healthcare. Although the influx of international actors is often important to start the process, only the genuine political will of local actors can provide sustainable results. The other critical issue that I did not properly address in my paper at that time would be the feasibility of longer-term supervision of nonspecialized healthcare providers by local mental health professionals. It is important to address this issue even before starting the process of integration of mental health into primary healthcare. Finally, today I would also add one important message to this paper and that is the significance of increasing mental health awareness of the local population in order to provide the necessary balance between the demand and supply of mental health services.
It is somewhat difficult for me to tell how this paper influenced the integration of mental health into primary healthcare in Sri Lanka, Pakistan and Jordan at that time. Actually, my article left me with the main question on further development and sustainability of integration of mental health into the primary healthcare system in these countries. To address this question, I would like to provide some feedback from the relevant mental health professionals with whom I remained in contact until today.
The feedback from Sri Lanka revealed that the programs in the districts of Kalmunai and Hambantota were effective as demonstration projects linked to discussions and plans on broader mental health reform in this country (Dr. M.J. Nowfel−personal communication). I published the details on the follow-up of these two programs in the journal Intervention in 2020, in the paper titled “Three models of scaling up mental healthcare post-disaster: common challenges” (Budosan et al., 2020).
According to the former Mental Health Coordinator of the International Medical Corps in Jordan, the mental health training for primary healthcare doctors in Jordan not only increased their knowledge and skills but also developed their awareness of mental health problems (Dr. J.J. Paniculam, personal communication). However, he emphasized that the development and delivery of a comprehensive training package have to be a long-term project to ensure the sustainability of the integration of mental health into primary healthcare services in this country.
In Pakistan, the majority of government-based primary healthcare doctors in the district of Mansehra received mental healthcare training to begin to integrate mental health into their practices. However, what was missing later was the political will of the government to continue the process that resulted in poor implementation of mental health services in the primary healthcare setting (Dr. Mohammad Irfan, personal communication).
In conclusion, I would say that the main findings from this paper remain relevant until today. Still, after having more experience with the integration of mental health into primary healthcare now, I realize how this is a complex process, and how it is essential to address some other critical factors to make it successful and sustainable in a long term.
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