. 2016 Jan;208 Suppl 56(Suppl 56):s55-62.

doi: 10.1192/bjp.bp.114.153841. Epub 2015 Oct 7.

Planning and evaluating mental health services in low- and middle-income countries using theory of change

Erica Breuer¹, Mary J De Silva², Rahul Shidaye², Inge Petersen², Juliet Nakku², Mark J D Jordans², Abebaw Fekadu², Crick Lund²

Affiliations

¹ 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.
² 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.

PMID: 26447178
PMCID: PMC4698557
DOI: 10.1192/bjp.bp.114.153841

Planning and evaluating mental health services in low- and middle-income countries using theory of change

Erica Breuer et al. Br J Psychiatry. 2016 Jan.

. 2016 Jan;208 Suppl 56(Suppl 56):s55-62.

doi: 10.1192/bjp.bp.114.153841. Epub 2015 Oct 7.

Authors

Erica Breuer¹, Mary J De Silva², Rahul Shidaye², Inge Petersen², Juliet Nakku², Mark J D Jordans², Abebaw Fekadu², Crick Lund²

Affiliations

¹ 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.
² 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.

PMID: 26447178
PMCID: PMC4698557
DOI: 10.1192/bjp.bp.114.153841

Abstract

Background: There is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in low-resource settings.

Aims: 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).

Method: 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.

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Conflict of interest statement

Declaration of interest

None.

Figures

**Fig. 1**
The PRogramme for Improving Mental health carE (PRIME) cross-country summary theory of change (ToC). *Example indicators for the summary TOC are outlined in Table 3 and Table 4. MHCP, mental healthcare plan; MNS, mental, neurological and substance use.

See this image and copyright information in PMC

References

1. Thara R, John S, Chatterjee S. Community mental health teams in low- and middle-income countries. Epidemiol Psychiatr Sci 2014; 23: 119–22. - PMC - PubMed
1. Saraceno B, Van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, et al. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 2007; 370: 1164–74. - PubMed
1. World Health Organization Mental Health Atlas 2011. WHO, 2011.
1. Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet 2011; 378: 1654–63. - PubMed
1. World Health Organization Mental Health Policy, Plans and Programmes. Mental Health Policy and Service Guidance Package. WHO, 2005.

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Planning and evaluating mental health services in low- and middle-income countries using theory of change

Affiliations

Planning and evaluating mental health services in low- and middle-income countries using theory of change

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical