Developing measures to improve access to integrated mental health care services in under-resourced global settings

Mental disorders are the leading cause of morbidity and mortality worldwide. Despite this immense burden, there are significant mental health care access gaps globally. It is necessary to demonstrate acceptance, feasibility, and efficacy of mental health care systems interventions prior to larger scale-up, as well as ongoing measurement to ensure evidence-based, effective, and economically efficient care delivery. Existing mental health care services access measures are limited in their ability to guide allocation of resources and to demonstrate improvements that translate to improved patient- and population- outcomes and reduction in mental health care access gaps. Mental health services evaluation in Peru and other under-resourced settings necessitates locally responsive and feasibly implemented measures that match local resource limitations, in addition to having the capacity to guide both individual- and population-level changes to address care access gaps. These measures are essential for future scale-up of mental health care service models at a national level with a focus on systems-level resource management and allocation. Study Objective: We propose to develop and pilot a mental health services access measurement system using existing data that is locally responsive, appropriate to local resources, and can guide resource distribution within integrated mental health care systems in Peru. Aim 1: Conduct a Community Based Participatory Research focused mixed methods needs assessment to inform access measurement adaptation for integrated mental health care services. Overall project implementation will be systematically guided using Failure Mode and Effects Analysis (FMEA) and Community-Based Participatory Research (CBPR) approaches. A mixed methods needs assessment will be completed with patients and health care providers, administrators, and staff. Aim 2: Adapt existing care access measurement frameworks to an integrated mental health care service model. Aim 1 needs assessment data will be utilized to systematically adapt and integrate two care access frameworks: the HIV Care Cascade and the Collaborative Care Model Population Registry. The adapted measurement system will generate mental health care access score reports for regional administrators to evaluate and guide systems changes and resource allocation. Aim 3: Conduct a pilot feasibility trial to assess the feasibility and acceptability of the adapted access measurement system. Regional health networks will be purposely selected for pilot implementation. Following implementation, a mixed methods needs assessment will be completed with health care providers, administrators, and staff to assess feasibility, acceptability, fidelity, and utility. Relevance to NIMH Mission and public health impact: Meet Goal 4 of the NIMH Strategic Plan through the development of a scalable access measurement system using existing data that can systematically evaluate mental health services impacts and guide resource allocation to reduce care access gaps in integrated mental health care systems in global settings.