Reducing stigma among healthcare providers to improve mental health services (RESHAPE)

项目概要/摘要 全球精神疾病负担与患者人数之间仍然存在重大差距 接受适当的治疗。为了解决低收入和中等收入国家的这一差距，一项关键战略是 使用初级保健卫生工作者来检测和提供精神疾病护理。世界卫生 该组织制定了心理健康差距行动计划（mhGAP），以培训初级保健工作者 检测精神疾病并提供有证据支持的治疗。然而，迄今为止的研究表明， mhGAP的实施策略是不充分的，如低检出率所证明的， 研究表明，在培训后发现精神疾病的人不到10%。一 在初级保健中有效实施检测的潜在障碍是初级保健工作者的耻辱感 对精神病患者的歧视我们的初步工作表明，减少初级保健工作者的耻辱感， 对精神病患者进行心理健康检查可能会提高对精神病的准确检测。我们开发了一个版本 mhGAP培训包括减少污名化的组成部分：“减少健康护理人员中的污名化 ProvidErs”（RESHAPE）。在RESHAPE中，患有精神疾病的人（即，心理健康服务使用者） 接受培训，分享康复故事，进行神话破灭会议，并促进心理健康宣传。我们 RESHAPE的初步研究表明，心理健康服务使用者参与培训初级 护理工作者减少了耻辱感，减少耻辱感可能会改善对精神疾病的检测。我们 建议在尼泊尔进行一项混合实施-有效性（3型）群集随机对照试验 比较mhGAP标准实施与RESHAPE实施策略。目标条件 将是抑郁症，广泛性焦虑症，精神障碍和酒精使用障碍。在目标1中，我们 评估RESHAPE服务用户参与对初级保健工作者污名化的影响。在Aim中 2、我们将评估RESHAPE培训对服务准确覆盖的影响（即，检测）和 评估污名作为准确性差异的中介。基于相同的理论方法， 在我们的初步研究中，我们将为目标3开展能力建设活动，以促进 服务使用者更多地参与研究。我们还将讨论开展反性别的活动- 心理健康研究职业中的相关污名。这些目标的成功实现将有助于 NIMH战略计划采用实施科学，以最大限度地提高研究和 涉及服务用户。这项研究推进了福格蒂国际中心的使命的实施 科学和致力于减少基于证据的污名化。我们将通过减少机构性支出， 研究中的性别平等障碍。这些研究结果将揭示服务使用者的潜在作用， 改善初级保健机构精神疾病筛查方案的实施和准确性。

PROJECT SUMMARY/ABSTRACT There continues to be a major gap between the global burden of mental illness and the number of patients receiving adequate treatment. To address this gap in low- and middle-income countries, a key strategy has been the use of primary care health workers to detect and deliver of care for mental illness. The World Health Organization has developed the mental health Gap Action Programme (mhGAP) to train primary care workers to detect mental illness and deliver evidence-supported treatment. However, research to date suggests that implementation strategies for mhGAP are inadequate as evidenced by low detection rates, with multiple studies demonstrating post-training detection at fewer than 10% of persons with mental illness detected. A potential barrier to effective implementation of detection in primary care is stigma among primary care workers against persons with mental illness. Our preliminary work suggests that reducing primary care workers' stigma against persons with mental illness may improve accurate detection of mental illness. We developed a version of mhGAP training that includes a stigma reduction component: “REducing Stigma among HealthcAre ProvidErs” (RESHAPE). In RESHAPE, persons with mental illness (i.e., mental health service users) are trained to share recovery stories, conduct myth-busting sessions, and promote mental health advocacy. Our preliminary studies of RESHAPE suggest that involvement of mental health service users in training primary care workers reduces stigma, and that stigma reduction may mediate improved detection of mental illness. We are proposing a hybrid implementation-effectiveness (Type-3) cluster randomized controlled trial in Nepal comparing mhGAP standard implementation with the RESHAPE implementation strategy. Target conditions will be depression, generalized anxiety, psychotic disorders, and alcohol use disorder. In Aim 1, we will evaluate the impact of the RESHAPE service user engagement on stigma among primary care workers. In Aim 2, we will evaluate the impact of the RESHAPE training on accurate reach of services (i.e., detection) and evaluate stigma as a mediator of differences in accuracy. Building on the same theoretical approaches to stigma in our primary research study, for Aim 3 we will conduct capacity building activities with to promote greater involvement of service users in research. We will also address conduct activities to counter gender- related stigma in mental health research careers. Successful completion of these aims will contribute to the NIMH Strategic Plan employing implementation science to maximize the public health impact of research and involve service users. This research advances the Fogarty International Center's mission for implementation science and commitment to evidence-based stigma reduction. We will build capacity by reducing institutional barriers to gender equity in research. These findings will shed light on the potential role of service users to improve implementation and accuracy of mental illness screening programs in primary care settings.