Optimizing Provider Attitudes and Competence in Learning Mental Health Systems

医疗保健提供者对精神病患者的污名化造成了缺乏循证护理、在开始护理之前精神病患者长期得不到治疗以及精神病患者缺乏适当的医疗保健。卫生系统内的结构性成见使这一问题更加严重，具体表现为政策和做法未能满足对精神卫生预算、对初级保健提供者的精神病监督以及安全和有效护理的有形基础设施的需求。我们提出的研究的目的是解决开发干预方案的迫切需要，以解决供应商的耻辱和结构性耻辱，重点是精神障碍。在低收入和中等收入国家（LMIC）进行这项研究的理由是，这些地区最缺乏循证服务，并且缺乏关于如何以改善低资源环境中患者临床结局的方式减少污名的研究。我们的目标是开发一个干预包优化提供者的态度和能力学习心理健康系统（OPAL）。利用解决提供者污名化问题的证据基础，OPAL将包括促进提供者与精神病患者之间的社会接触。对于结构性污名，学习卫生系统将作为一种模式，以改善态度和临床护理，通过病人参与服务设计，增强供应商获得系统数据，并促进团队为基础的卫生系统管理。为了实现开发OPAL一揽子计划以减少供应商和结构性污名化的目标，我们将实现三个目标：（1）通过定性研究制定干预一揽子计划草案，包括对一揽子计划的利益相关者分析和对消费者培训员的试点培训，（2）调整和制定评估一揽子计划的措施，以及（3）加强LMIC的实施科学能力。这项拟议的研究将在埃塞俄比亚和尼泊尔进行。这些非洲和亚洲的环境满足了中低收入国家的心理健康服务需求，并正在通过中低收入国家新兴心理健康系统和改善心理健康护理方案参与实施研究，该方案采用了世界卫生组织（世卫组织）的心理健康全球行动计划（mhGAP）。成功完成我们的研究目标的影响将是（1）可以添加到mhGAP并由WHO试点的干预包，以及（2）申请资金进行有效性试验的干预内容和措施，以评估改善提供者的态度和能力，作为改善患者结局的机制。

Stigma against persons with mental illness by health care providers contributes to lack of delivery of evidence- based care, long duration of untreated mental illness before initiation of care, and lack of appropriate medical care for persons with mental illness. This is compounded by structural stigma within health systems, which is exemplified by policies and practices that fail to meet needs for mental health budgets, psychiatric supervision of primary care providers, and physical infrastructure for safe and effective care. The purpose of our proposed research is to address the vital need for development of intervention packages to address provider stigma and structural stigma, with a focus on psychotic disorders. The rationale for conducting this study in low-and-middle income countries (LMIC) is because these regions demonstrate the greatest dearth of evidence-based services, and there is a lack of research on how to reduce stigma in a manner that improves patient clinical outcomes in low resource settings. Our goal is to develop an intervention package for Optimizing Provider Attitudes and competence in Learning mental health systems (OPAL). Drawing on the evidence base for addressing provider stigma, OPAL will include facilitated social contact between providers and persons with mental illness. For structural stigma, learning health systems will serve as a model to improve attitudes and clinical care through patient engagement in service design, enhanced provider access to systems data, and promotion of team-based health system administration. To accomplish the objective of developing the OPAL package to reduce provider and structural stigma, we will undertake three aims: (1) develop a draft intervention package through qualitative research including a stakeholder analysis of the package and a pilot training of trainers for consumers, (2) adapt and develop measures to evaluate the package, and (3) strengthen capacity for implementation science in LMIC. This proposed research will take place in Ethiopia and Nepal. These African and Asian settings exemplify LMIC mental health service needs and are participating in implementation research through Emerging Mental Health Systems in Low and Middle Income Countries (EMERALD) and Programme for Improved Mental Health Care (PRIME), which employ the World Health Organization’s (WHO) mental health Global Action Programme (mhGAP). The impact of successful completion of our research aims will be (1) an intervention package that can be added to mhGAP and piloted by WHO, and (2) intervention content and measures to apply for funding to conduct effectiveness trials to evaluate improving provider attitudes and competence as mechanisms to improve patient outcomes.