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This article is being prepared as an assignment for Megan Lyster's Fall 2012 Social Entrepreneurship class.

The Mental Health Gap Action Program (mhGAP) is a programme administered by the World Health Organization created to address global mental health needs. The program was launched in 2008 with the aims of scaling up services for mental, neurological and substance use disorders for countries especially with low and middle income.

History, Purpose, and Objective
On October 9th, 2008, the World Health Organization launched a new mental health needs program called the Mental Health Gap Action Programme. The WHO identified a treatment gap among low income countries mental health needs and the mental health services currently provided. Mental Health Gap Action Programme’s purpose is to implement evidence-based interventions for issues such as depression, epilepsy, schizophrenia, and substance use disorders. “While 14% of the global burden of disease is attributed to these disorders, most of the people affected - 75% in many low-income countries - do not have access to the treatment they need.” This programme was created to address a lack of mental health resources in low- and middle-income countries across the world.

The Mental Health Gap Action Programme states its objectives as: “To reinforce the commitment of governments, international organizations, and other stakeholders to increase the allocation of financial and human resources for care of MNS disorders. To achieve much higher coverage with key interventions in the countries with low and lower middle incomes that have a large proportion of the global burden of MNS disorders.”

Intervention Guide
One of mhGAP’s largest initiatives was to create and disseminate a comprehensive guide for mental health professionals around the world. The mhGAP intervention guide has been created through the collaboration of over 150 professionals, associations, and organizations in the field of mental health care. In 2010, mhGAP published a one-hundred page, “Intervention Guide for mental, neurological, and substance use disorders in non-specialized health settings.” The guide is meant to be a tool for implementing mental health treatments in areas without many resources or specialists in mental health care. The guide was created to be a simple tool to assist healthcare professionals in the detection, diagnosis, and treatment of the most prevalent neurological and substance use disorders. The intervention guide was created based off evidence-based recommendations with a focus on psychosocial-based interventions.The guide was created in accordance with current scientific and epidemiological research and aims to provide a template that can be adapted on a specific communities needs. The guide is currently available in English, French, and Spanish, with plans to release versions in Arabic, Chinese, Russian, Greek, Indonesian, Japanese, Portuguese and Thai. WHO also launched a training package to be used alongside the mhGAP intervention guide. The training package has been piloted in Panama, Honduras, Nigeria, Lebanon, Libya, Ethiopia and Jordan. The training package is constructed in two stage parts, one being the Base Course which comprises thirty five hours of training on priority motor neuron diseases (MNS.) The second stage, which is currently under development, would offer a more thorough and intensive training on a larger array of mental health issues.

Evidence Resource Center
The Evidence Resource Center aims to make all the necessary background material, process documents, evidence profiles and recommendations available online to anyone who needs it. The idea is to provide as much evidence based clinical and non-clinical information to anyone in the field of mental health around the globe. This information will hopefully help in planning, setting up policy, and in the treatment of individuals. The WHO tries to search for the best possible evidence, looked at from a multicultural angle by many specialists. The information is focused on the priority conditions. “The priority conditions identified by mhGAP are depression, psychosis and bipolar disorders, suicide prevention, epilepsy, dementia, disorders due to use of alcohol and substance use and mental disorders in children and adolescents.”

Training Courses
MhGAP works with all levels of institutions to initiate a successful mental health care infrastructure including policy makers, healthcare providers, and stakeholders.

Uganda
In June 2012, the Mental Health Gap Action Programme initiated a three year programme in Uganda to support and train medical professionals in non-specialized health care settings. The mhGAP programme is run through Uganda’s Ministry of Health and various NGO’s. The project is being funded by World Vision Australia alongside collaboration with World Health Organization and World Vision Uganda.

Panama
mhGAP launched projects in San Miguelito and Colon, Panama, working alongside Panama’s Ministry of Health. Primary health care doctors were trained specifically in identifying and treating epilepsy and depression. According to Dr. Yarida Boyd, the Director of Panama’s National Institute of Mental Health, these are the most common mental and neurological conditions that appear in primary care settings in Panama. Additionally, Panama’s Ministry of Health and mhGAP have worked to edit the Intervention Guide for local needs and hope to include it in training programmes.

Jordan
In February 2011, mhGAP held its first training session in Jordan. The five-day workshop located in Amman, Jordan, was intended to help health workers in Jordan to become familiar with the Intervention Guide and to develop skills needed to adopt it in clinical practice. This included training on the recognition and treatment of developmental disorders, depression, self-harm, suicide, and more. The training included multiple methods, including quiz games role plays, which participants said helped the training feel more real and useful

Disorders with Protocols
MhGAP aims to treat depression, bipolar disorders, epilepsy, developmental and behavioral disorders in children and adolescents, dementia, alcohol and drug use disorders, self-harm/suicide, as well as other serious mental conditions.

Joint Partners
Along with WHO, the Delegation of the European Union to Ethiopia, the Fondation d’Harcourt, The European Commission (EC), Universidad Autónoma de Madrid, Spain and the Ministries of Health of Ethiopia and Nigeria partnered to implement mhGAP in Ethiopia and Nigeria. The objective of this program is simply stated on the mhGAP website as “Expanding services for mental, neurological and substance use disorders in selected districts of Ethiopia and Nigeria.”

Part of this project has included adapting the Intervention Guide based on the local needs in Ethiopia. Additionally, mhGAP hopes to work with Ethiopian medical schools in order to ensure mental health training for all medical students, as well as to create a network for sharing experiences and resources among these medical schools.

In Nigeria, this project’s goals include integrating mental health into primary health care. This includes, with supervision and support from specialists, training non-specialized health staff in recognizing various mental health issues.

The Programme for Improving Mental Health Care (PRIME)
Prime is a Research Programme Consortium (RPC) that has partnered with WHO and mgGAP and is using a few primary countries as a study to create world-class research evidence to implement and scale up mental health treatment around the world, specifically in primary and maternal health care in low resource settings. The program is funded by the UK government’s Department for International Development (DFID), and is led by the Centre for Public Mental Health at the University of Cape Town in South Africa.

This six-year program brings together multiple research institutions and ministries of health in Ethiopia, India, Nepal, South Africa and Uganda.

“PRIME aims to improve the coverage of treatment for priority mental disorders by implementing and evaluating the WHO's mental health Gap Action Programme (mhGAP) guidelines.”

Other partners include CBM, The Fondazione St. Camille de Lellis in Switzerland, BasicNeeds, and Cittadinanza ONLUS.