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Putting Implementor Know-How Center Stage for the Delivery of Results in Mental Health

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In recent years, growing interest and awareness has resulted in global mental health finally stepping out of the narrow field of psychiatry and beginning to occupy space in public health discourse. Indeed the WHO launched the Mental Health Program (mhGAP) specifically to acknowledge and respond to the treatment gap -- as high as 85 percent in developing countries -- by galvanizing actors to identify, implement and scale up solutions in accessible community mental health.

Addressing this treatment gap clearly requires investment. Indeed, a small number of funders, including DFID and the European Commission, have shown willingness to invest in the implementation of mental health service delivery, providing a rich source of data and evidence, and in doing so, validating models of delivery that really work.

Yet when it comes to investing in global mental health, the majority of the big players have largely constrained their scope to research. Such funding typically supports a consortia of researchers and teams from different countries, often a mix of low, middle and high income countries, including key government personnel from the Ministries of Health. Such research certainly plays a valuable role in testing how integrating evidence based interventions (treatment) for different conditions (such as schizophrenia, depression) into primary health care systems can work. Indeed, BasicNeeds is a member of two such research groups, PRIME and EMERALD.

The challenge, however, is translating such findings into the "real world" delivery of services. What do these findings mean for the wide-scale implementation of affordable, sustainable services? Do these findings look beyond the medical intervention to take account of the impact of poverty and social pressures on the uptake of services and the subsequent recovery (or relapse) of affected individuals?

Indeed, World Bank President Jim Yong Kim, has called for the development of a "science of delivery" -- similar to what some are now referring to as "implementation science" -- which recognizes the experience and insight of "implementors" as a route through which to generate real-world solutions which will actually deliver results where paper-based policies have not translated into practice. Development implementors, he outlines, "test solutions, observe the results, make corrections, test again... In most cases where countries and partners achieve good development outcomes, it's actually this tacit implementor know-how that is driving the success."

BasicNeeds, by virtue of having developed, tested, adapted and scaled its Model for Mental Health and Development over a period of 13 years across 12 low- and middle-income countries, has developed significant implementor know-how. The Model is a community-based holistic model which acknowledges peoples' multi-dimensional lives. For example, we know that a person who is living in poverty is unlikely to adhere to a treatment regime and achieve a sustainable recovery if the health intervention is not coupled with access to peer support (self-help groups) and livelihoods opportunities (which provide an individual with a sense of purpose as well as the income to pay for medication, food and other household needs.)

To date, BasicNeeds has reached more than 580,000 people, including people with mental illness and epilepsy, their carers and family members. Last year, through the implementation of the Model for Mental Health and Development, BasicNeeds enabled 94 percent of mentally ill people in the communities it serves to access treatment (of which 70 percent report reduced symptoms). Against the WHO baseline for access to treatment in developing countries of only 15 percent, this constitutes clear evidence of a delivery model that yields results. Further to this, the BasicNeeds Model supported 79 percent of these participants to be able to work, of whom 48 percent are earning an income.

There is a clear need to invest in the capacity of implementors to disseminate learning and share delivery knowledge. It is only through the large-scale replication of proven models that we stand any chance of closing the mental health treatment gap which is growing apace. Innovative multi-sector partnerships which place implementors at the heart of delivery solutions are therefore key to achieving transformative systems change in mental health.

By supporting BasicNeeds through the CrowdRise challenge we can reach out to more people with mental illness and epilepsy who are in need of help.

-- Julia Beart, Head of Business Development and Shoba Raja, Director of Policy and Practice