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Inception phase (year 1)
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| What are the feasible and acceptable components of mental health care? How can these components be integrated into packages of care? What are the methods for integration of these packages into routine primary health care and maternal health care? |
Synthesis of evidence and systematic reviews; theory of change workshops in each country; formative studies, e.g., semi-structured interviews and focus group discussions, to assess acceptability and feasibility of the packages of care |
Review of interventions that break the cycle of poverty and mental illness in LMICs [29]; draft integrated mental health care plan for routine primary health care and maternal health care in each country; evidence on the acceptability and feasibility of implementing the mental health care plan |
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Implementation phase (years 2–4)
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| What are the costs and impact of delivering the packages of care in routine primary health care and maternal health care settings? What are the health system requirements for scaling up—human resources, training and supervision needs, infrastructure, drugs, budgets—and the incremental cost of increasing coverage, per new patient treated? What is the impact of the integrated mental health care plan on coverage and utilisation of mental health care? How equitable is the distribution of these outcomes? What are the specific barriers that influence access to services for people living in poverty, people with severe mental disorders, and women, particularly during the perinatal period? |
Costing of the components of the care package; repeated facility surveys to assess changes in detection; before–after evaluations of mental health, social, and economic outcomes in cohorts; repeated community surveys to assess changes in coverage and service utilisation |
Evidence on the resources required for implementing the mental health care plan and its impact on health, social, and economic outcomes; knowledge about barriers to equitable access of services for disadvantaged populations and strategies to address these barriers; final intervention guide for each level of health care, for use in primary and maternal health care; evidence about the impact of scaling up on coverage and utilisation of mental health care, as well as the equity of coverage and utilisation |
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Scaling up phase (years 4–6)
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| What is the optimal level of integration of mental health interventions in the existing primary and maternal health care system to ensure effectiveness, sustainability, quality, and coverage of services? What are the drivers and constraints to scaling up, and how can these be addressed? |
Mixed methods case studies at the level of individual districts using document reviews, qualitative methods, and health management information systems data to assess health management and planning for mental health |
Evidence on the optimal level of integration of mental health into primary and maternal health care in a variety of settings, as well as the residual barriers to scaling up and the strategies to address these |
