Table 5.

Overview of mental healthcare plans, delivery process, prime role, barriers and facilitators

MHCP component, delivery process	PRIME support process	Barriers	Facilitating factors
Health organisation level
Engagement and advocacy
Mental health experts, policymakers, PHC workers and patients were involved in development of the MHCP	Organising workshops and consultative meeting with concerned stakeholders, and logistics management	No mental health focal person/unit in the MoH Mental health was lower in priority in the government system No separate budget allocated for mental health	Appointment of a senior-level MoH officer as a focal person to coordinate PRIME activities Involvement of MoH in the implementation process Implementation of the evidence-based intervention packages
Referral for specialist consultation
Trained health workers referred difficult cases or those requiring specialists care to psychiatric ward in the district hospital	Encourage health workers to refer difficult cases to the specialists Establish formal collaboration between PRIME and district hospital	Busy schedule of psychiatrists because of high client flow Medicines provided by the psychiatrist did not match with the medicines available in the PHC facilities	Availability of specialist mental health services in the district hospital Supportive role of psychiatrists from the district hospital
Health facility level
Service providers awareness raising and stigma reduction
Both psychiatrist and psychologists delivered the training Sufficient time was allocated to discuss stigma and basic information about mental illness	Conducting of training programmes Logistics management for the training	Logistics for the training (daily allowance etc.) Frequent transfer of trained health workers Mental health stigma among PHC workers	Motivation of health workers to learn about mental health Supportive role from MoH and DPHO
Screening and assessment
Health workers were trained on WHO mhGAP intervention guides Sufficient time was allocated for role-play and practice sessions	Conduction and logistics management for the training Protocol and guidelines development Clinical supervision	Lack of confidential place for assessment and consultation in the health facilities Lack of sufficient time provided by health workers for assessment because of heavy client flow Frequent transfer of trained health workers	Easy and user-friendly flow chart in the mhGAP Intervention Guide Motivation of health workers to learn about mental health Supportive role of psychiatrists to provide phone supervision to the trained health workers
Basic psychosocial support
Psychologists/clinical supervisors conducted 4 days training on communication skills and basic psychosocial support to both prescribers and non-prescribers Sufficient role-plays and practice session were conducted	Conducting and logistics management for the training Protocol and guidelines development Clinical supervision	Prescriber-level health workers did not have much time to provide psychosocial support No separate rooms/space for providing basic psychosocial support	Motivation of health workers to learn about mental health Health workers considered psychosocial component as an important element in mental healthcare
Focus psychosocial support
Non-prescribers received 5-days training on healthy activity programme and counselling for alcohol problems Received monthly/quarterly supervision from psychosocial counsellors	Conducting of training and logistics management Protocol and guidelines development Clinical supervision	No separate rooms for psychological intervention in the health facilities Lack of coordination between prescribers and non-prescribers	Motivation of health workers to learn about mental health Health workers considered psychosocial component as an important element in mental healthcare
Psychotropic treatment
Initially PRIME procured and distributed of the medicines After necessary revision in the essential drugs list, medicines were distributed by DPHO through the existing system	Financial support for drugs Distribution and record-keeping Monitored stock register and buffer stock	Lengthy procurement process and distribution system Frequent transfer of senior-level officers in the MoH and DPHO	Supportive role of DPHO memorandum of understanding with MoH Primary Health Care Revitalization Division facilitated the process
Community level
Mass community sensitisation
FCHVs and community counsellors conducted 2–3 h sensitisation programmes in the community Posters, leaflets and brochures were distributed	Logistics management Supervision of FCHVs	Huge stigma associated with mental illness Low mental health literacy Myths and misconception on mental illness Cultural beliefs and practices	Supportive role of community members Motivation of community members to learn about mental health
Community detection
Two days training for FCHVs on CIDT Monthly/quarterly supervision	Training and supervision	Difficult to use CIDT by illiterate FCHVs Incentives for FCHVs	Motivation of FCHVs FCHVs as a part of the existing healthcare system Knowledge of FCHVs about the community
Advanced psychosocial counselling
PHC workers referred cases requiring psychological intervention to community counsellors Community counsellors visited respective health facilities or patient's house for delivering services	Training and supervision of community counsellors Salary and other logistics management for community counsellors	No separate rooms for counselling in most of the health facilities Stigma associated with mental illness to provide services in the community	Locally hired counsellors Support from trained PHC workers
Home-based care (HBC)
FCHVs received 2-day training on HBC Supervision of FCHVs by community counsellors	Training and supervision of FCHVs Logistics management for training and supervision	No/low incentives for FCHVs Low literacy level of FCHVs	Motivation of FCHVs FCHVs as a part of the existing healthcare system

MHCP, mental healthcare plan; PRIME, PRogramme for Improving Mental Health carE; PHC, primary healthcare; MoH, Ministry of Health; DPHO, district public health office; WHO, World Health Organization, Geneva; mhGAP, Mental Health Gap Action Programme; FCHV, female community health volunteers; CIDT, Community Informant Detection Tool.