Table 1: Overview of MhINT Model Provider Roles, Technical Support and Implementation Strategies.

Provider, Roles and MhINT technical support provided
Provider	Role		MhINT technical support including orientation workshops, training and mentorship 1
Mental health coordinator/district mental health task team.	Provide overall coordination, monitoring and evaluation.		District mental health task team supported through two day workshop and mentoring support to undertake a situational analysis that informs a district mental health care plan that is incorporated into district plans.
Psychologist.	Provides training, supervision.		Psychologists orientated and trained through a 4-day workshop in their roles of providing training, supervision and emotional support to PHC level within a task sharing approach.
Registered Psychological Counsellors/ Social.	Training, supervision, and supporting Lay Counsellors.		Orientation and training of registered counsellors or equivalent through a 4-day workshop to train and supervise PHC facility-based non-specialist counsellors.
PHC coordinators & Operational managers	Support mental health integration using Continuous Quality Improvement (CQI)		Two-day training workshop in CQI tools with CQI mentor provided by MhINT providing mentorship for PHC coordinators and facility managers in CQI to support PHC facilities in integration of depression care using CQI.
Facility managers.	Oversee implementation and integration.		Orientation to responsibilities of different role players in collaborative care model through a half-day workshop; Capacitated in CQI for monitoring implementation and data management.
PHC Staff Nurses/ Enrolled Nurses.	Conduct initial mental health screening on the PHC facility population.		As per Department of Health (DoH) guidelines. MhINT did not initially provide technical support
PHC Clinical Nurse Practitioners (CNPs).	Identifies CMDs, provides brief intervention, referral and re-assessment.		Existing facility trainers capacitated through a 3-day workshop to provide onsite sessions orientating CNPs to person-centred care and their role of case managers within the collaborative care model; equipping them with clinical communication skills for person-centered care, use of Adult Primary Care (APC) for treatment and referral of CMDs.
PHC doctors.	Initiate medication, monitor psychotropic medication.		Orientated to collaborative care model, APC and capacitated in mhGAP guidelines through a half-day workshop.
Lay counsellors/Enrolled nurses.	Provide evidence-based counselling (CMDs and adherence).		Oriented to collaborative care model; capacitated in manualised, depression counselling package using problem solving and cognitive behavioural techniques through a 5-day workshop. The training is followed by individual in-vivo supervision and monthly emotional support by the psychological counsellors/social workers
Outreach team leaders (OTL) (PHC Clinical Nurse Practitioners/Enrolled nurses).	Supervision of CHWs; Home visits of difficult cases.		As per DoH guidelines. MhINT did not initia provide technical support
Community Health Workers (CHWs).	Case identification, Psychoeducation; Tracing & linkage to care.		As per DoH guidelines. MhINT did not initia provide technical support
Implementation Strategies
MhINT Strategy	ERIC Strategy	Level	Purpose
Situational analysis	Conduct local needs assessment	System	Inform development of district mental health plan
Train-the-trainer model for building capacity	Use train-the-trainer strategies	Facility	Efficiently train primary care providers
Supportive supervision	Audit and feedback; provide clinical supervision	Provider	Mentor providers, monitor competency, and offer emotional support
Adult Primary Care (APC) decision support tool	Remind clinicians	Provider	Promote nurse-led identification and management of patients with depression and other common mental disorders
Continuous quality improvement	Develop and organize quality monitoring systems	System	Identify implementation bottlenecks and propose solutions through learning collective

¹Details of the MhINT training and orientation workshops can be found in the training and orientation manuals on the Centre for Rural Health (CRH) website www.crh.ukzn.ac.za