Mental Health Gap Action Programme: a theoretical model of barriers to implementation by health personnel in Choco, Colombia/Programa de accion para superar las brechas en salud mental: un modelo teorico de las barreras de implementacion desde el personal de salud en Choco, Colombia/Programa de Acao para Reduzir as Lacunas em Saude Mental: modelo teorico das barreiras de implementacao por profissionais de saude de Choco, Colombia

• Published in: Revista panamericana de salud pública 2024-05, Vol.48
• Main Authors: Agudelo-Hernandez, Felipe, Plata-Casas, Laura, Botero, Helena Velez, Vieira, Luz Maria Salazar, Mayorga, Bibian Moreno
• Format: Article
• Language: Spanish
• Subjects: Analysis; Decision-making; Health care reform; Information management; Mental health; Nurses; Primary health care; Psychiatric services; Psychologists; Public health; Substance abuse
• ISSN: 1020-4989
• DOI: 10.26633/RPSP.2024.49

Objectives. Mental, neurological, and substance use (MNS) disorders have a high prevalence In Colombia and there is a treatment gap. The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) has various components. The mhGAP 2.0 Intervention Guide, aimed at improving primary health care, is a guide for the assessment and management of MNS disorders based on clinical decision-making protocols. The objective of this study was to determine the barriers that may hinder the program implementation process. Methods. A qualitative study with content analysis was conducted in three phases: i) study preparation, organization, and presentation; ii) open coding, categorization, and abstraction of contents; and iii) information analysis. The study included semi-structured interviews with 21 people involved in the provision of mental health services in Choco (Colombia): five medical doctors, seven nurses, and three psychologists, as well as six professionals working in the administrative area of the department's health secretariats. The perceptions of these stakeholders were explored. Open-ended questions were asked to explore experiences with the process, as well as the barriers identified in practice. Results. Four different thematic categories were identified: intersectoral action, long-standing challenges, opportunities, and suitability of tools. Conclusions. A theoretical model of barriers to implementation of the mhGAP program was constructed, based on stakeholder perceptions. Controlling barriers is perceived as a possible way to contribute significantly to population health. Keywords Models, theoretical; barriers to access of health services; mental health; primary health care; Colombia. Objetivo. Los trastornos mentales, neurologicos y por consumo de sustancias psicoactivas (MNS) tienen una prevalencia alta y existe una brecha para su atencion en Colombia. El Programa de accion para superar las brechas en salud mental (mhGAP, por su sigla en ingles) de la Organizacion Mundial de la Salud (OMS) tiene varios componentes. Uno de ellos es la Guia de intervencion mhGAP2.0, orientada a la mejora de la atencion primaria en salud; se trata de una guia para la evaluacion y el manejo de trastornos MNS a partir de protocolos de toma de decisiones clinicas. Se planteo como objetivo determinar las barreras que se pueden presentar en el proceso de implementacion del programa. Metodos. Se realizo un estudio cualitativo con enfoque de analisis de contenido