Two randomised control trials on problem management plus reviewed

Rawalpindi
The Institute of Psychiatry and WHO Collaborating Centre for Mental Health, Research and Training at BBH in collaboration with various stakeholders has been working on the ‘task-shifting’ model in mental health to address the issue of treatment gap in a low resource mental health setting in Pakistan.
To bring about an improvement in mental health state within the country, the Institute of Psychiatry (IoP) has been in a long-standing partnership with a consortium of partners and in this background, a three-day meeting to review two randomised control trails on problem management plus (PM+) individual and group intervention was held here at the Institute of Psychiatry last week.
The three-day meeting to Review ‘Cluster Randomised Control Trail to Evaluate the Effectiveness and Cost Effectiveness of Adaptation of Problem Management Plus (PM+) in Swat, Pakistan’ was organised as a joint collaborative initiative among partners including World Health Organization, Institute of Psychiatry, University of Liverpool, University of New South Wales, Human Development Research Foundation, Saidu Teaching Hospital and University of Swat, Department of Psychological Sciences Pakistan.
PM+ is a psychological intervention that aims to provide psychological support for people in communities that are exposed to adversity, such as populations affected by humanitarian crises. The individual version of the intervention focuses on the improvement of individual functioning using the techniques of stress management, behavioural activation and problem solving. The group version of PM+ was designed to help reduce symptoms of emotional distress in women affected by adversity and to empower women to be their own helpers to continue to maintain gains they make in treatment. Workshops for the group version of the PM+ were conducted at the Institute of Psychiatry and the field trial of this psychological intervention was carried out in Swat by local ladies who attended these workshops. The individual version was implemented in Peshawar.
The inaugural session of the three-day meeting held at the IoP was attended by representatives from departments in public health sector and various national and international mental health institutions.
Rawalpindi Medical College Principal and Chief Allied Hospitals Professor Muhammad Umar chaired the inaugural session that was attended by Professor Atif Rahman from University of Liverpool, Dr. Katie Dawson from University of New South Wales, Anna Chiumeto from University of Liverpool, Merit Sijbrandij from University of Amsterdam, Nagendra Luitel from Trans Cultural Psychosocial Organisation, Nepal and Dr. Siham Sikander, Dr. Shamsa Zafar and Dr. Usman Hamdani from Human Development Research Foundation.
In addition, the Swat PM+ Randomized Control Trail (RCT) team participants headed by Dr. Naseem Khan from Khyber Medical College, team from Department of Psychological Sciences at University of Swat, participants from HDRF and IoP also attended the session. Moreover, representatives from the public health departments including District Coordinator Lady Health Worker Programme Dr. Javed Chaudry and representatives from district education department and district health department attended the session.
Head of Institute of Psychiatry Professor Dr. Fareed Minhas delivered a lecture on ‘Bridging the Gap for mental Health services in Pakistan’. He highlighted the barriers to mental health emphasising upon WHO figures that in developing countries like Pakistan, one per cent of the population suffers from severe and 10 per cent from mild mental disorders.
In the background of negligible budgetary mental health allocation, increasing global burden of mental health disorders, provision of limited trained mental health professionals in the country, he stated that there was a dire need to implement WHO mhGAP action programme in the primary care setting all across the country.
He also stressed upon the need to nurture and cement collaborative relations between mental health institutions and the public health sector and lastly to scale up mental health service provision using WHO task shifting model. He gave a brief overview of the collaborative researches being conducted at the Institute with the partners and gave an outline of community mental health program initiatives by the Institute over the years.
Professor Atif Rahman while speaking at the inaugural session acknowledged the support of all collaborative partner institutions and appreciated the efforts of Swat RCT research team on the successful completion of the PM+ feasibility RCT. Furthermore, he lauded the leadership of Dr. Minhas, for providing an enabling environment for collaboration and research in the field of mental health in Pakistan.
Dr. Atif stressed that the only way forward was the collaborative approach between the mental health institutions and the departments of public health sector. Moreover, he stressed upon the need of further expansion of collaborative partnerships between institutions so as to introduce and facilitate capacity building, and bring forth a culture of scientific research at public health departments.
Professor Umar briefly addressed the participants and applauded efforts of all the collaborative partners for all research initiatives in the past. He specifically commended Dr. Atif for embarking on various research initiatives at the grass root level in the community, for engaging local institutions and for facilitating the capacity building of the local personnel.
The public health sector delegates, the deputy district officer health, district education officer and district coordinator LHW programme were invited to share their thoughts.
Following the inaugural session, Dr. Atif chaired the proceedings of the three-day meeting. The proceedings included presentation of findings of PM+ Swat feasibility pilot project. On day two of the meeting, an in depth discussion was held on the preparation of the PM+ group intervention definitive RCT in Swat. Professor and Head Lady Reading Hospital Dr. Saeed Farooq co-chaired the session on the third and final day of the meeting. The Peshawar team presented progress review of the individual PM+ intervention of Peshawar definitive trail. The hallmark of day three was the discussion on shared learning between the two sites.