Project Title

Improving Networks of Community Mental Health Services in the Asia Pacific Economies  

Project Year

2018   

Project Number

HWG 02 2018A 

Project Session

Session 1   

Project Type

Standard 

Project Status

Project in Implementation   
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Project No.

HWG 02 2018A 

Project Title

Improving Networks of Community Mental Health Services in the Asia Pacific Economies       

Project Status

Project in Implementation 

Publication (if any)

 

Fund Account

APEC Support Fund 

Sub-fund

ASF: General Fund 

Project Year

2018 

Project Session

Session 1 

APEC Funding

149,645 

Co-funding Amount

2,240 

Total Project Value

151,885 

Sponsoring Forum

Health Working Group (HWG) 

Topics

Health 

Committee

SOM Steering Committee on Economic and Technical Cooperation (SCE) 

Other Fora Involved

 

Other Non-APEC Stakeholders Involved

 

Proposing Economy(ies)

Peru 

Co-Sponsoring Economies

Australia; Canada; Chile; Japan; Russia; Chinese Taipei; United States 

Expected Start Date

03/09/2018 

Expected Completion Date

30/08/2019 

Project Proponent Name 1

Yuri Cutipe Cardenas 

Job Title 1

Psychiatrist 

Organization 1

Ministry of Health 

Postal Address 1

801 Salaverry Ave, Jesus Maria, Lima, 15072, Peru 

Telephone 1

51-1 3156600  -2660  -2337 

Fax 1

Not Applicable 

Email 1

ycutipe@minsa.gob.pe 

Project Proponent Name 2

Maria Mendoza Vilca 

Job Title 2

Mental Health Nurse 

Organization 2

Ministry of Health 

Postal Address 2

801 Salaverry Ave, Jesus Maria, Lima, 15072, Peru 

Telephone 2

51-1 3156600  -2660  -2337 

Fax 2

Not Applicable 

Email 2

mmendozavi@minsa.gob.pe 

Declaration

Maria Mendoza Vilca 

Project Summary

Mental health problem is one of the growing major public health issues in the Asia Pacific region. The great majority of people suffering from these problems do not have adequate access to mental health care.

Many economies have already developed processes of mental health reform by implementing models of community-based services or care. Although there is consensus on the principles and ingredients to ensure success, challenges and concerns arise about the health outcomes of the community mental health services networks.

The present proposal seeks to foster an exchange of experiences and knowledge transfer in community mental health care through a multi-economy workshop, involving different stakeholders from Asia Pacific economies, and a implementation training for health providers and coordinators of mental health networks.

Relevance

Relevance – Region: Mental health problem is one of the growing major public health issues in the Asia Pacific region. Worldwide, it account for 9 out of the 20 leading causes of years lived with disability and 10% of the global burden, especially in low- and middle-income economies (LMIEs)[1]. The majority of the economies which fall under this category are in the Asia Pacific region. Furthermore, mental health problems hamper the achievement of Sustainable Development Goals, particularly, eradicate extreme poverty and hunger, promote gender equality and empower women, reduce child mortality and improve maternal health. One in five persons are affected by a mental disorder in their lifetime. This prevalence is not homogenous across groups; the economically impoverished are disproportionately affected. In addition, the need and demand for mental health care is increasing as vulnerable populations expand.

Despite the implications of the high mental disorders burden, the great majority of people suffering from these disorders do not have adequate access to care. Nearly, 85% of people with severe mental disorders do not receive treatment1. The primary reasons for not seeking care are the lack of public mental health services in the nearby area, and lack of financial resources. Most LMIE have few mental health human resources available, and those that exist are inadequately trained or are inefficiently distributed within the health system leading to ineffective or inappropriate treatment and a low probability of recovery[2]. Untreated mental disorders frequently lead individuals and families into poverty, predispose to disabilities, exacerbate their marginalization and vulnerability. Because of stigmatization and discrimination, persons with mental disorders often have their human rights violated and many are denied economic, social and cultural rights. Likewise, its projected costs are estimated in $6.0 trillion by 2030[3].

To address this situation, the mental health care reform includes restructuring of mental healthcare services at the primary and secondary care level to conform community mental health services networks. It implies strengthening the role of primary health centres, implementing community mental health centres, units of hospitalization for mentally disorder people at general hospitals, sheltered homes and psychosocial rehabilitation centres[4]. In this field,like others, Peru, Chile and Mexico are Asia-Pacific economies with different experiences. It is important to share these advances and take them as inputs for critical reflection on the achievements made in this area of health by the APEC economies.

In Peru, according to the epidemiological studies one in five Peruvians is affected by a mental disorder. The Peruvian Burden of Disease Study 2012[5] revealed that neuropsychiatric conditions accounted for the highest number of disability-adjusted life years (DALYs) lost with around 1 million years lost out of the total 5.8 million lost to all health conditions. Depression, especially in women, ranked as the second leading cause of disease burden after respiratory tract infections in childhood. Likewise, the burden of alcohol abuse and dependence, schizophrenia, dementia, family violence is also important. The epidemiological studies show that, on average, 20.7% of the population over 12 years of age suffer from some type of mental disorder. Despite, this situation, the great majority of people suffering from these disorders do not have adequate access to care.  Among those, stating a need for mental healthcare, 69% -93% sought no care.[6] [7]  [8]   [9]  For mental health care, it is invested between 1.5% and 2% of the national health budget. Of this amount, around 80% is still destined to psychiatric hospitals.

During 2012, the Peruvian Congress approved Law 29889, to guarantee the rights of people with mental health problems[10]. Since 2015, it is  setting out the community mental health model to restructure psychiatric care and strengthening the first and second level of the healthcare system to expand the availability of programs and services for mental health care economy-wide, including interventions related to the promotion, prevention, rehabilitation and  recovery every citizen. The most important challenges are the achievement of citizen participation in the protection of mental health, the elimination of structural forms of stigma and the introduction of changes in the management paradigm of the health services system to ensure integration and sustainability of community mental health care. In order to face these challenges, the Ministry of Health is implementing the Plan of Strengthening Community Mental Health Services 2018-2021[11].

In Chile, mental problems and disorders are the main source of disease burden in Chile. According to the latest Study on Burden of Disease and Attributable Burden, 23.2% of the years of life lost due to disability or death are determined by neuropsychiatric conditions. In women, unipolar depressive disorders and anxious disorders are among the first five causes of DALYs. In men, alcohol use disorders play a predominant role, along with injuries from traffic and external violence. When considering the risk factors that underlie the various diseases for both sexes, alcohol consumption reaches 12% of the attribution of weight more determinant of the burden of disease, doubling the weight of hypertension and overweight[12].

The implementation of three national plans for mental health and psychiatry during the years 1993, 2000 and 2017[13] has allowed transition from a mental health network centered in four psychiatric hospitals, to a mental health network predominantly aligned to general health and community environments.  The  mental health services  in primary care has been universalized, the specialized ambulatory care is mainly provided in community  Mental Health centers and  hospitalization services is mostly  provided in general hospitals. Psychiatric hospitals have decreased in size and importance. The psychiatric institutionalization in these facilities has been reduced by 80%.The mental health budget is close to 2.3% of the health budget and the percentage allocated to psychiatric hospitals has been reduced to about 25% of the mental health budget. However, important gaps related to budget, service and coverage remain, as well as qualitative gaps with respect to the community care model, highlighting the lack of intersectoral action and disharmonies of national regulations with international human rights standards.

In México mental disorders as a group ranked as the 50 leading cause of DALYs after diabetes and cardiovascular diseases, major depressive disorder was responsible for the highest proportion of mental disorders with 7.02% of DALYs[14].   One in four Mexicans between 18 and 65 years old has suffered at some point in his life a disorder mental, but only one in five of those who suffer receives treatment.  The time patients take to receive, care in a health center ranges from 4 and 20 years depending on the type of condition[15].  Stigma and discrimination suffered by the sick mental illnesses and their families can prevent them from turning to the appropriate health services.[16] Of the health budget, it is only intended about 2% to mental health. In addition, 80% of mental health spending is used to maintain psychiatric hospitals, while it is assigned very little to detection, prevention and rehabilitation.

The Program of Specific Action (PAE) in Mental Health 2013-2018[17] considers among its objectives the strengthening and modernization of psychiatric care services with a community, integral and multidisciplinary approach; the formalization of the specialized network of psychiatric care to achieve greater efficiency; the prevention and education of priority mental disorders and their risk factors. Finally, it is also important the training of researchers and specialists in mental health research and the development of community care models.

Economies in the Asia Pacific region have already developed processes of mental health reform. Although there is consensus on the principles and ingredients to ensure success, challenges and concerns arise about the implementation and management of networks of mental health services. These facts are related to innovation, adequacy, universal health coverage, economic sustainability and outcomes of mental health interventions. In addition, mental health research remains very limited. Therefore, this project proposes cooperation among economies as an effective tool to strengthen, share and accelerate the development of community mental health in the economies of the region. This cooperation aims not only to illustrate best practices in community mental health care, but also to develop the capacities of mental health staff for implementation and management through research and transferring knowledge.

Relevance – Eligibility: The proposed project is linked to the first ECOTECH Priority Themes: "Developing human capital". The cooperation between economies, the exchange of their experiences, research and translation of knowledge related to the implementation of community of mental health networks will contribute to the organizational learning, leadership and commitment of their respective teams to expand their capacity for action, so that they produce satisfactory results in the mental health care of the communities they serve and also in their own professional projects.

In addition, this project is aligned with the funding goals of the APEC Support Fund (ASF), to which we are applying. The ASF aims for member economies to “obtain, share, strengthen, maintain and develop knowledge, abilities, skills and technical know-how to improve their policies and regulations or their institutional structures or processes”. The proposed project is focused on capacity building in community mental health care and the exchange of knowledge and experiences implementing these types of initiatives in different settings through a workshop and training event.

Relevance – Capacity Building: By facilitating cross-border training and skills development, one of the expected outcomes of the proposed workshops is a pool of skilled mental health workers involved to improve implementation of community mental health services, through the exchange and dissemination of knowledge regarding their work in their economies. In addition, we expect to encourage these trained professionals to be more involved in research and use of evidence to better assess the implementation of community mental health practices in their own context.


[1] World Health Organization (WHO). Investing in Mental Health: Evidence for Action. Geneva: WHO; 2013.

[2] Toyama M, Castillo H, Galea JT, Brandt LR, Mendoza M, Herrera V, Mitrani M, Cutipé Y et al. Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services. Int J Health Policy Manag. 2017 Jan 22;6(9):501-508. PubMed PMID: 28949462; PubMed Central PMCID: PMC5582436.

[3] Insel T. Mental Health Awareness Month: By the Numbers. National Institute of Mental Health (NIMH), 2015. Available in https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mental-health-awareness-month-by-the-numbers.shtml

[4] World Health Organization (WHO). The global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the economylevel. Geneva: WHO, 65th World Health Assembly; 2012.

[5] Ministerio de Salud. Carga de enfermedad en el Perú: Estimaciones de los años de vida saludables perdidos 2012. Lima: Dirección General de Epidemiología Ministerio de Salud. 2014.

[6]   Instituto Especializado de Salud Mental “Honorio Delgado – Hideyo Noguchi” Estudio Epidemiológico de Salud Mental   en la Sierra Peruana 2003. Informe General. Anales de Salud Mental 2004; XIX (1-2):1- 197

[7] Instituto Especializado de Salud Mental “Honorio Delgado – Hideyo Noguchi” Estudio Epidemiológico de Salud Mental en la Selva Peruana. Informe General. Anales de Salud Mental 2005; XXI (1-2).1-212

[8] Instituto Especializado de Salud Mental “Honorio Delgado – Hideyo Noguchi” Estudio Epidemiológico Salud Mental en Fronteras 2005. Informe General Anales de Salud Mental 2006; XXII ( 1 – 2): 1-227

[9] Saavedra J. Situación de la atención de salud mental en el Perú. Conferencia de Salud Mental. Lima: Instituto Nacional de Salud Mental “Honorio Delgado- Hideyo Noguchi”; 2014

[10] Ley que modifica el Artículo 11 de la Ley 26842, Ley General de Salud, y garantiza los derechos de las personas con problemas de salud mental. El Peruano.  2012 Jun 24.

[11] Ministerio de Salud de Perú. Plan de fortalecimiento de servicios de salud mental. 2018-2021.

[12] Ministerio de Salud de Chile. Subsecretaría de Salud Pública. Estudio de carga de enfermedad y carga atribuible

[13] Ministerio de Salud de Chile. Plan Nacional de Salud Mental 2017 -2025. Chile: Ministerio de Salud Subsecretaría De Salud Pública; 2017.

[14] Diaz-Castro L. Global burden of mental disorders in Mexico and the health system intervention. 3rd International Conference on Mental Health and Human Resilience. Int J Emerg Ment Health 2017, 19:2(Suppl). DOI: 10.4172/1522-4821-C1-008

[15] Berenzon Gorn S, Saavedra Solano N, Medina-Mora Icaza ME, Aparicio Basaurí V, Galván Reyes J.Evaluación del sistema de salud mental en México:¿Hacia dónde encaminar la atención? Rev. Panam. Salud Pública. 2013; 33 (4):252–8.

[16] Mascayano-Tapia F, Lips-Castro W, Mena-Poblete C, et al. Salud Mental, 38(1), Ene-Feb, 2015.

[17] Estados Unidos Mexicanos. Programa de Acción Específico en Salud Mental2013-2018.Mexico:  Secretaría de Salud; 2013 disponible en https://www.gob.mx/cms/uploads/attachment/file/11918/Salud_Mental.pdf

Objectives

1)   To share the experiences and lessons learned between Asia-Pacific economies regarding their implementation process of their community mental health services, as well as the systematization, management and coordination of their community mental health service networks; and

2) To build capacity of the mental health staff regarding implementation processes of interventions and its evaluation to improve the quality of care in community mental health services networks, as well as the systematization of data for progress evaluations.

Alignment

Alignment - APEC:  Improving implementation and management of community mental health services networks, through capacity building, contributes to the health system strengthening towards universal health coverage and sustainable development. Thus, this project supports the APEC theme adopted by Vietnam, the Healthy Asia Pacific 2020 strategy, endorsed by APEC Leaders and Ministers in 2014, the implementation of “The Healthy Asia Pacific 2020 Roadmap”, specifically the key areas through to the Year 2020: Strengthening the prevention and control of non-communicable diseases, including mental illnesses, and the APEC Roadmap to Promote Mental Wellness in a Healthy Asia Pacific (2014-2020).

Alignment – Forum: The effective implementation and management of networks of mental health services contribute to the reduction of the burden of mental illness, which is related to the loss of productivity. This project which aim to improve the community mental health services will lead to greater well-being, and in the long term will benefit the economic growth and social development of a large number of vulnerable population. Therefore, this project will also provide recommendations for the implementation of the HWG's Work Plan for 2017, HWG 2016-2020 Strategic Plan, the Sustainable Development Goals (SDG) 2030. Likewise, the proposal will contribute to the 6th APEC high level meeting on health and the economic statements, the priorities to achieve innovative development and economic reform with sustainable growth.

TILF/ASF Justification

Not Applicable.

Beneficiaries and Outputs

Outputs: The proposed project has five main outputs, which are aligned with the three objectives proposed. These outputs are as follows:

Workshop: This is a training workshop that will be conducted during four days in Peru, the host economy, with the participation of Chile and Mexico, involved in this proposal, and other Asia-Pacific economies that decide to participate in this event.  As participants will be invited: Policymakers, and, researchers involved in community mental health, officials responsible of the management of community mental health services or networks, from each economy.

This activity aims to gather these participants with different backgrounds to share their experiences in the implementation, management and evaluation of community mental health services and care initiatives within their economies, in order to learn from each other and strengthen theirs capacities and the linkages among them to foster future collaborations. The keynote speakers and the workshop will actively interact with participants in the workshop on issues such as: i. Community mental health models, ii. Evaluation of the management of community mental health services, iii. Evaluation of integration of mental health into primary care, iv. Consumers’ empowerment and community awareness in mental health. v. prevention of psychosocial problems, (especially, family violence (violence against women). vi. mental health recovery approach, vi. community mental  health care for children,   vii. evaluation mental health responses to natural disasters and traumatic events. viii.  Development of human resources and information system in community mental health, ix. And, research on mental health policies results and impact. It is planned to have around 14 presentations.

The participants will be selected and convened through the ministries of health of each Asia Pacific economy, so that each of them will be officially presented. For the selection of participants, criteria such as their experience in the formulation, implementation, management and evaluation (researching) of community mental health policies will be considered.

Report of the multi-economy workshop: This experience will be collected and developed into a written report, which will summarize the contents discussed during the two days of the event. The content of the report will include the models of community mental health in the Asia Pacific economies, an overview of the processes of implementation of service networks and the best practices of community mental health, summaries of APEC economy community mental health assessment submissions, appendix presenting each APEC economy community mental health assessments. An estimated number of pages is around 80. This report will be then delivered to the participants of the workshop and to the health ministries of each economy. Additionally, this report will be disseminated to the other member economies, in order to share with them this experience and encourage the conduction of similar initiatives.

Set of training materials: In order to ensure an adequate provision of the training, a set of materials will be developed. This set of materials will be based on priorities in capacity building, evidence-based interventions in mental health and strengthening of community mental health services. These materials will be then shared with the participants in digital format during the workshop for them to disseminate the knowledge gained with their local teams. Participants will be in charge of using this set of materials and can adapt them, when necessary, to their local contexts.

Outcomes: The previously described outputs are expected to achieve a series of outcomes in the medium-term. These expected changes are as follows:

Multi-economy workshop:

·  Strengthening of local leadership and mental health policy: This activity will improve the current local leadership through the collaboration with other stakeholders and the sharing of experiences from other settings. Moreover, this encounter will allow mental health policymakers of different economies to learn from each other and thus improve the design and implementation of current and future policies.

·  Knowledge exchange: The member economies involved in this project share some social and cultural characteristics, which are valuable when trying to capture and use external expertise. Additionally, this exchange will provide different perspectives of similar problems, thus the integration of them will be highly important to improve the community mental health care provided in each of these economies.

·  Strengthening capacities to improve implementation and evaluation of community mental health care in line with the priorities of APEC economies in capacity building. It is critical that the mental health policies and plans be carefully implemented and assessed, as well as, the changes made if they do not have their desired outcomes or effects. In that sense, participants are expected to apply the learnings acquired in this fied whitin their economies to improve community mental health networks responsiveness and appropriateness to deliver high-quality interventions in each economy. This alignment will also facilitate its usefulness for its beneficiaries even when the project is finished.

Report of the multi-economy workshop:

·  Systematization of community mental health initiatives: This report will be useful to understand how other economies implement and assess their interventions in community mental health, and might be taken as a precedent to report the process of these initiatives in different contexts.  

Set of training materials:

·  Improvements on the implementation and evaluation of community mental health interventions: The set of training materials, which are also based on priorities in capacity building, evidence-based interventions and strengthening of health services, will provide a solid basis to improve the implementation of community mental health interventions among APEC economies. This set of materials will also promote the sustainability of this initiative and its further replication in local contexts.

Beneficiaries: The beneficiaries for the proposed activities will be selected and convoke through the Ministries of Health of the APEC economies. Each one of them will be asked for one representative for each group of as follows:

·   Policy makers or planners in mental health: These beneficiaries are the stakeholders in mental health within their economy government. The workshop will benefit them through the exchange of experiences in the implementation and evaluation of community mental health initiatives in other contexts, and the possibility to establish linkages with their peers from other economies, as well as with academics.

·   Researchers (involved in community mental health research): Researchers will be selected by each member economy, and will be valuable to provide crucial feedback to understand, implement and assess community mental health interventions within and outside their home economies. These researchers will benefit from the multi-economy workshop by building alliances with other researchers advocated to community mental health care as well as strengthening their partnership with policymakers; whereas, their participation on the multi-economy research proposal will provide them with the opportunity to develop research opportunities within the health system. Parity among male and female researchers will be encouraged.

·   Coordinators or manager of community mental health networks: Coordinators are responsible of the management of the community mental health services in the mental health networks in their assigned territories, in charge to ensure the appropriate development, implementation, and evaluation of community mental health initiatives. They will be an important source of information to capture how their health systems work, helping to understand the main achievements and barriers that they have faced. On the other side, they will be benefited by this workshop since they will be able to learn from other experiences and the strategies used to overcome barriers. Additionally, the implementation training will benefit them through the development of the necessary skills to implement and assess interventions in community mental health care, tailoring that knowledge to their economies and learning from other experiences.

·   Technical teams and Health providers working at community mental health services: Health care providers in community mental health services usually are psychiatrists, psychologists, nurses, social workers, occupational therapist and educators. These professionals are responsible to provide community mental health care interventions, based on their economies priorities and their users demands. The workshop will help them to learn how community mental health interventions are conducted in other settings, understanding their achievements and challenges in doing so. Not only that, but they will also have the opportunity to share their experiences with policymakers, researchers and coordinators, in order to make them know about their necessities and main limitations during their daily work. Regarding the implementation training, health providers will be benefited by the capacity building strategies and the development of their skills in implementation and evaluation processes during the implementation of community mental health interventions. Moreover, the set of materials from this training will be a valuable resource to share with their peers and promote the implementation and evaluation of these interventions across their home economies. Parity among men and women will be encouraged.      

Dissemination

Dissemination: The proposed project will focus on the dissemination of two specific outputs:

Report of the multi-economy workshop: This report will be disseminated among governmental entities of the APEC economies, the academia, and the health providers working at community mental health centers. This report aims to share the experiences of the economies involved in the project among those who are involved in community mental health interventions. These reports will provide detailed information about the contents presented during this workshop, in a easy-to-read manner. This report is also intended to be shared with those economies that do not have implemented a community mental health care model in their settings, in order to provide useful information on how to do it, the main challenges faced and how the participating economies have work through them. Finally, they will be available in digital format in accordance with, the APEC Publication Guidelines for online publishing on the APEC website.

Set of training materials: The set of materials will be disseminated among the  mental health official at Ministry of health of each APEC economy, who will be responsible of delivering this material to the health providers of their community mental health services. We expect the participants to disseminate the knowledge gained and improve their services. This set of materials will include all the contents used during the training workshop. No outputs are intended to be sold.

Gender

The proposed project will encourage the participation of both women and men throughout its implementation, especially in those fields in which the participation of women is still lower than men (policymakers, researchers, and specialized mental health providers). Since it is intended to incorporate women in all the proposed activities, women will be represented, at least 30% of speakers will be women. -  Among the participants, we will coordinate with ministries of health to select the representatives for their ecomomies to equal numbers of women and men. For example in nursing and social work professionals, since the majority of them are women, but it will be intended to attempt for gender parity among the participants.

Likewise, data on the participants and speaker/experts will be collected sex-disaggregated and included in the report.

Work Plan

The training workshop will be held in Peru. However, members from all economies will be asked to present their experiences. In the first place, a responsible team will be formed with members proposed by the ministries of health of the three economies that support the proposal: Peru, Chile and Mexico. This team will be responsible for the detailed design of the activities, the implementation and the reports of the training workshop. This organizing team will meet weekly through teleconferences. For this, in Peru there will be a responsible professional, who from the beginning, coordinate propose the necessary personnel contract and follow up on the actions.

The workshop design will include sessions to share experiences in community mental health of APEC economies and training sessions on fundamental aspects of the implementation and evaluation of comprehensive mental health care in the context of primary care and integrated service networks of health. The technical visit of the participants to some of the community mental health services implemented in Peru will also be proposed.

Related to sharing best practices in community mental health. For the selection of presentations, timely communications will be sent to all APEC economies inviting them to participate according to a pre-established scheme both for their presentations and for the publication thereof in the report of the workshop. The organizing team will make the selection of the presentations jointly.

During this activity information exchange will occur considering different levels; firstly, on a political level, in terms of establishing and managing service networks, creating policies and standardized implementation procedures, etc. Secondly, service network coordinators, and thirdly mental health care service providers will present their economy-specific experiences, considering successes as well as challenges, for instance, the obstacles they had to face, how they overcame them, and what difficulties still persist in the particular setting. This will be especially helpful considering the wide expectation towards the community mental health services, not only implementing community models of mental health care, but also increasing empowerment and participation of mental health services users, offer preventive interventions and employment support, generating evidence and innovation, conducting research and evaluations of community mental health services and mental health informations systems.

Related to training on implementation and evaluation. The participants will increase their knowledge about different implementation strategies for evidence-based interventions, and strategies to improve process evaluation procedures, including optimizing data collection for process indicators, as well as standard documentation and systematization procedures. This project aims for the participants of this training to disseminate the knowledge gained through this training in their economies of residence, within their health care systems and networks, in collaboration with their coordinators and political stakeholders. We expect this dissemination to amplify the number of beneficiaries of the program to other health care workers.

Given this information exchange on different levels within the mental health care system, from each participating economy, people with different professional backgrounds and trajectories will be invited to actively participate in the workshop: policymakers, researchers (involved in community mental health research), coordinators of community mental health networks, and health care providers working at community mental health services. This project aims at having at least one speaker for every one of these categories from each economy - economy, 11 speakers in total- to present their experiences to enrich the knowledge transfer and the discussions.

The work plan specific activities are the following (in chronological order):

1) Confirmation of   APEC economies that support the initiative.

2) Conformation of the organizing team with members from Peru, Chile and Mexico (two for each economy).

3)  Design of the workshop activities.

4) Selection and confirmation of speakers and facilitators.  4. Advertising the international training workshop, invite guest authorities.

5) Confirmation of national and international participants

6) Conducting workshop preparations (logistics, materials, hotels, administrative staff, etc.). 

7) Create training materials

8)  Holding of a four -day Workshop.

9) Elaborating the workshop report

10) Preparation of Workshop report.

11) Validation of the workshop report by the fora participants.

12) Drafting of the final version of the workshop report.

13) Dissemination of the workshop report.  (See activity chronogram below). The output of this phase will be the workshop itself and the workshop report, of which latter will be published virtually to be accessible to all other economies in the world interested in community mental health care.

The coordination team in Peru will be responsible for the overall coordination However, the Organizing Team will identify and engage at least one responsible contact person from each APEC economy to facilitate the diffusion of the training  workshop information to the corresponding individuals and organizations.

Time

Tasks

Deliverables

Multi-economy training  workshop

August  - December  2018

1.     Confirmation of   APEC economies that support the initiative

1.     Multi-economy workshop program or agenda

2.     Conformation of the organizer team with two members from Peru, Chile and Mexico

3.     Design workshop activities

4.     Selection and confirmation of speakers and facilitators.

January  – May  2019

5.     Advertising  the workshop

2.     List of APEC economies participants and representatives

3.     Training materials

6.     Confirmation of participants

7.     Conducting workshop preparations

8.     Create training materials

June   - 2019

9.     Holding of a four -day training Workshop

July  2019

10.  Preparation of Workshop report

4.     Preliminary version of the workshop report

August 2019

11.  Validation of the workshop report by the fora  participants and by the Secretariat

September 2019

12.  Drafting of the final version of the workshop report

October 2019

13.  Dissemination of the workshop report

5.     Workshop report

October –November 2019

14.  Drafting, endorsement and submission of the Completion Report and all supporting documents to the Secretariat

6.     Completion Report to the Secretariat

October 2019 – August 2020.

15.  Participation in the Long Term Evaluation of APEC Projects conducted by the Secretariat.

7.     Presentation of the Workshop report

Risks

1) Risk of not attracting the right participants.  The selection criteria of the candidates will be made known and the ministries of health will request their careful compliance.

2)  Risk of not having an adequate proportion of the four types of participants desired. We will encourage all economies to have representatives of the four groups as one of the most important aspects of their participation. Since there is likelihood that representative of health service providers will have greater difficulties in attending, representatives of the mental health technical teams of the ministries of health will also be included. They usually know the services and programs within their economies and are in charge of providing technical assistance and disseminating information among the different social actors.

3) Risk of low quality of training program Within the Asia Pacific economies, the best professionals will be contacted to design with them the specific objectives, the design of the program and the materials. For this, teleconferences will be used.

In addition, there could be changes in the mental health administrations at the Ministries of Health and, therefore, the long-term commitment to the dissemination of the implementation training may be affected. However, it is expected that policymakers attending the workshop will be motivated to establish the need to implement and evaluate appropriately community interventions in each economies’ mental health agenda.

Monitoring and Evaluation

The project coordination will establish a detailed chronogram of all the activities included in this proposal and will be in charge of monitoring that all of them are completed in the expected timeline. Furthermore, there will be a designated person at each participating economy to help to build the activities’ contents and to organize the traveling logistics. Therefore, bi-weekly meetings between the economies’ designated persons and the project coordination will be conducted to monitor the progress closely. Moreover, to assess if the project achieves its objectives, each objective will be analyzed by the following standards:

The Multi-economies  training workshop will be monitored by the number of participants invited and registered, and then contrasted with the number of attendees. To evaluate the success, a brief survey will be handed to each participant at the end of the workshop to determine the percentage of people satisfied with the workshop’s contents and relevance. In addition, if it corresponds, the gained knowledge and competencies will be assessed by conducting pre- and post-implementation training evaluations to all participants. It will also help to determine if the event served them to develop new ideas for their own contexts, as well as if they felt the meeting represented an opportunity to build new regional networks linked to their day-to-day work. The two last points will also be assessed in a survey three months after the training took place. Finally, a final report of the process will be produced considering the experiences and lessons learned presented by all economies involved.

It is expected up to 25 participants funded, with a maximum of 60 participants; 80 % of people satisfied with the workshop’s contents and relevance, 15 implementation processes presented by Asia Pacific economies, proportion of participants according to the four types of participants proposed. (Breakdown in the number of men and women).

Linkages

Engagement: Within APEC, we are only engaging with the participating economies: Peru, Chile, and Mexico; however, we expect to benefit other APEC economies by delivering the multi-economies workshop report to the Ministries of Health of the other APEC member economies, and also outside APEC, since this report will be available to all public as well. Additionally, it is important to mention that it has not been defined yet who are the experts conducting the implementation training, leaving open the possibility to include experts from all over the world, and not only restricted to the APEC member economies. Furthermore, although our target population is the providers that already work in the health system, the academia is also being considered in this proposal because they could identify potential research opportunities within their health systems, and could foster collaborations with policymakers and mental health providers.

Previous work: There is one previous experience of a mental health network within the APEC region (APEC Digital Hub for Mental Health) that has done extensive work in the mental health field. Nonetheless, this proposal considers necessary to build a different type of network, directed to community mental health center providers and community mental health network coordinators, who work under a specific framework. Considering Latin American economies share similar cultural characteristics, it is crucial to generate a constant exchange of experiences and promote capacity building specific to the region.

APEC’s comparative advantage: The APEC Mental Health Initiative has established “seven common focus areas on which APEC economies could focus their collaborative efforts”. This project is aligned with two of them:

a) integration with primary care and community-based settings, since a community mental health framework is prioritized in the proposal; and

b) data collection and standardization, considering that the implementation training proposed also includes the learning of guidelines to evaluate implementation processes[1].



[1] APEC Mental Health Initiative. Report on Strategic Needs in Mental Health. July 2016

Sustainability

The project coordination will encourage participants to engage with the later training of mental health implementation directed to providers of community mental health centers and managers of mental health networks, in order to guarantee that the project’s efforts have a wider impact in the region.

Initially, the project overseers will contact each economy’s designated persons to observe if the planned activities are being conducted. Later on, it is expected that the person in charge of the mental health strategy of the Peruvian Ministry of Health will lead this task with the compromise of assuring the continuity of the communication and the reporting of the goals and challenges of each economy via virtual meetings with the other economies included in this proposal.

Finally, to measure the impact in medium-terms outcomes, a virtual survey will be sent to all participants three months after the activities to inquire about the maintenance and fluency of the network created according to their perception.

Project Overseers

Dr. Yuri Cutipé will manage the project. He is a Peruvian child and adolescent psychiatry.  His professional career integrates individual and public health care, mental health policy and service development. He worked at the National Institute of Mental Health “Honorio Delgado Hideyo Noguchi” (INSM) leading processes to integrate mental health care in primary care. From the Ministry of Health, as Executive Director of Mental Health led the team that achieved the formulation and implementation of the Budgeting Program 0131 "Control and Prevention of Mental Health" that currently allows the differentiated financing of mental health services and programs in the sector public. He also encourage the formulation and approval of the Regulation of Law 29889 "Law that guarantees the rights of people with mental health problems". In the last year, his team has achieved the approval of the "National Plan for the Strengthening of Community Mental Health Services 2018-2021" with which the development of the community mental health care network for the economy will continue. He has also been a collaborator in epidemiological research in mental health.

Maria Mendoza Vilca, point of contact responsible for this project. She is a nurse, specialized in community mental health and public health. She has served as Head of the Department of Community Mental Health and of the Department of Epidemiology at the Peruvian National Institute of Mental Health “Honorio Delgado Hideyo Noguchi”. Currently, she as member of Mental Health Directorate technical team at Ministry of Health of Peru, is responsible for formulating, implementing and evaluation of  the "National Plan for the Strengthening of Community Mental Health Services 2018-2021".

Cost Efficiency

Not Applicable.

Drawdown Timetable

Not Applicable.

Direct Labour

Short-term clerical fees: 2 people working 8 hrs a day during the 4-day workshop. Their general duties involve logistic support during the workshop.

Contractor fees:

·  Project coordinator: 1 person working over the 9-month project (6 months part-time, 3 months full time - 960 hrs). Their general duties involve the coordination between the economies for the multi-economy training workshop, the overall logistic tasks and the workshop report preparation.

·  Experts in implementation: 4 people working 2 hrs a day during 3 months (preparation phase - 120 hrs), and 8 hrs a day during the 4-day implementation training (32 hrs). Their general duties involve the design of the implementation training contents, the development of the training materials and the facilitation of the implementation training sessions.

Waivers

Not Applicable.

Are there any supporting document attached?

No 
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