Researchers to study efficacy of RESHAPE program to reduce stigma of primary care providers

Researchers from the George Washington University (GW), Transcultural Psychosocial Organization Nepal, Tribhuvan University Teaching Hospital, Epidemiology and Disease Control Division of the Ministry of Health and Population of Nepal, Duke University, and King's College London are developing a strategy to reduce mental health stigma among health care providers and subsequently improve detection of patients with mental illness.

With the aid of a $2.96 million grant from the National Institutes of Health, the team led by Brandon Kohrt, MD, PhD, Charles and Sonia Akman Professor of Global Psychiatry at the GW School of Medicine and Health Sciences, will study the implementation of a stigma reduction training strategy called "Reducing Stigma among HealthcAre ProvidErs" (RESHAPE) at various sites in the Gandaki Province of Nepal.

In the United States and other high-income countries, approximately 1 out of 5 patients with mental illness receives minimally adequate care. In low- and middle-income countries, the range can span from 1 out of 27 to 1 out of 100 patients. This signifies a major gap between the global burden of individuals with mental illness and the number of people receiving adequate treatment.

The World Health Organization developed the mental health Gap Action Programme (mhGAP) to train primary health care workers to detect mental illness and deliver evidence-supported treatment. However, since these programs have been implemented, primary care workers trained in mental health accurately detect fewer than 10% of patients with mental illness.

We previously conducted a pilot in Nepal comparing mhGAP training delivered by mental health experts with a mhGAP+RESHAPE training delivered by experts and service users. We found that stigma was lower among the health care workers trained with RESHAPE. The results of the pilot also suggested that reducing stigma may improve detection of mental illness.

Brandon Kohrt, MD, PhD, Charles and Sonia Akman Professor of Global Psychiatry at the GW School of Medicine and Health Sciences

With this grant, the team will compare mhGAP standard implementation with RESHAPE implementation with the primary implementation outcome being reach of mental health services and the second outcome being effectiveness. Through the study, the team will evaluate the impact of the RESHAPE implementation strategy on primary care workers' attitudes toward patients with mental illness, the impact of RESHAPE implementation on the reach of mental health services, and build research capacity and expand research networks, with a focus on gender equity in research development.

The targeted conditions for the study will be depression, generalized anxiety, psychosis, and alcohol use disorder.