RESEARCH

With limited number of psychiatrists for an estimated population of 198 million people,
Nigeria exemplifies the severe lack of capacity for mental healthcare services in low
and middle-income countries (LMICs). An estimated 26% of adult Nigerians have a
lifetime prevalence of at least one Diagnostic and Statistical Manual (DSM IV)-coded
mental disorder, a rate similar to that in high income countries, yet only 10% receive
any care irrespective of severity. A significant factor limiting access to mental health
care in Nigeria is limited availability of mental health specialists. Other factors are
pervasive societal negative attitudes and stigmatizing beliefs about mental disorders
even among health care providers. Finding innovative approaches to reduce barriers
and increase access to effective treatments for these common mental disorders in
LMICs like Nigeria is in line with WHO Millennium Development Goals and the 2030
Agenda for Sustainable Development and its Goals. The challenge is to find efficient,
effective, acceptable and sustainable ways to do this. An increasingly accepted and
effective approach is training lay and non-psychiatric health workers to deliver
packages of mental health care under the supervision of psychiatrists in a
collaborative, stepped-care, task sharing approach.
The HAPPINESS Project uses the WHO’s mhGAP intervention guide (mhGAP-IG-2.0) to
train non-specialists health workers in primary health centers to provide evidence-
based care for people with mental, neurological and substance use disorders at the
community level.
We utilize mobile technology to support continuing education, clinical supervision,
consultation and referral to specialist care.
Through the HAPPINESS Research project, we hope to answer the following research
questions:

•  Feasibility:  What is the role of mobile technology in increasing the reach
  of the few distantly located psychiatrists to provide supervision and
  clinical support for primary healthcare workers?
• Acceptability: Will primary healthcare workers and service users accept
  this model of mental health screening, treatment and referral in the
  community health centers?
• Effectiveness: What is the impact of mhGAP-IG implemented in primary
  health centers using the HAPPINESS model on clinical and functional
  outcomes compared to usual care? Can a project like the HAPPINESS
  Project reduce the gap in access to mental health care compared to usual
  care? Can it reduce stigma and negative attitude among health care
  workers and the general public?
•  Sustainability and scalability: Can The HAPPINESS project be supported
  by existing state health infrastructure, personnel and policy frameworks?
  Is it scalable to all primary care centers in Imo state and other states in
  Nigeria? Can a similar model be utilized for other medical specialities
  beyond mental health?
• What are the mediators, facilitators or mitigating factors for
  feasibility, acceptability, effectiveness, sustainability and scalability of an
  mhGAP-based project like The HAPPINESS project?

These and other research questions can only be answered with a well-designed,
rigorously implemented pilot and clinical trial study. With further funding and support,
our team is well positioned and prepared to answer these implementation research
questions.