A program to further integrate mental health into primary care: lessons learned from a pilot trial in Tunisia

Abstract

# Background Tunisia is a lower-middle-income country located in North Africa. Since the 2010-2011 Revolution, a campaign of civil resistance to protest high levels of youth unemployment, difficult living conditions, and government corruption, a rise in mental health problems, substance use disorders, and suicide attempts/deaths has been recorded. To address untreated mental health symptoms, a mental health training program was offered to primary care physicians (PCPs) working in the Greater Tunis area of Tunisia, a collaboration between members of the Tunisian Ministry of Health, the *School of Public Health* at the *Université de Montréal* (Québec, Canada), the *World Health Organization* (*WHO*) office in Tunisia, and the *Montréal WHO-PAHO Collaborating Center (CC) for Research and Training in Mental Health* (Québec, Canada). # Program description The training was based on the *Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG)*, a program developed by the *WHO* to help further develop the mental health competencies of non-specialists working in non-specialized settings. Our team adapted the *mhGAP-IG* training to the primary care realities of the Greater Tunis area, offered the training program to PCPs between February and April 2016, and evaluated the program using a randomized controlled trial and implementation analysis. # Discussion The adaptation, implementation, and evaluation of the training program equipped our team with important lessons learned, supported by evidence in the field of *Global Mental Health*. First, developing partnerships helped create a feasible program that met the practical and research needs of the country. Second, benefitting from political commitment to mental health facilitated the development of partnerships, the implementation of the training program, and the training's accompanying evaluation. Third, piloting the program helped identify challenges attributed to the training program and its implementation, the mental health care system, and the research tools, information that may be used to "build back better." Last, sharing research findings collaboratively helped ensure their validity and encouraged greater knowledge uptake. # Conclusion We hope that sharing such lessons learned will aid other countries with similar profiles to develop and/or adapt, implement, and evaluate programs that target untreated mental health symptoms in primary and community-based settings and hence address priorities in *Global Mental Health*.