Integrating mental health into primary health care in fragile and conflict-affected settings: a scoping review of mhGAP effectiveness

Queiroz, Marcello Roriz de; Rubini, Elena; Valente, Martina; Hubloue, Ives; Corte, Francesco Della

doi:10.1590/0102-311XEN199224

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THEMATIC SECTION: GLOBAL MENTAL HEALTH • Cad. Saúde Pública 41 (9) • 2025 • https://doi.org/10.1590/0102-311XEN199224 linkcopy

Integrating mental health into primary health care in fragile and conflict-affected settings: a scoping review of mhGAP effectiveness

Integração da saúde mental à atenção primária à saúde em contextos precários e atingidos por conflitos: uma revisão de escopo sobre a eficácia do programa mhGAP

Integrando la salud mental en la atención primaria de salud en entornos frágiles y afectados por conflictos: una revisión exploratoria de la efectividad de mhGAP

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

In 2008, the World Health Organization launched the Mental Health Gap Action Program (mhGAP) to scale up mental health care in non-specialized health care settings. Studies have demonstrated the benefits of mhGAP implementation while highlighting the need for better contextual adaptation and ongoing support. The challenge of integrating mental health into primary care is particularly noticeable in fragile and conflict-affected settings, where the need for such services is greater and health systems are often disrupted. A literature search was conducted on PubMed, PsycINFO, Scopus, and Web of Science to identify relevant peer-reviewed studies addressing the effectiveness of mhGAP in fragile and conflict-affected settings. Information was collected on study characteristics and design, impact of mhGAP, and main operational challenges. After full-text review, 10 articles met the inclusion criteria, reporting the impact of mhGAP on primary care personnel, on service user outcomes and in health systems. Studies reported post-training improvements in knowledge, mainly on epilepsy and psychosis. However, gaps remained in skills related to conducting mental state examinations, assessing suicide risk, and strengthening psychosocial support. The evidence was inconclusive regarding the impact of mhGAP on improving access to mental health care at the primary level. Several implementation challenges were identified, including an overemphasis on short-term knowledge transfer and the lack of structured supervision following mhGAP training.

Keywords:
Mental Health; Primary Health Care; Capacity Building; Effectiveness; Emergency

STUDY	COUNTRY	STUDY PERIOD	STUDY TYPE	STUDY OBJECTIVE	POPULATION
Echeverri et al. ²²	Cameroon, Chad, Democratic Republic of the Congo, Ethiopia, Kenya, Uganda, and Tanzania	2015-2017	Qualitative	Describes and analyzes how the capacity building program was perceived among trainees and other local stakeholders, evaluating its effects	54 clinicians and 30 community workers from 6 countries that participated in the mhGAP training
Tarannum et al. ²⁴	Bangladesh	2017	Mixed methods	Describes how UNHCR and health partners worked towards the integration of mental health into primary care	62 primary health care workers involved in the mhGAP training. Most (36) were physicians. Others were medical assistants (10), psychologists (6), health educators (7), medical coordinators (2), or nurses (1)
Siriwardhana et al. ²⁵	Sri Lanka	2014	Mixed methods	Tests the feasibility of improving identification, treatment, and referral of common mental disorders by primary care practitioners using mhGAP-based training. The secondary objective was to explore attitudes and perceptions of primary care practitioners on integrating mental health into primary care	12 primary care practitioners from the Northern Province of Sri Lanka
Hughes et al. ²⁹	Iraq, Turkey, and Syria	2014-2016	Qualitative	Aims to review a training program in Iraq, Turkey, and Syria, whose goal is to improve access to mental health care for affected vulnerable populations	98 health care providers from Syria (30), Iraq (52), and Turkey (16)
Humayun et al. ²⁶	Pakistan	2014	Quantitative	Describes the training process including the adaptation of the mhGAP curriculum, training of trainers, training workshops for primary care staff, and analysis of results of pre- and post-testing of their knowledge about common mental disorders using a 25-item questionnaire	58 participants, including physicians (51) and psychosocial staff of humanitarian agencies (7)
Kohrt et al. ²³	Uganda, Liberia, and Nepal	2015	Quantitative	Evaluates competency among primary care workers trained in mhGAP and community-based mental health services for a program targeting psychosis (including mania) and epilepsy in settings impacted by humanitarian conflict	206 health workers in humanitarian settings
Momotaz et al. ²⁷	Bangladesh	2017-2018	Qualitative	Describes the adaptation of mhGAP training guidelines, results assessment, and practical challenges encountered during implementation	21 participants, including physicians from government facilities (8), humanitarian agencies working in the refugee camps (7), and psychosocial staff from humanitarian agencies (6)
Agudelo-Hernández et al. ³¹	Colombia	2023	Mixed methods	Describes barriers and challenges on mhGAP implementation and determines the correlation between facilitators, accessibility, acceptance, and the component of supervision	41 participants: 30 health personnel (5 physicians, 7 nurses, 18 psychologists) and 11 administrative workers
Doherty et al. ²⁸	Sri Lanka	2018-2021	Quantitative	Measures stigma using pre- and post-mental health knowledge training to understand if stigma among healthcare professionals and community members could be reduced with knowledge gain	22 primary care practitioners, 61 public health professionals across 22 primary care facilities, and 48 community representatives from facility catchment areas
Al-Uzri et al. ³⁰	Iraq	2022	Quantitative	Assesses the impact of mhGAP-IG 2.0 training in MNS disorders in improving physicians’ knowledge of evaluation and management of MNS conditions	17 primary care physicians

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[TFN1] mhGAP: Mental Health Gap Action Program; MNS: mental, neurological and substance use disorders; UNHCR: United Nations High Commissioner for Refugees.