Integrating mental health care into primary care systems in low- and middle-income countries: lessons from PRIME and AFFIRM

Mental, neurological and substance use (MNS) disorders are now the leading cause of disability worldwide, contributing to 23% of global years of life lived with disability (Whiteford et al. 2013). Most of this burden is carried by lowand middle-income countries (LMICs). However, MNS disorders in LMICs do not receive the research attention or service personnel they deserve (Saxena et al. 2006), with the demand for services for outweighing the provision of services and treatment personnel. This gap in service provision is often referred to as the ‘treatment gap’. In response, a number of research priorities were proposed for MNS disorders by the Grand Challenges in Global Mental Health initiative in an article published in Nature in 2011 (Collins et al. 2011). In keeping with this agenda, there has been a burgeoning of new innovations in global mental health in the last 5–6 years, including a wide range of initiatives funded by the US National Institute of Mental Health (NIMH), the European Commission (EC), the UK Department for International Development (DFID), Grand Challenges Canada and the Wellcome Trust, among others. These innovations aim to provide a concrete evidence base to test and demonstrate the effectiveness of interventions to narrow the treatment gap. One key strategy is to integrate mental health into primary care systems in LMICs, through task shifting or task sharing, in line with the objectives of the WHO global mental health action plan (WHO, 2013b). This paper will present case studies of two such initiatives: the PRogramme for Improving Mental health carE (PRIME) and the Africa Focus on Intervention Research for Mental health (AFFIRM). We will then draw out lessons from our experiences of integrating mental health into primary care in LMICs.