Mental Wellness Coordinated Specialty Care (mWell-CSC) in Mozambique: Implementing evidence-based early intervention services for young people with untreated psychosis

About This Grant

The onset of psychotic symptoms usually occurs in young people and 80% of those developing psychosis live in low and middle-income countries (LMICs). In LMICs, 90% of people with mental disorders are cared by families, and duration of UP is twice that in high-income countries (HICs). A longer duration of untreated psychosis (UP) is associated with poorer treatment response, high suicide rates, premature death, and greater disability and caregiver burden. No studies have examined Early Intervention Services (EIS) for young people in LMICs with new-onset, non-substance-induced, affective and non-affective UP. Coordinated Specialty Care [CSC] programs were developed in HICs to offer EIS that combines medication management and evidence- based psychosocial interventions to reduce duration of UP, symptoms, relapse, treatment discontinuation and hospitalization, and improve social and occupational functioning. Challenges to CSC programs' implementation in HICs ( e.g., inadequate community-based detection, high rates of disengagement, and scant infrastructure ) can be addressed through t echnology-based screening, community-based participatory services design, and enhanced mental health (MH) resources, all of which we are poised to apply in Mozambique, through our established partnerships, MH services infrastructure, and ongoing work. In Mozambique, the 4th poorest country in the world and with 40% of the 34 million inhabitants aged 15-24 years, psychotic disorders are the leading Since 2014, we have had a productive partnership among local and global researchers, the Mozambique Ministry of Health (MoH), providers, traditional healers, and community health committees at 64 rural primary care clinics. Together, we are implementing a novel patient-centered decision-support Mental Wellness Digital Platform (mWell) comprising (a) community-based detection with a brief, valid household screening tool, the Mental Wellness Tool (mwTool); (b) evidence-based care for common mental and substance use disorders, and suicide risk, (c) guidance for cause of inpatient admissions and the second reason for outpatient psychiatric care. diagnosis of severe mental disorders, and (d) psychotropic medication management. mWell also tracks implementation, services, and clinical outcomes. More than 1,200 community health workers (CHWs) and MH and primary care providers (PCPs) in Mozambique have adopted mWell as the new community MH “usual care” where care was absent. MH providers and PCPs use mWell's digitized diagnostic and medication decision aid to treat people with psychosis and to offer some rehabilitation services. Yet, a comprehensive evidence-based EIS program like a CSC does not exist. Our multi-sector partners in Mozambique have prioritized building capacity and integrating CSC interventions into mWell to develop and implement mWell-CSC country-wide. To respond to this critical mandate we will adapt CSC, create the digital decision-support platform mWell-CSC, develop strategies for implementation, and examine mWell-CSC implementation, services, and patient-level outcomes using a quasi-experimental design and mixed-methods evaluation to inform a future RCT.