Effectiveness of the Mental Health Gap Action Programme in Thailand - ประสิทธิผลโครงการเพื่อลดช่องว่าง การบริการสุขภาพจิตในประเทศไทย

Abstract

This study was an evaluation research which aimed to study the psychotic patient care process of
the Mental Health Gap Action Programme in Psychosis (mhGAP: Psychosis). The study sites were
conducted in 4 areas: (1) Klong Tom district, Khrabi province, (2) Wang Nam Kiew district, Nakorn
Ratchasima province, (3) Sarapee district, Chaing Mai province and (4) Nong Song Hong district,
Khonkaen province. A total of 1,167 patients aged 15 years old and over who received psychosis
treatment and care were interviewed during April and September 2012. Three sets of standard questionnaires
were used which included the General Health Questionnaire (GHQ), the Global Assessment
of Functioning (GAF) and the Thai version of WHO Quality of Life(WHO-QOL). Method for assessment
of effectiveness of the program was based on the CIPP Model. The content analysis approach was
used to analyze qualitative data, while the quantitative data were analyzed by using frequency, percentage,
mean, median, standard deviation for characterisitics and the Chi-square test for association.
Univariate analysis and estmimated Odds Ratio were presented with significant level of p = 0.05. The
results inidicated that percentage of psychotic patients in the pilot hospital areas was 0.7 of the targeted
population screended; and highest percentage was found in Nong Song Hong District (0.9%). Majority
of the patients were male (73.7%), aged between 26-35 years old (42.7%) and with primary school
education (40.3%). Regarding the project effectiveness, 6 of the 7 target indicators were achieved
which included psychosis screening (91.4%), mean of duration of untreated psychosis (96.1% reduction),
completed 3-month medication (95.3%), access to service (95.0%), re-admission (2.2%)
and increased QOL (98.4%). The ability of self-care (GAF) was only at 63. 1% (compared to 80%
target). Assessment of outcomes at 3 months after the intervention showed significantly increasing QOL
and GAF scores (p<0.001). The age factor was found to be associated with improving quality of life.
Patients aged 46–55 year old had QOL-score 4 times higher than that of patients with aged over 55
years (Crude OR = 3.93, 95%CI: 1.737 – 9.021). Patients aged under 25 years old also had better
QOL-score than patients aged over 55 though not statistically significant. Other independent variables
such as gender and abililty of self-care showed no significant association with QOL score. The key
success factors of this mhGAP implementation were identified to be patient registration system, high
coverage of capacity building of personnel, emphasis on treatment, good understanding of patients and
family, and the referral system.
Key words: psychotic patient, project effectiveness, mental health gap