As part of this initiative, International Medical Corps (IMC) contracted the first author (AH) to conduct mhGAP training for primary care staff. The camps also provided an opportunity to assess needs and train healthcare and psychosocial staff working in the district. Despite severely restricted conditions, a monthly mental health camp was held for 6 months to strengthen the local mental health services. In view of the emergency situation, a mental health and psychosocial support (MHPSS) initiative was launched (Humayun et al. In June 2014, a military operation in North Waziristan displaced over a million people into the district of Bannu (KPK), where mental health services were limited to a single psychiatrist.
In addition, some attempts to train primary care staff have also been made in the province, but to the best of our knowledge no effort has been made to implement mhGAP-IG for training primary care physicians in Pakistan. However, the need to strengthen the capacity of primary care staff has already been identified as a priority intervention in the province of Khyber Pakhtunkhwa (KP), which has been facing ongoing geo-political conflict for decades (Budosan & Aziz, 2009 Shah et al. There have been sporadic community mental health initiatives to train non-specialist health workers (Ali et al. Glaring gaps are reported in the capacity of primary care physicians to address mental disorders in Pakistan (Naqvi et al. Like most LMICs, Pakistan faces an overwhelming challenge of scarcity of mental health resources with only 342 psychiatrists in a population of 182 million (0.20 per 100 000 population) (WHO, 2009). 2011 Hussain & Hughes, 2013 Andrea, 2014 Gureje et al. Since then, there have been encouraging reports of mhGAP training in several resource-limited settings (Hijazi et al. The mhGAP-Intervention Guide (mhGAP-IG) offers guidelines to enable non-specialists in primary healthcare to detect and treat priority disorders, and make appropriate referrals to the next level of care (Dua et al. In 2010, the WHO launched the Mental Health Gap Action Programme (mhGAP), to assist LMICs to scale up mental health services (WHO, 2010). 2012), Sri Lanka (Jenkins, 2012), Pakistan and Jordan (Budosan, 2011), Lebanon (Hijazi et al. There have been some successful trainings aimed at integrating mental health into primary care in countries such as Afghanistan (Ventevogel et al. This huge disparity can be addressed through the training of primary care staff to recognize and treat mental disorders (Patel, 2008).
There is an estimated shortage of 1.18 million mental health workers in LMICs alone (WHO, 2011).
A major barrier to address this gap in LMIC is the scarcity and unequal distribution of specialist mental health professionals (Saraceno et al. This treatment gap persists even though effective low-cost treatments can be provided in primary healthcare settings (WHO, 2008 Eaton, 2011). More than 75% of the treatment gap for mental disorders exists in low- and middle-income countries (LMICs) where four out of five people with mental illness do not receive effective treatment (Dua et al. Despite these estimates, resources needed to address the burden are inadequate (Saxena et al. Recent estimates show that the global burden of mental illness is a serious public health concern, accounting for 32♴% of years lived with disability and 13% of disability-adjusted life-years (DALYs) (Vigo et al.
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