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A Philippine Adaptation of the Mental Health Gap Action Programme Intervention

A Philippine Adaptation of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG)InterventionGuideforDisordersduetoSubstanceUseatthePrimaryCareSettingMANAGEMENT MANAGEMENT OPTIONS I. For Low Risk; Harmful Drug Use State clearly the results of the assessment tool and explain the links between this level of substance use, the person’s health problems, and the short-term and long-term risks of continuing use at the current level State clearly the recommendation to stop harmful substance use and your willingness to help the person to do so. General health education Psychoeducation Community care/intervention Psycho-socio-spiritual support Brief Interventions Appropriate referral (especially for adolescent and pregnant or breastfeeding) Follow up at next opportunity II. Substance Use Disorder A. All Cases Of Substance Use Disorder Accomplish complete history, review of systems Conduct physical examination State clearly the diagnosis and inform about the risks of short-term and long-term harm. Explore the person’s reasons for their drug use, using brief intervention techniques. Advise the person to stop using the substance Completely and indicate the intention to support the person in doing so. Ask the person if they are ready to try to stop using the substance. Address housing and employment needs. Provide information and support to person, carers and family members. B. Mild Substance Use Disorder Case management Psychoeducation/advocacy Brief intervention Counseling Education/unemployment support Relapse prevention C. Moderate Substance Use Disorder Follow available treatment protocols Refer to health facility-based intensive outpatient treatment and rehabilitation Manage other mental and neurological conditions Relapse prevention Specialized out-patient treatment models available Offer harm reduction strategies for people who inject drugs. Refer to specialists or inpatient or residential care facilities as necessary. D. Severe Substance Use Disorder Follow available referral, admission and treatment protocols. Detoxification Relapse prevention Halfway care Refer to other appropriate residential care facilities as necessary. III.When With Co-Existing Conditions A. For Intoxication, Overdose Or Wthdrawal Assess and manage Emergency Cases according to available treatment protocols. Refer as necessary. B. For Any Concomitant Health Problem: If available, provide appropriate treatment and request for further necessary laboratory examinations. Refer as necessary. C.For Any Indication of a Need to Assess Mental Health Priority Condition Assess for any mental and neurological priority condition using the mhGAP or available treatment protocol and intervene accordingly. MANAGEMENT DETAILS Below are a few psychosocial interventions that can be provided at the primary health care level. It is important to remember that there are other community resources that can also provide psychosocial interventions including faith-based organizations, community organizations, social services, educational institutions, and non-government orgazinations to name some. Clinical Practice Guidelines for managing abuse of specific substances are also available in specialized settings. Part of a good clinical management is knowing when to refer to the hospital or specialist. Brief intervention techniques Engage the person in a discussion about Their substance use in a way that he/ she is able to talk about both the perceived benefits of it and the actual and / or potential harms, taking into consideration the things that are most important to that person in life. Steer the discussion towards a balanced evaluation of the positive and negative effects of the substance by challenging overstated claims of benefits and bring up some of the negative aspects which are perhaps being understated. Avoid arguing with the person and try to phrase something in a different way if it meets resistance – seeking to find understanding of the real impact of the substance in the person’s life as much as is possible for that person at that time. If the person is still not ready to stop or reduce substance use,then ask the person to comeback to discuss further, perhaps with a family member or friend. Encourage the person to decide for themselves if they want to change their pattern of substance use, particularly after a balanced discussion of the pros and cons of the current pattern of use. Self-help groups Consider advising people with drug dependence to join a self-help group, e.g. Narcotics Anonymous if available. Consider facilitating initial contact Supporting families and carers Discuss with families and carers the impact of drug use and drug use disorders on themselves and other family members, including children. Based on feedback from families:  Offer an assessment of their personal, social and mental health needs. Provide information and education about drug use and drug use disorders. Help to identify sources of stress related to drug use; explore methods of coping and promote effective coping behaviors. Inform them about and help them access support groups (e.g. self-help groups or families and carers) and other social resources. Harm-reduction strategies Advise on the risks of drug injection. Provide information on less risky injection techniques and the importance of using sterile injection equipment. Harm-reduction strategies Give information on how to access needle and syringe exchange programs where they exist,or other sources of sterile injection equipment. Encourage and offer testing for blood-borne viral illnesses, whenever possible. Harm-reduction strategies Offer treatment for complications of drug use and other medical and psychiatric problems, and psychosocial support, even if the person does not wish to cease using drugs at this time. Over time, when a relationship has been established, intensified efforts should be made to encourage people who inject drugs to receive treatment for their drug use disorders. THANK YOU uploads/Finance/ a-philippine-adaptation-of-the-mental-health-gap-action-programme-intervention-guide-mhgap-ig 1 .pdf