Mental disorder is extremely common in all countries, in all parts of the world and no country, however rich, can afford enough specialists to look after everyone with a mental disorder. The high prevalence, severity, duration and accompanying disability of mental health problems at the primary care level have major implications for the delivery of services to meet population needs, and it has been widely recognised since Alma Ata (1979) that it is essential to integrate mental health into primary care in all countries.1
This is true for rich countries, and even more so for low- and middle-income countries where specialist services are much more scarce.2–4
Whereas rich countries often have around one psychiatrist per 10 000 population, low-income countries in sub-Saharan Africa have, on average, one psychiatrist per million population, and in practice such a ratio is much worse outside the large cities where psychiatrists tend to be based.5
A ‘brain drain’ of specialists to richer countries has compounded the difficulties of low-income countries trying to develop their health systems.6
However, despite the long-standing intent to integrate mental health into primary care, and early significant efforts to implement and evaluate such integration, these efforts have not been well sustained in many countries, and there remains a worldwide treatment gap for mental health conditions.7
This is even more severe in low- and middle-income countries such as Nigeria. For example, a recent report from Nigeria suggests that only about 10% of people with current mental disorders had received any form of treatment and that fewer than 1% of those had received what could be considered as minimally adequate treatment.8
Thus there have been renewed calls from the World Health Organization (WHO) and others to integrate mental health into primary care by the effective training and support of primary care providers in the identification and treatment of mental health problems.9–12
Indeed, the integration of mental health into primary healthcare services has had official policy backing in Nigeria since 1991.13
However, the reality is that, to date, little or no mental health care has been offered in primary care settings in Nigeria. A major reason for this discordance between policy intention and real life is the lack of adequate training for primary care providers in the country.14
In Nigeria, primary care clinics are staffed by community health officers who have two years of training in basic health issues, but limited training in mental health. Their basic training is delivered in health technology colleges by tutors who are mostly registered nurses and midwives who have had three years of training in tutors training institutions.
We organised a one-week mental health training workshop for teachers from selected institutions for the training of primary care providers in Nigeria, in order to train them in the use of a structured package of mental health training materials which they could then adapt and use in their own training courses for trainee primary care providers. This paper describes the conduct of the training of trainers workshop and assesses its immediate impact on the knowledge and attitudes of the trainers. A second paper will assess the longer term impact of the training on the training behaviour of the trainers.