About project MIND

Project MIND is a collaborative research study between the South African Medical Research Council (SAMRC), the University of Cape Town, Oxford University, and the Western Cape Department of Health (WCDoH).

The purpose of this study is to develop two collaborative care models for mental health and chronic disease care and to test which of these models is the most effective for improving mental health and chronic disease outcomes.

Apecifically we aim to:

  1. Assess current capacity and barriers to delivering mental health interventions within chronic disease services in order to inform the development of feasible and acceptable collaborative care models.
  2. Conduct a randomized controlled trial to compare the effectiveness of a “dedicated” model of service integration relative to a “designated” model relative to treatment as usual (TAU).
  3. Evaluate the cost-effectiveness of a “dedicated” model of service integration relative to a “designated” model relative to TAU.

 

study overview

Phase 1: A health systems assessment and a pilot of the collaborative care models (CCMs) Phase 2: A randomized controlled trial of the collaborative care models. We will be testing these models across 24 primary care clinics during the trial. Phase 3: A process evaluation in which we will assess the implementation of the CCMs. Phase 4: A feedback phase in which we will return to all participating facilities and share findings. We will also provide them with training in the CCM shown to be most effective and support them to implement this model.

Hover over the Phases to view more information

Collaborative Care Model 1: Dedicated approach

In clinics assigned to this approach, we will provide the chronic disease team with basic training in common mental disorders and prepare them to integrate a brief intervention for common mental disorders into chronic disease care. This brief counselling intervention will be provided by a trained Community Health Worker (CHW). We will add an additional CHW to the existing chronic disease team. This person will be dedicated to providing the counselling programme across both HIV and diabetic clinics.

The brief counselling programme provided by the CHW consists of three structured counselling sessions based on a blend of motivational interviewing and problem solving therapy (MI-PST). Supervision, debriefing, and ongoing training will be provided to the CHW to support the delivery of a quality service.

Collaborative Care Model 2: Designated approach

In this approach, we also will provide the chronic disease team with basic training in common mental disorders and prepare them to integrate a brief intervention for common mental disorders into chronic disease care. Unlike the dedicated approach, in the designated model we will identify CHWs already working as adherence counsellors within primary care facilities who will be designated to provide the counselling programme across both HIV and diabetic clinics in addition to their usual adherence counselling responsibilities.

CHWs in the Designated approach will be trained to provide exactly the same structured counselling programme as provided in the Dedicated model. They will also receive the same amount of supervision, debriefing, and ongoing training as provided to CHWs in clinics assigned to the dedicated approach.

Treatment as usual (TAU)

In clinics assigned to Treatment as Usual, patients will receive the types of services that are normally offered to patients with chronic diseases and a suspected common mental disorder (such as depression, anxiety or alcohol-related problems). Generally, if a health care provider suspects that a patient may have a common mental disorder, the patient would be referred to a mental health nurse for further assessment and referral, an off-site organization providing mental health services or a social worker. In addition to this referral, we will provide patients with an information brochure that provides contacts for mental health and substance use services.

treatment sites

24 Primary Health Care facilities in the Western Cape have been identified for project MIND research activities. These are:

9 Non-metro sites

Worcester; TC Newman; Ceres; Klawer; Lutzville; Vredendal; Grabouw; Hermanus; and Railton.

15 Metro sites

Mfuleni; Michael Mapongwana; KhayelitshaSite B; Nolungile; Nyanga; Gugulethu; Browns Farm; Macassar; Kraaifontein; Elsies River; Delft; Retreat, Hanover Park; Mitchells Plain; Crossroads.

OUR TEAM

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Prof. Bronwyn Myers

Principal Investigator: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council

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Assoc. Prof Katherine Sorsdahl

Co-Investigator: Alan Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University Cape Town

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Dr. Petal Petersen-Williams

Trial Manager: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council
 

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Dr. Claire Van der Westhuizen

Data Manager: Alan Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town

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Nombuso Moshiga

Field Supervisor: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council

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Lesley-Ann Erasmus-Claassen

Quality Assurance Officer: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council

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Yuche Jacobs

Counsellor Supervisor: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council

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Dr Carrie Brooke-Sumner

Post-doctoral Fellow: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council

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Vimbayi Mafunda

Health economist: University of Cape Town

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Our investigators


  • Prof. Bronwyn Myers
  • Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council

  • Prof. Crick Lund
  • Alan Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health University of Cape Town

  • Dr. Tracey Naledi
  • Chief Director: Health Programmes, Western Cape Department of Health

  • Prof. John Joska
  • Division of HIV neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town

  • Dr. Pete Milligan
  • Head of division: General hospital psychiatry and principal specialist psychiatrist: Valkenberg hospital, WC Department of Health

  • Prof. Naomi Levitt
  • Chronic Disease Initiative for Africa, Division for Diabetes and Endocrinology, University of Cape Town

  • Prof. Dan Stein
  • Department of Psychiatry and Mental Health, University of Cape Town

  • Assoc. Prof Katherine Sorsdahl
  • Alan Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town

  • Prof. Carl Lombard
  • Biostatistics Unit, South African Medical Research Council

  • Prof. Sue Cleary
  • Health Economics Unit, School of Public Health, University of Cape Town

  • Prof. Christopher Butler
  • Nuffield Department of Primary Care Health Services, Oxford University, United Kingdom