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Table 2 Implementation of Nigeria’s Mental Health Policy on Primary Care in Benue State (adapted from FMOH 2013)

From: Partnership for the implementation of mental health policy in Nigeria: a case study of the Comprehensive Community Mental Health Programme in Benue State

Policy directiveCCMHP approach
1. Supervision
 A psychiatric nurse should ideally be posted to each health centre and supervised by a doctor in primary care, who is in turn supervised by a community psychiatric consultant at a Federal Neuropsychiatric Hospital or university department
A CPN or CHEW trained in mhGAP-IG is posted to one health centre per local government area, receives clinical supervision from a psychiatrist from Federal Medical Centre Makurdi or CBM, and receives additional supervision from the CCMHP Community Mental Health Project Officer
2. Medicine supply
 Relevant systems for procurement, distribution, storage, quality management and monitoring must be in place to ensure that health centres have an adequate supply of essential medicines
CCMHP procures medicines from CHAN Medi-Pharm and sets up Drug Revolving Fund at each health centre to ensure constant supply. CCMHP Community Mental Health Project Officer is responsible for oversight
3. Outreach
 Staff should have access to transport to visit clients at home who have complex mental disorders
CCMHP provides each CPN with a motorbike for outreach. Local government is responsible for fuel
4. Training
 Ensure medical student and nurse training includes common mental disorders, psychosocial interviewing skills and orientation to primary health care. Their curricula of training should be adjusted adequately to include these
CPNs receive formal training and accreditation, funded by CCMHP. Both CPNs and CHEWs receive CCMHP-funded mhGA-IG training and retraining
5. Referrals
 Clear procedures are required for upward and downward referral, from psychiatric nurses to doctors to specialists, and vice versa
Referrals are made directly between the CPN or CHEW and specialists at Federal Medical Centre Makurdi or Benue State University Teaching Hospital
6. Rehabilitation
 Social rehabilitation should be encouraged by promoting inclusion in community activities, which might be supported by self-help or peer groups
CCMHP-funded self-help groups and vocational training provide opportunities to combat exclusion and support livelihoods of users and carers. Two community-based rehabilitation facilities also operate under CCMHP
7. Community
 Engagement with community aspects of primary care system facilitates health promotion, surveillance, referral and follow-up
CCMHP trains lay people as community-level mental health advocates for promotion, identification and referral. CPNs and CHEWs conduct community outreach for follow-up