Contextualization and adaptation of the child and adolescent mental and behavioural disorders module of the mhGAP-IG in Kilifi and Nairobi counties in Kenya

Abstract

The Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) was developed by the World Health Organization as a key tool for delivering evidence-based mental healthcare in non-specialized settings. The mhGAP-IG requires contextualization and adaptation to ensure local relevance. However, evidence on adapting the Child and Adolescent Mental Disorders (CMH) module of the mhGAP-IG is limited. This study contextualized and adapted the 2016 mhGAP-IG CMH module through two workshops with local mental health experts and stakeholders, preceded by six in-depth interviews exploring the child and adolescent mental health contexts in Nairobi and Kilifi. Data were analysed in NVivo-Lumivero© software. Interviews with mental health stakeholders revealed significant challenges in both counties, including a shortage of mental health specialists, frequent medication stockouts, stigma and inadequate resources. Key adaptations to the module included using locally acceptable terms (e.g., replacing 'failure to thrive' with 'suboptimal growth'); expanding training to five days; adding the mhGAP-IG Essential Care and Practice module to address culturally sensitive communication in mental healthcare provision; streamlining referral pathways; and incorporating aspects of self-harm/suicide and substance use linked to the CMH module content. Contextualizing the CMH module is crucial for effective implementation, but sustaining impact will require addressing systemic barriers beyond capacity-building.