mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings
MNS Conditions
Anyone can experience depression since it is a
common condition. People with depression
experience:
 Fatigue
 sleep problems
 multiple physical symptoms
 dejected mood for at least two weeks.
Moreover, they have significant difficulty
functioning in the social, familial, personal,
educational, and/or occupational aspects of their
lives; they also experience anxiety as well as
unexplained medical somatic symptoms.
Two extreme conditions under psychoses are
bipolar disorder and psychosis.
Management and Intervention
Depression
An assessment is done on an individual to
gauge other possible MNS conditions that could
be why the individual experiences depression;
after evaluating the individual, they can be
diagnosed either with depression or depression
in bipolar disorder.
People diagnosed with depression can
experience delusions/hallucinations, while
people with depression in bipolar disorder are at
risk for mania.
Apart from medicinal intervention, it is
recommended that the individual should try to
participate in group/community and social
activities such as interpersonal therapy (IPT)
and cognitive behavioral therapy (CBT).
 Interpersonal Therapy (IPT) for
Depression - Group IPT may be
offered at community mental health
centers, mental health units in general
hospitals, and tertiary mental health
care services.
 Multi-component behavioral
treatment (PM+) – various strategies
are done to have people schedule
activities they may have been avoiding
so that they may improve their mental
well-being.
 Cognitive behavioral therapy (CBT)
– CBT in depression is done to treat
women with perinatal depression.
Psychoses
During the first stages of assessment and
evaluation, delirium could be caused by other
medical conditions that are not MNS; at times,
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

 Psychosis is categorized by a person having

the delirium could also be caused by other
delusions – false beliefs; severe behavior
MNS conditions (Dementia, depression,
abnormality – agitation, lack
substance abuse/withdrawal).
of/hyperactivity; emotion disturbances –
disconnect from emotions (facial
 A person could be diagnosed with
expressions and body language).
Bipolar Disorder Manic episodes by
 Bipolar Disorder is a mental health
experiencing symptoms for one week
condition wherein an individual’s mood and
that is severe enough to require
activity level are notably disrupted. On some
confinement; they could also be
occasions, mania can happen, which is the
diagnosed with Psychosis if they have
rapid rise of mood, energy, and activity; in
delusions, hallucinations, and
addition, depression can occur, which is the
disorganized speech.
rapid decrease of mood, energy, and
activity. Bipolar disorder is also attributed to
 It is important for patients diagnosed
people who only experience manic episodes.
with psychoses to avoid sleep
deprivation and stress and maintain a
healthy lifestyle; it is also essential to
facilitate the inclusion of the patient in
activities, life training skills, and social
skills.
 Research shows that traditional mental
hospitals may not be the best way to
help a person diagnosed with
psychoses; as such, helping people with
psychoses in non-specialized healthcare
facilities can make it easier for
treatment and reduce the negative
stigma about mental hospitals.

Epilepsy

Epilepsy is one of the most common
neurological disorders; it is a chronic
noncommunicable brain disorder, and people
with epilepsy often experience unprovoked
seizures. The condition can be genetic or happen
in people who experienced brain
trauma/injury/infections.
There are two types of seizures: convulsive and
non-convulsive:
 Nonconvulsive epilepsy is not visually
physical; however, there is a change in
The first phase of epilepsy is often an
emergency case; the priority is to mitigate
convulsions; if the case that convulsions
haven’t stopped, the patient is referred to a
health facility; if the seizures have stopped, an
assessment is then carried out.
People who experience epilepsy have a higher
risk for depression and substance use disorders;
moreover, children and adolescents are also at
risk for mental and behavioral disorders and
substance use disorders.
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

mental status. It is important to have a discussion on the

 Convulsive epilepsy is characterized by
the body's sudden abnormal movements
(stiffening or shaking).
environmental factors that may contribute to
seizures and epilepsy. To ensure proper
management of seizures and epilepsy, seeking
medical care at a healthcare facility is
recommended.

Child & Adolescent Mental & Behavioral Disorders (CMH)

A Developmental disorder is an umbrella term The child/adolescent is first assessed to

that covers intellectual disability and autism determine the stressors and other possible MNS
spectrum disorders; they usually start in conditions that explain the symptoms that they
childhood with their central nervous system have been experiencing; after the assessment,
(CNS) maturation impaired/delayed in its they can be diagnosed with the following:
function.
 Developmental Delay/Disorder
 Emotional Disorders are indicated by  Behavioral Problems
increased levels of depression, anxiety, and  Attention Deficit Hyperactivity
somatic symptoms; it is the leading mental Disorder (ADHD), Conduct Disorder
health condition found in younger people.  Emotional Problems
 Behavioral Disorder is an umbrella term for  Emotional Disorder/Depression.
attention deficit and conduct disorders
Community-based rehabilitation and at least 60
(ADHD) and conduct disorders; children
minutes of physical activity through sports and
and adolescents that experience a moderate
the like keep a stimulating environment for
to severe case of social, educational,
children and adolescents. Moreover,
psychological, or occupational disabilities
Psychological interventions like Cognitive
are diagnosed with behavioral disorders.
behavioral therapy (CBT) and Interpersonal
People within this age group present symptoms Therapy (IPT) are recommended for children
of one or more of the conditions mentioned; at and adolescents experiencing emotional
times, those symptoms may overlap. The cause disorders.
of such symptoms may be traced back to the
social and educational background of the
children, with a heavy emphasis on the influence
of their home life as well; as their well-being
and functionality are dependent on these factors,
it is important to address possible stressors and
explore support systems that can help the
child/adolescent in improving their mental
health condition.

Dementia

Dementia is a disability that progressively A person can be diagnosed with the following:
affects brain activity, resulting in a decline in
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings
cognitive functioning; this decline affects how
older people deal with their daily activities and
social life as there is a deterioration in their
memory, motivation, social behavior, and
emotional control. Although there is no cure for
dementia, proper management, care, and
treatment can improve their well-being and
health.
Substance Use Disorders
Substance use includes alcohol intake and drug
use involving overdose and withdrawal
symptoms.
 Acute Intoxication - a short-term
condition resulting from substance
intake that affects consciousness,
behavior, and/or perception.
 Overdose – is a severe physical and/or
mental effect of substance intake, while
Withdrawal is a symptom that the
person experiences after the reduction of
substance use.
 Dementia without
behavioral/psychological symptoms
 Dementia with
behavioral/psychological symptoms.
Other symptoms can also be caused by:
 Delirium - a transient fluctuating
mental state characterized by disturbed
attention that develops over a short
period and tends to fluctuate during the
day. It may result from acute organic
causes such as infections, medication,
metabolic abnormalities, substance
intoxication, or substance withdrawal.
 Pseudodementia - a cognitive
impairment that is the direct result of
depression.
To manage the behavioral and psychological
symptoms of patients with dementia, it is
advised that the environment be considered
where there is appropriate seating, safe areas
for patients to wander, and directional/place
signs; moreover, calming distraction strategies
should also be implemented. It is also important
that participation in the community is
facilitated.
An emergency assessment for individuals is to
suspect if they are undergoing intoxication or
withdrawal symptoms. People with ongoing
substance use problems may need longer and
more comprehensive treatment that includes
social support, such as help finding
employment and housing; It is recommended
that individuals seek longer-term treatment and
access to social support to aid their recovery.
Considering joining peer support groups or
rehabilitation communities could prove
advantageous in facilitating the recovery
process. It is highly suggested that admission
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

 Harmful use - is applied to the habitual into a residential rehabilitation program or

intake of psychoactive substances that another psychosocial support program is done
causes physical (liver diseases) and/or before embarking on the withdrawal process.
mental (depressive episodes) harm to
oneself. In contrast, the term
dependence denotes the strong craving
for a substance in which the use of such
takes precedence over the individual’s
basic needs.

Self-harm/Suicide

Suicide is the act of killing oneself; meanwhile,
self-harm is used when an individual
intentionally does an act, resulting in a fatal
outcome such as self-inflicted poisoning.
When an individual engages in self-harm that
poses a significant medical risk, providing them
with a safe and nurturing environment within a
healthcare facility is crucial. This will ensure
that they receive the necessary medical
attention and emotional support to aid in their
recovery and prevent further harm.

In the event that an individual is at imminent

risk of self-harm or suicide, it is crucial to
establish an environment that is safe and
provides ample support. It is recommended to
provide a separate and serene space for the
individual to wait as they seek treatment. This
will help ensure they are comfortable and
receive the appropriate help they need in a
conducive setting.

World Health Organization. (2016). Mhgap intervention guide for mental, neurological and
substance use disorders in non-specialized health settings: Version 2.0.

World Health Organization and Columbia University. (2016). Group Interpersonal Therapy (IPT) for
Depression: Version 1.0.

Depression

Anyone can experience depression since it is a common condition; people with depression experience
fatigue, sleep problems, multiple physical symptoms, and a dejected mood for at least two weeks.
Moreover, they have significant difficulty functioning in the social, familial, personal, educational,
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

and/or occupational aspects of their lives; they also experience anxiety as well as unexplained
medical somatic symptoms.

Management and Psychosocial Interventions

An assessment is done on an individual to gauge other possible MNS conditions that could be the
reason why the individual experiences depression; after evaluating the individual, they can be
diagnosed either with depression or depression in bipolar disorder. People diagnosed with depression
can experience delusions/hallucinations, while people with depression in bipolar disorder are at risk
for mania. Apart from medicinal intervention, it is recommended that the individual should try to
participate in group/community and social activities such as interpersonal therapy (IPT) and cognitive
behavioral therapy (CBT).

Interpersonal Therapy (IPT) for Depression - Group IPT may be offered at community mental health
centers, mental health units in general hospitals, and tertiary mental health care services.

Multi-component behavioral treatment (PM+) – various strategies are done to have people schedule
activities they may have been avoiding so that they may improve their mental well-being.

Cognitive behavioral therapy (CBT) – CBT in depression is done to treat women with perinatal
depression.

Psychoses

Two extreme conditions under psychoses are bipolar disorder and psychosis. Psychosis is categorized
by a person having delusions – false beliefs; severe behavior abnormality – agitation, lack
of/hyperactivity; emotion disturbances – disconnect from emotions (facial expressions and body
language). Bipolar Disorder is a mental health condition wherein an individual’s mood and activity
level are notably disrupted. On some occasions, mania can happen, which is the rapid rise of mood,
energy, and activity; in addition, depression can occur, which is the rapid decrease of mood, energy,
and activity. Bipolar disorder is also attributed to people who only experience manic episodes.

Management and Psychosocial Interventions

mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

During the first stages of assessment and evaluation, delirium could be caused by other medical
conditions that are not MNS; at times, the delirium could also be caused by other MNS conditions
(Dementia, depression, substance abuse/withdrawal). A person could be diagnosed with Bipolar
Disorder Manic episodes by experiencing symptoms for one week that are severe enough to require
confinement; they could also be diagnosed with Psychosis if they have delusions, hallucinations, and
disorganized speech. It is important for patients diagnosed with psychoses to avoid sleep deprivation
and stress and maintain a healthy lifestyle; it is also essential to facilitate the inclusion of the patient
in activities, life training skills, and social skills.

Research shows that traditional mental hospitals may not be the best way to help a person diagnosed
with psychoses; as such, helping people with psychoses in non-specialized healthcare facilities can
make it easier for treatment and reduce the negative stigma about mental hospitals.

Treating individuals with psychoses in non-specialized healthcare facilities can increase accessibility and
reduce the stigma associated with institutional care. Studies suggest that traditional mental hospitals are not
the most effective approach to treatment and may even infringe upon fundamental human rights.

Give the person freedom of movement, avoid restraining them, and ensure that personal and others’ security is
also achieved. The person should live with family or community outside of a hospital setting; long-term
hospitalization should be avoided.

Epilepsy

Epilepsy is one of the most common neurological disorders; it is a chronic noncommunicable brain
disorder, and people with epilepsy often experience unprovoked seizures. The condition can be
genetic or happen in people who experienced brain trauma/injury/infections. There are two types of
seizures: convulsive and non-convulsive; non-convulsive epilepsy is not visually physical; however,
there is a change in mental status; convulsive epilepsy is characterized by sudden abnormal
movements (stiffening or shaking) of the body.

Management and Psychosocial Interventions

mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

The first phase of epilepsy is often an emergency case; the priority is to mitigate convulsions; if the
case that convulsions haven’t stopped, the patient is referred to a health facility; if the seizures have
stopped, an assessment is then carried out. People who experience epilepsy have a higher risk for
depression and substance use disorders; moreover, children and adolescents are also at risk for mental
and behavioral disorders and substance use disorders.

It is important to have a discussion on the environmental factors that may contribute to seizures and
epilepsy. To ensure proper management of seizures and epilepsy, seeking medical care at a healthcare
facility is recommended.

Discussing local environmental factors that may contribute to seizures and epilepsy is crucial. Encouraging
participants to participate in the discussion is recommended to ensure they are aware of the local causes.
Additionally, managing seizures and epilepsy should take place in a healthcare facility.

Child and Adolescent Mental & Behavioral Disorders

A Developmental disorder is an umbrella term that covers intellectual disability and autism spectrum
disorders; they usually start in childhood with their central nervous system (CNS) maturation
impaired/delayed in its function. Emotional Disorders are indicated by increased levels of depression,
anxiety, and somatic symptoms; it is the leading mental health condition found in younger people.
Meanwhile, Behavioral Disorder is an umbrella term for attention deficit and conduct disorders
(ADHD) and conduct disorders; children and adolescents that experience a moderate to severe case of
social, educational, psychological, or occupational disabilities are diagnosed with behavioral
disorders.

People within this age group present symptoms of one or more of the conditions mentioned; at times,
those symptoms may overlap. The cause of such symptoms may be traced back to the social and
educational background of the children, with a heavy emphasis on the influence of their home life as
well; as their well-being and functionality are dependent on these factors, it is important to address
possible stressors and explore support systems that can help the child/adolescent in improving their
mental health condition.

Management and Psychosocial Interventions

The child/adolescent is first assessed to determine the stressors and other possible MNS conditions
that explain the symptoms that they have been experiencing; after the assessment, they can be
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

diagnosed with the following: Developmental Delay/Disorder, Behavioral Problems, Attention

Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, Emotional Problems, and Emotional
Disorder/Depression.

Community-based rehabilitation and at least 60 minutes of physical activity through sports and the
like keep a stimulating environment for children and adolescents. Moreover, Psychological
interventions like CBD and IPT are recommended for children and adolescents experiencing
emotional disorders.

Dementia

Dementia is a disability that progressively affects brain activity that results in a decline in cognitive
functioning; this decline affects how older people deal with their daily activities and social life as
there is a deterioration in their memory, motivation, social behavior, and emotional control. Although
there is no cure for dementia, proper management, care, and treatment can improve their well-being
and health.

Management and Psychosocial Interventions

A person can be diagnosed with:

Dementia without behavioral/psychological symptoms

Dementia with behavioral/psychological symptoms.

Other symptoms can also be caused by:

Delirium - a transient fluctuating mental state characterized by disturbed attention that develops over
a short period and tends to fluctuate during the day. It may result from acute organic causes such as
infections, medication, metabolic abnormalities, substance intoxication, or substance withdrawal.
Pseudodementia - a cognitive impairment that is the direct result of depression.

To manage the behavioral and psychological symptoms of patients with dementia, it is advised that
the environment be considered where there is appropriate seating, safe areas for patients to wander,
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

and directional/place signs; moreover, calming distraction strategies should also be implemented. It is
also important that participation in the community is facilitated.

Substance-use Disorders

Substance use includes alcohol intake and drug use involving overdose and withdrawal symptoms.
Acute Intoxication is a short-term condition resulting from substance intake that affects
consciousness, behavior, and/or perception. Overdose is a severe physical and/or mental effect of
substance intake, while Withdrawal is a symptom that the person experiences after the reduction of
substance use. Harmful use is applied to the habitual intake of psychoactive substances that causes
physical (liver diseases) and/or mental (depressive episodes) harm to oneself. In contrast, the term
dependence denotes the strong craving for a substance in which the use of such takes precedence over
the individual’s basic needs.

Management and Psychosocial Interventions

An emergency assessment for individuals is to suspect if they are undergoing intoxication or

withdrawal symptoms. People with ongoing substance use problems may need longer and more
comprehensive treatment that includes social support, such as help finding employment and housing;
It is recommended that individuals seek longer-term treatment and access to social support to aid their
recovery.
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

Considering joining peer support groups or rehabilitation communities could prove advantageous in
facilitating the recovery process. It is highly suggested that admission into a residential rehabilitation
program or another psychosocial support program is done before embarking on the withdrawal
process.

Consider referral to peer help groups or rehabilitation/residential therapeutic communities. Withdrawal is best
undertaken when there is a plan for admission to a residential rehabilitation or other psychosocial support
program.

Suicide/Self-Harm

Suicide is the act of killing oneself; meanwhile, self-harm is used when an individual intentionally
does an act, resulting in a fatal outcome such as self-inflicted poisoning.

Management and Psychosocial Interventions

When an individual engages in self-harm that poses a significant medical risk, providing them with a
safe and nurturing environment within a healthcare facility is crucial. This will ensure that they
receive the necessary medical attention and emotional support to aid in their recovery and prevent
further harm.

In the event that an individual is at imminent risk of self-harm or suicide, it is crucial to establish an
environment that is safe and provides ample support. It is recommended to provide a separate and
serene space for the individual to wait as they seek treatment. This will help ensure they are
comfortable and receive the appropriate help they need in a conducive setting.
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

Medically Serious Act of Self-Harm For all cases: Place the person in a secure and supportive environment at
a health facility.

Imminent Risk of Self-Harm/Suicide Create a secure and supportive environment; offer a separate, quiet room
while waiting for treatment if possible.

Altered mental status A changed level of awareness or mental state that falls short of unconsciousness
which is often induced by substance intake or other mental or neurological conditions. Examples
include confusion and disorientation. See delirium and confusional state

Autism spectrum disorders An umbrella term that covers conditions such as autism, childhood
disintegration disorder and Asperger’s syndrome.

Behavioural activation Psychological treatment that focuses on improving mood by engaging again in
activities that are task-oriented and used to be enjoyable, in spite of current low mood. It may be used
as a stand-alone treatment, and it is also a component of cognitive behavioural therapy

Cognitive Mental processes associated with thinking. These include reasoning, remembering,
judgement, problem-solving and planning

Cognitive behavioural therapy (CBT) Psychological treatment that combines cognitive components
(aimed at thinking differently, for example through identifying and challenging unrealistic negative
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

thoughts) and behavioural components (aimed at doing things differently, for example by helping the
person to do more rewarding activities).

Comorbid, comorbidity Describing diseases or disorders that exist simultaneously

Convulsion, convulsive movementClinical or subclinical disturbances of cortical function due to a

sudden, abnormal, excessive, and disorganized discharge of brain cells (see seizure). Clinical
manifestations include abnormal motor, sensory and psychic phenomena.

Delirium Transient fluctuating mental state characterized by disturbed attention (i.e., reduced ability
to direct, focus, sustain, and shift attention) and awareness (i.e., reduced orientation to the
environment) that develops over a short period of time and tends to fluctuate during the course of a
day. It is accompanied by (other) disturbances of perception, memory, thinking, emotions or
psychomotor functions. It may result from acute organic causes such as infections, medication,
metabolic abnormalities, substance intoxication or substance withdrawal.

Delusion Fixed belief that is contrary to available evidence. It cannot be changed by rational
argument and is not accepted by other members of the person’s culture or subculture (i.e., it is not an
aspect of religious faith).

Detoxification The process by which an individual is withdrawn from the effects of a psychoactive
substance. Also referring to a clinical procedure, the withdrawal process is carried out in a safe and
effective manner, such that withdrawal symptoms are minimized.

Disability Any restriction or lack (resulting from an impairment) of ability to perform an activity in
the manner, or within the range, considered to be normal for a human being. The term disability
reflects the consequences of impairment in terms of functional performance and activity by the
individual

Interpersonal therapy (IPT)Psychological treatment that focuses on the link between depressive
symptoms and interpersonal problems, especially those involving grief, disputes, life changes and
social isolation. It is also known as Interpersonal Psychotherapy.

Irritability, irritable moodA mood state characterized by being easily annoyed and provoked to anger,
out of proportion to the circumstances
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

Motivational enhancement therapyA structured therapy (lasting 4 or less sessions) to help people with
substance use disorders. It involves an approach to motivate change by using motivational
interviewing techniques i.e. engaging the person in a discussion about their substance use including
perceived benefits and harms in relation to the persons own values, avoiding arguing with the person
if there is resistance, encouraging the person to decide for themselves what their goal may be.

Occupational therapy Therapy designed to help individuals improve their independence in daily
living activities through rehabilitation, exercises and the use of assistive devices. In addition, such
therapy provides activities to promote growth, self-fulfilment and self-esteem.Oppositional behaviour
Markedly defiant, disobedient, provocative or spiteful behaviour that may be manifest in prevailing,
persistent angry or irritable mood, often accompanied by severe temper outbursts or in headstrong,
argumentative and defiant behaviour

Pseudodementia A disorder resembling dementia but not due to organic brain disease and potentially
reversible by treatment; can manifest as symptoms of depression in some older adults.
Psychoeducation The process of teaching people with MNS disorders and their carers/family
members about the nature of the illness, including its likely causes, progression, consequences,
prognosis, treatment and alternatives

Racing thoughts Rapid thought pattern with tangential movement from one idea to the next often
associated with mania or other mental illnesses.

Relapse A return to drinking or other drug use after a period, of abstinence, often accompanied by
reinstatement of dependence symptoms. The term is also used to indicate return of symptoms of MNS
disorder after a period of recovery.

Relaxation training Involves training in techniques such as breathing exercises to elicit the relaxation
response.

Respite care Provision of temporary health-care facilities to a person normally cared for at home

Seizure Episode of brain malfunction due to disturbances of cortical function resulting in sudden,
abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include
abnormal motor, sensory and psychic phenomena.
mhGAP Intervention Guide for Mental, Neurological, and substance use disorders in Non-Specialized Health Settings

Self-harm Intentional self-inflicted poisoning or injury to oneself, which may or may not have a fatal
intent or outcome.

Stigma A distinguishing mark establishing a demarcation between the stigmatized person and others
attributing negative characteristics to this person. The stigma attached to mental illness often leads to
social exclusion and discrimination and creates an additional burden for the affected individual.

Suicidal thoughts / ideation Thoughts, ideas, or ruminations about the possibility of ending one's life,
ranging from thinking that one would be better off dead to formulation of elaborate plans

Wandering People living with dementia feel the urge to walk about and in some cases leave their
homes. They can often experience problems with orientation, which may cause them to become lost.