Mental health reporting performance in primary health care: a comparative mixed-methods study of mhGAP-trained and untrained facilities in Nepal

Background Mental health disorders are a significant contributor to the global burden of disease. The quality of routine reporting of mental health indicators is poor, particularly in low- and middle-income countries. The World Health Organization's Mental Health Gap Action Programme (mhGAP) is widely implemented to improve primary health care facility capacity. The effect of mhGAP on routine mental health reporting remains poorly understood. This study aimed to compare the performance of routine mental health reporting between mhGAP-trained and untrained primary health care facilities in Nepal. Methods An explanatory mixed-methods study was conducted in 28 primary health care facilities in Parsa District, Nepal. There were 28 facilities in all, 14 of which were mhGAP-trained and 14 of which were not. Quantitative data were collected through a retrospective analysis of 12 months of routine mental health reporting data from the Health Management Information System (HMIS) / DHIS2. Reporting performance was compared between mhGAP-trained and untrained primary health care facilities. Qualitative data were collected through in-depth interviews with 11 health workers. The Consolidated Framework for Implementation Research (CFIR) was used to analyze the data. Results Mental health reporting performance was consistently poor in both mhGAP-trained and untrained facilities. Completeness of mental health reporting was extremely low, with most facilities reporting no mental health cases over a 12-month period. Accuracy in mental health reporting was not observed in all the facilities, as no consistency was observed between facility registers and DHIS2 data. However, the timeliness of reporting was consistently high in all the facilities, with a mean timeliness of 99.6%. No statistically significant difference was found in the timeliness between the two types of facilities, with a p-value of 0.309. Although structural readiness was higher in mhGAP- trained facilities, the overall performance in the mental health reporting domain was rated as poor in all the facilities, indicating a lack of functional routine reporting systems. Conclusions Mental health reporting performance in primary health care facilities in Nepal remains critically weak and is similar in both the mhGAP-trained and untrained facilities. Training increases structural preparedness, but without supportive supervision, system-level coordination, and integration of mental health into regular health information systems, reporting performance may not be improved. Comprehensive system-level interventions beyond training are needed to strengthen routine mental health reporting.