Mental health care cascade performance and associated factors: longitudinal analyses of routine Ministry of Health services in Mozambique

Abstract Introduction Mental, neurological and substance use (MNS) disorders are leading causes of disability worldwide. Nevertheless, limited research exists regarding MNS health system performance across the care cascade and associated patient characteristics in low-income and middle-income countries (LMICs) such as Mozambique. Methods We used baseline data from an ongoing randomised controlled trial, collected across 16 outpatient clinics on variables of sex, age, marital status, tuberculosis and HIV status, alcohol and drug use, suicidal ideation, pregnancy and MNS diagnosis. Mixed-effects multivariable regression was used to examine factors associated with patient functional improvement or low functional impairment measured by a standardised disability questionnaire. Results From February to September 2022, there were 4323 patient visits, of which 65.9% (n=2851) were attended on time (±5 days), 41.4% (n=1793) had medication adherence and 30.5% (n=1321) achieved a functional impairment score Conclusions This analysis revealed gaps in patients reaching functional improvement or low functional impairment in outpatient MNS care in Mozambique. Gaps were more pronounced for patients who are ≤18 years of age, single or expressing suicidal ideation. Implementation strategies to optimise patient outcomes are needed as nascent mental health systems are scaled-up in Mozambique and other similar LMICs. Trial registration number NCT05103033.