L Michel is MD, PhD, psychiatrist and specialist in addiction medicine. He is the head of the Pierre Nicole Centre in Paris, France and researcher in the CESP/Inserm 1018 unit (Villejuif, France).

Background: Access to psychiatric care for people who inject drugs (PWID) is limited and stigmatized in most low-middle-income countries (LMICs). Innovative interventions involving peer support, and based on skill transfer and task shifting, are needed. We aim to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam.
Methods: In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms assessed with the MINI International Neuropsychiatric interview and the Clinical Global Impression scale. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention.
Results: Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally.
Conclusion: Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Peers can play a crucial role to facilitate access and psychiatric care for the most marginalized populations. Similar interventions should be implemented and evaluated in different LMICs and contexts.