Global Mental Health 5 - Barriers to improvement of mental health services in low-income and middle-income countries

Harvard University, Cambridge, Massachusetts, United States
The Lancet (Impact Factor: 45.22). 10/2007; 370(9593):1164-74. DOI: 10.1016/S0140-6736(07)61263-X
Source: PubMed


Despite the publication of high-profile reports and promising activities in several countries, progress in mental health service development has been slow in most low-income and middle-income countries. We reviewed barriers to mental health service development through a qualitative survey of international mental health experts and leaders. Barriers include the prevailing public-health priority agenda and its effect on funding; the complexity of and resistance to decentralisation of mental health services; challenges to implementation of mental health care in primary-care settings; the low numbers and few types of workers who are trained and supervised in mental health care; and the frequent scarcity of public-health perspectives in mental health leadership. Many of the barriers to progress in improvement of mental health services can be overcome by generation of political will for the organisation of accessible and humane mental health care. Advocates for people with mental disorders will need to clarify and collaborate on their messages. Resistance to decentralisation of resources must be overcome, especially in many mental health professionals and hospital workers. Mental health investments in primary care are important but are unlikely to be sustained unless they are preceded or accompanied by the development of community mental health services, to allow for training, supervision, and continuous support for primary care workers. Mobilisation and recognition of non-formal resources in the community must be stepped up. Community members without formal professional training and people who have mental disorders and their family members, need to partake in advocacy and service delivery. Population-wide progress in access to humane mental health care will depend on substantially more attention to politics, leadership, planning, advocacy, and participation.

Download full-text


Available from: Alex Cohen,
808 Reads
  • Source
    • "In order to address this treatment gap, India's National Mental Health Program (NMHP) has revised its plan to cover all districts in the country through decentralization and integration of mental health services with the existing primary care system (Ministry of Health and Family Welfare, n.d.). However, barriers to accessing mental health care have slowed down the process of mental health service delivery in India, and other low-income and middleincome countries as well (Gater et al, 1991; James et al, 2002; Saraceno et al, 2007). The findings from the few studies on such barriers in developing countries suggest modest use of services, costs, proximity of treatment centers, doubts about efficacy of care, stigma, and beliefs in traditional healers (Gater et al, 1991; James et al, 2002). "
    [Show abstract] [Hide abstract]
    ABSTRACT: India has a vast, diverse socio-cultural background and is a multilingual society. The literacy levels in general, and particularly in mental health literacy, have been found wanting, especially in rural India. The aim of this project was to enhance knowledge about mental illness in a rural population. We targeted a rural population near Bangalore, India to enhance knowledge about mental illness. We devised a script for a street play that would enhance knowledge, and shift attitudes and beliefs about mental illness. After identification of the villages in the catchment area, a professional theatre group conducted pilot shows and the script was modified in its design and content. Schizophrenia was the chosen illness. In a manner familiar to them, the theatre group who specialized in street plays staged them in various villages in the chosen catchment area. We received a positive response from the village folk that turned out in large numbers. We were able to coordinate , devise and conduct street plays on mental illness in a rural setup in Bangalore, in a feasible manner, which was keeping in consonance with the local socio-cultural background. WCPRR September/December 2015: 189-200.
  • Source
    • "The success of a country's local research efforts depends largely on the capacity of the available research workforce (Kennard 2000; Saraceno et al. 2007). Therefore, for the existing and future efforts aimed at addressing neurological diseases and related problems in Ghana to be successful, the preparedness of resident scientists to help execute these assignments needs to be addressed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Neurological and neuropsychiatric diseases account for considerable healthcare, economic and social burdens in Ghana. In order to effectively address these burdens, appropriately-trained scientists who conduct high-impact neu-roscience research will be needed. Additionally, research directions should be aligned with national research priorities. However, to provide information about current neuroscience research productivity and direction, the existing capacity and focus need to be identified. This would allow opportunities for collaborative research and training to be properly explored and developmental interventions to be better targeted. In this study, we sought to evaluate the existing capacity and direction of neuroscience-related research in Ghana. To do this, we examined publications reporting research investigations authored by scientists affiliated with Ghanaian institutions in specific areas of neuroscience over the last two decades (1995–2015). 127 articles that met our inclusion criteria were systematically evaluated in terms of research foci, annual publication trends and author affiliations. The most actively-researched areas identified include neurocognitive impairments in non-nervous system disorders, depression and suicide, epilepsy and seizures, neurological impact of substance misuse, and neurological disorders. These studies were mostly hospital and community-based surveys. About 60 % of these articles were published in the last seven years, suggesting a recent increase in research productivity. However, data on experimental and clinical research outcomes were particularly lacking. We suggest that future investigations should focus on the following specific areas where information was lacking: large-scale disease epidemiology, effectiveness of diagnostic platforms and therapeutic treatments, and the genetic , genomic and molecular bases of diseases.
    Metabolic Brain Disease 09/2015; DOI:10.1007/s11011-015-9724-7 · 2.64 Impact Factor
  • Source
    • "In LMICs, limited budgets dedicated to mental health are confounded by scarce human resources and ineffective infrastructure. These represent significant barriers to improving mental health care (Saxena et al. 2006; Saraceno et al. 2007; Jenkins et al. 2011). Scant resources ensure that essential research for the most basic evidencebased policies will be insufficient. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There are significant gaps in the accessibility and quality of mental health services around the globe. A wide range of institutions are addressing the challenges, but there is limited reflection and evaluation on the various approaches, how they compare with each other, and conclusions regarding the most effective approach for particular settings. This article presents a framework for global mental health capacity building that could potentially serve as a promising or best practice in the field. The framework is the outcome of a decade of collaborative global health work at the Centre for Addiction and Mental Health (CAMH) (Ontario, Canada). The framework is grounded in scientific evidence, relevant learning and behavioural theories and the underlying principles of health equity and human rights. Grounded in CAMH's research, programme evaluation and practical experience in developing and implementing mental health capacity building interventions, this article presents the iterative learning process and impetus that formed the basis of the framework. A developmental evaluation (Patton M.2010. Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. New York: Guilford Press.) approach was used to build the framework, as global mental health collaboration occurs in complex or uncertain environments and evolving learning systems. A multilevel framework consists of five central components: (1) holistic health, (2) cultural and socioeconomic relevance, (3) partnerships, (4) collaborative action-based education and learning and (5) sustainability. The framework's practical application is illustrated through the presentation of three international case studies and four policy implications. Lessons learned, limitations and future opportunities are also discussed. The holistic policy and intervention framework for global mental health reflects an iterative learning process that can be applied and scaled up across different settings through appropriate modifications. © The Author 2015; all rights reserved. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
    Health Policy and Planning 03/2015; DOI:10.1093/heapol/czv016 · 3.47 Impact Factor
Show more