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

ABSTRACT 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.

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Available from: Alex Cohen, Aug 20, 2015
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    • "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. "
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    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 · 3.00 Impact Factor
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    • "Policy is important for guiding appropriate training for healthcare providers, community-health workers, and volunteers who deliver mental health interventions in resource-constrained settings (Fisher et al. 2012). Indeed, cost-effective interventions led by nonspecialists are available to treat postnatal depression in LMIC where adequate mental health budgets and formallytrained healthcare professionals are often limited (Fisher et al. 2012; Saraceno et al. 2007). "
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    • "Depression lowers quality of life, affects socio-economic prosperity, education and employment (Lund et al., 2010) and affective disorders are prevalent in 59% of suicides (Cavanagh et al., 2003), contributing to a substantial proportion of global morbidity and mortality(Bertolote and Fleischmann, 2002). Despite the pervasive effects of depression, little attention has been given to research and health planning in low and middle income countries (LMICs) which has resulted in a lack of detection, treatment and a shortage of trained staff (WHO, 2008a; Saxena et al., 2007; Saraceno et al., 2007). Since 2008, the World Health Organization (WHO) has increased its effort in addressing this unmet need (mhGAP) (WHO, 2008b), but the treatment gap is still large (WHA, 2012) and evidence-based studies on the availability of and barriers to health care is scarce (Lancet, 2007; WHO, 2008b). "
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