Scale up of services for mental health in low-income and middle-income countries

Mental disorders constitute a huge global burden of disease, and there is a large treatment gap, particularly in low-income and middle-income countries. This paper assesses the progress in scaling up mental health services worldwide, using a survey of key national stakeholders in mental health.

The paper notes that major barriers to scaling up of mental health services in countries with low and middle incomes include absence of financial resources and government commitment and over-centralisation. In addition, challenges of integration of mental health care into primary care settings, scarcity of trained mental health personnel and shortage of public health expertise among mental health leaders are tangible barriers as well.

As a result, the authors argue that a systemic and strategic approach to scaling up is needed.

Conclusions and recommendations are as follows:

• specific interventions to increase coverage of mental health services need to be a part of a broad and integrated process
• if services are to be scaled up, a substantial increase in resources (i.e. strong advocacy for financial commitment) and more efficient use of the resources that exist is needed
• decision makers and political leaders are urged to understand the situation, recognise their importance, and prioritise action to address mental health needs
• task sharing is the means to most efficiently use low numbers of trained personnel - a high proportion of need can be met with simple packages of care delivered in non-hospital settings by non-specialists
• mental health professionals and practitioners need to broaden their roles, accepting responsibility for planning, training, supervision, and advocating with decision makers in their area of expertise
• close collaboration between research groups, government, non-governmental organisations, and other stakeholders is essential for the meant purpose.