The reviewed paper is the fifth in the Global Mental Health Series – ‘Barriers to improvement of mental health services in low-income and middle-income countries’ by Benedetto Saraceno, Mark van Ommeren and colleagues and is freely available online.
The aim of the paper was to identify barriers to improvement of mental health services in low and middle-income countries (LAMIC).
The method was briefly outlined in the paper although in more detail elsewhere. International experts and leaders with knowledge of LAMIC’s were selected although the inclusion criteria weren’t clear from the description. A set of 7 open-ended questions were administered and the results were analysed independently (using thematic analysis) by two data analysts.
57 responses were obtained with a total of 90848 words from people in 30 countries (18 LAMIC’s). The respondents were described as ‘senior experts’.
The paper was then organised into four themed sections followed by a summary of the lessons that were learnt.
In the section on the public health priority agenda and funding, the lack of mental health as a Millenium Development Goal was noted. A lack of consensus amongst ‘leading experts’ was cited as a barrier to obtaining funds, with different areas within mental health competing for resources and different strategies being suggested. Similarly there were different approaches by groups with an interest in mental health and it was also thought that mental health parlance was difficult to understand. The relative dearth of numerical markers equivalent to mortality figures was yet another reason suggested as well as the ‘absence of a ground-swell’.
In terms of the organisation of services, institutions and community care were the main themes emerging. The models of insitutional care were thought to be less cost-effective and also less effective in delivering care to the rural areas where this was needed. The interesting point of training needing to occur in rural areas was also raised. The translation of government directives at the local level was also cited as presenting a barrier. The interaction with primary care was also mentioned – with reference to the 1978 declaration of Alma-Ata which suggests that primary care should be supported and integrated with the referral systems.
In terms of human resources there were thought to be too few appropriately qualified people to provide the level of care that was needed particularly in rural areas. One creative solution was to train hairdressers and barbers to identify mental health problems and refer as appropriate. Another suggestion was about use of community resources. Public mental health leadership was another area with comments on the need for training in public mental health skills.
There are many valuable lessons from this paper that can be used for the mental health problems of low and middle-income countries.
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