Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

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Abstract

Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.

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Poverty and common mental disorders in low and middle income countries: A systematic review.

Crick Lund, Alison Breen, Alan J Flisher … (2010)

In spite of high levels of poverty in low and middle income countries (LMIC), and the high burden posed by common mental disorders (CMD), it is only in the last two decades that research has emerged that empirically addresses the relationship between poverty and CMD in these countries. We conducted a systematic review of the epidemiological literature in LMIC, with the aim of examining this relationship. Of 115 studies that were reviewed, most reported positive associations between a range of poverty indicators and CMD. In community-based studies, 73% and 79% of studies reported positive associations between a variety of poverty measures and CMD, 19% and 15% reported null associations and 8% and 6% reported negative associations, using bivariate and multivariate analyses respectively. However, closer examination of specific poverty dimensions revealed a complex picture, in which there was substantial variation between these dimensions. While variables such as education, food insecurity, housing, social class, socio-economic status and financial stress exhibit a relatively consistent and strong association with CMD, others such as income, employment and particularly consumption are more equivocal. There are several measurement and population factors that may explain variation in the strength of the relationship between poverty and CMD. By presenting a systematic review of the literature, this paper attempts to shift the debate from questions about whether poverty is associated with CMD in LMIC, to questions about which particular dimensions of poverty carry the strongest (or weakest) association. The relatively consistent association between CMD and a variety of poverty dimensions in LMIC serves to strengthen the case for the inclusion of mental health on the agenda of development agencies and in international targets such as the millenium development goals. Copyright 2010 Elsevier Ltd. All rights reserved.

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Mental health literacy. Public knowledge and beliefs about mental disorders.

A. JORM (2000)

Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected. To introduce the concept of mental health literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps in the area. A narrative review within a conceptual framework. Many members of the public cannot recognise specific disorders or different types of psychological distress. They differ from mental health experts in their beliefs about the causes of mental disorders and the most effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common. Much of the mental health information most readily available to the public is misleading. However, there is some evidence that mental health literacy can be improved. If the public's mental health literacy is not improved, this may hinder public acceptance of evidence-based mental health care. Also, many people with common mental disorders may be denied effective self-help and may not receive appropriate support from others in the community.

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Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative.

Philip Wang, Matthias Claus Angermeyer, Guilherme Borges … (2007)

Data are presented on patterns of failure and delay in making initial treatment contact after first onset of a mental disorder in 15 countries in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Representative face-to-face household surveys were conducted among 76,012 respondents aged 18 and older in Belgium, Colombia, France, Germany, Israel, Italy, Japan, Lebanon, Mexico, the Netherlands, New Zealand, Nigeria, People's Republic of China (Beijing and Shanghai), Spain, and the United States. The WHO Composite International Diagnostic Interview (CIDI) was used to assess lifetime DSM-IV anxiety, mood, and substance use disorders. Ages of onset for individual disorders and ages of first treatment contact for each disorder were used to calculate the extent of failure and delay in initial help seeking. The proportion of lifetime cases making treatment contact in the year of disorder onset ranged from 0.8 to 36.4% for anxiety disorders, from 6.0 to 52.1% for mood disorders, and from 0.9 to 18.6% for substance use disorders. By 50 years, the proportion of lifetime cases making treatment contact ranged from 15.2 to 95.0% for anxiety disorders, from 7.9 to 98.6% for mood disorders, and from 19.8 to 86.1% for substance use disorders. Median delays among cases eventually making contact ranged from 3.0 to 30.0 years for anxiety disorders, from 1.0 to 14.0 years for mood disorders, and from 6.0 to 18.0 years for substance use disorders. Failure and delays in treatment seeking were generally greater in developing countries, older cohorts, men, and cases with earlier ages of onset. These results show that failure and delays in initial help seeking are pervasive problems worldwide. Interventions to ensure prompt initial treatment contacts are needed to reduce the global burdens and hazards of untreated mental disorders.

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Journal

Journal ID (iso-abbrev): PLoS ONE

Title: PloS one

Publisher: Public Library of Science (PLoS)

ISSN (Electronic): 1932-6203

ISSN (Print): 1932-6203

Publication date (Electronic): 2014

Volume: 9

Issue: 2

Affiliations

[1 ] Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ; Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom.

[2 ] Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.

[3 ] School of Psychology, University of KwaZulu-Natal, Durban, South Africa.

[4 ] PRIME India team, Sangath Non-Governmental Organisation, Goa, India.

[5 ] Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.

[6 ] Butabika National Mental Hospital, Kampala, Uganda.

[7 ] Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

[8 ] Centre for Mental Health, Public Health Foundation of India, New Delhi, India.

[9 ] Department of Research and Development, HealthNet Transcultural Psychosocial Organisation, Amsterdam, The Netherlands ; Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

[10 ] Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.

[11 ] Sangath Non-Governmental Organisation, Goa, India ; Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

[12 ] Centre for Public Mental Health, Department of Psychology, Stellenbosch University and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.

[13 ] Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.

[14 ] Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

[15 ] Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom.

Article

Publisher Item ID: PONE-D-13-35284

DOI: 10.1371/journal.pone.0088437

PMC ID: 3928234

PubMed ID: 24558389

SO-VID: 40d23d9f-ecb4-4aba-a03a-2492fac7a7e7

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Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

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Most cited references 23

Poverty and common mental disorders in low and middle income countries: A systematic review.

Mental health literacy. Public knowledge and beliefs about mental disorders.

Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative.

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