Evidence-Based Guidelines for Mental, Neurological, and Substance Use Disorders in Low- and Middle-Income Countries: Summary of WHO Recommendations

Dua, Tarun; Barbui, Corrado; Clark, N.J.; Fleischmann, Alexandra; Poznyak, Vladimir; Ommeren, Mark van; Yasamy, M. Taghi; Ayuso-Mateos, José Luís; Birbeck, Gretchen L.; Drummond, Colin; Freeman, Melvyn; Giannakopoulos, Pantéleimon; Levav, Itzhak; Obot, Isidore; Omigbodun, Olayinka; Patel, Vikram; Phillips, Michael R.; Prince, Martin; Rahimi-Movaghar, Afarin; Rahman, Atıf; Sander, Josemir W.; Saunders, John B.; Servili, Chiara; Rangaswamy, Thara; Unützer, Jürgen; Ventevogel, Peter; Vijayakumar, Lakshmi; Thornicroft, Graham; Saxena, Shekhar

doi:10.1371/journal.pmed.1001122

Cited by 270 publications

(232 citation statements)

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“…A detailed discussion of the scientific basis for the mhGAP guidelines is beyond the scope of this article, but can be found elsewhere. 16 Briefly, WHO established a Guideline Development Group in 2008 to develop evidence-based recommendations that adhered to the Grading of Recommendations Assessment, Development and Evaluation principles for developing transparent, evidence-based WHO guidelines. 17 By using this methodology, the group systematically synthesized and appraised the evidence base for interventions, leading to the publication of the mhGAP-IG.…”

Section: Figurementioning

confidence: 99%

“…Nevertheless, these results indicate strong trends toward a positive impact. It should be borne in mind that the intervention is based on WHO mhGAP guidelines that are evidence-based, 16 and the positive outcomes indicate that the integrated innovation in implementation is producing change in outcomes in the right direction. Further robust evaluation (through randomized controlled trial design) of scaled-up programs would…”

Section: Monitoring Outcomes: Mobile Information Management Systemmentioning

confidence: 99%

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Model for Service Delivery for Developmental Disorders in Low-Income Countries

et al. 2015

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As in many low-income countries, the treatment gap for developmental disorders in rural Pakistan is near 100%. We integrated social, technological, and business innovations to develop and pilot a potentially sustainable service for children with developmental disorders in 1 rural area. Families with developmental disorders were identified through a mobile phone–based interactive voice response system, and organized into “Family Networks.” “Champion” family volunteers were trained in evidence-based interventions. An Avatar-assisted Cascade Training and information system was developed to assist with training, implementation, monitoring, and supervision. In a population of ∼30 000, we successfully established 1 self-sustaining Family Network consisting of 10 trained champion family volunteers working under supervision of specialists, providing intervention to 70 families of children with developmental disorders. Each champion was responsible for training and providing ongoing support to 5 to 7 families from his or her village, and the families supported each other in management of their children. A pre-post evaluation of the program indicated that there was significant improvement in disability and socioemotional difficulties in the child, reduction in stigmatizing experiences, and greater family empowerment to seek services and community resources for the child. There was no change in caregivers’ well-being. To replicate this service more widely, a social franchise model has been developed whereby the integrated intervention will be “boxed” up and passed on to others to replicate with appropriate support. Such integrated social, technological, and business innovations have the potential to be applied to other areas of health in low-income countries.

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confidence: 99%

Section: Monitoring Outcomes: Mobile Information Management Systemmentioning

confidence: 99%

Model for Service Delivery for Developmental Disorders in Low-Income Countries

et al. 2015

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“…12 Few studies exist to provide an evidence-based approach to the diagnosis of dementia by GPs. The World Health Organization recommends that dementia is diagnosed by non-specialists in routine cases in low and middle income countries 13 ; indeed the global clinical judgement of repeated GP consultations (three or four 10-minute-consultations) has moderate utility for the diagnosis of dementia with an area under the curve (AUC) of 0.74. 14 An AUC of 0.5 indicates a test no better than chance, such as coin-tossing, whereas an AUC of 1 indicates no diagnostic errors.…”

Section: Introductionmentioning

confidence: 99%

Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study

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et al. 2015

Br J Gen Pract

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“…To date much of the mental health research undertaken in LAMICs has been on classification, epidemiology and identification of mental disorders. Yet recent developments include improved policy guidance, treatment guidelines and generation of evidence on the cost-effectiveness of interventions in LAMICs, especially those relevant for primary and community care staff (Patel & Thornicroft, 2009 (Barbui et al 2010;World Health Organization, 2010;Dua et al 2011), and the recent Grand Challenges in Global Mental Health review (Collins et al 2011), which singled out improved treatment and access to care as the core agenda for future research and development efforts. There is therefore now a strong and growing international consensus that the shortage of specialist mental health care staff requires a policy shift to a clear commitment that LAMICs horizontally integrate mental health care into primary care and into maternal health care (Eaton et al 2011;United Nations, 2011).…”

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Evidence-based mental health care and implementation science in low- and middle-income countries

Thornicroft

2012

Epidemiol Psychiatr Sci

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Although the evidence base for what to do about the mental health gap in low-and middle-income countries (LAMICs) has improved significantly over the last decade, mental health care in LAMICs still provide services to only a small minority of people with mental disorders. The problem is how to translate the relevant body of scientific knowledge into routine practice. It is clear from over two decades of research that the creation of evidence-based guidelines is necessary but not sufficient for evidence-based practice, whether in high-or low-income settings. In this Editorial, I discuss whether the recent development of 'implementation science' may offer an opportunity towards effective guideline implementation in low-and medium-income settings, so that clinical practice is more often based on evidence that does lead to patient benefit. First published online 28 May 2012Key words: Guidelines, implementation, low-and middle-income countries.If there can be 'no health without mental health' (Prince et al. 2007), then a health system does not function properly if it cannot protect and take care of the basic health rights and needs of people who are unwell or vulnerable -including people with mental illness (Chisholm et al. 2007). In most low-and middleincome countries (LAMICs), resources and services for mental health are meagre in the extreme, with lowincome countries allocating on average 0.5%, and lower-middle income countries 1.9% of their health budget to the treatment and the prevention of mental disorders, even though they represent over 10% of the overall disease burden World Health Organization, 2011). In LAMICs, there is on average one psychiatrist per 1.7 million inhabitants and one psychiatric inpatient bed per 42 000 inhabitants (Jacob et al. 2007). Most of the funds that are made available by governments are directed towards the running costs of mental hospital service provision. This limits the development of more equitable and cost-effective community-based services. The result of inadequate, inequitable and inefficient resourcing for mental health is a substantial treatment gap (Thornicroft, 2007). An international survey supported by WHO showed that 76-85% of people with severe mental disorders in low-income countries had not received any treatment in the previous 12 months ( Demyttenaere et al. 2004). The adverse consequences of this unmet need include the violation or abuse of human rights (Callard et al. 2012), long-term disability and ill-health (Chisholm et al. 2005), and increased mortality (Thornicroft, 2011;Wahlbeck et al. 2011).It is therefore clear that the quantity and quality of mental health care in LAMICs are grossly deficient. Is there sufficient relevant evidence from LAMICs on cost-effective interventions that do need to be put into practice? To date much of the mental health research undertaken in LAMICs has been on classification, epidemiology and identification of mental disorders. Yet recent developments include improved policy guidance, treatment guidelines and generation of...

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Evidence-Based Guidelines for Mental, Neurological, and Substance Use Disorders in Low- and Middle-Income Countries: Summary of WHO Recommendations

Abstract: Shekhar Saxena and colleagues summarize the recent WHO Mental Health Gap Action Programme (mhGAP) intervention guide that provides evidence-based management recommendations for mental, neurological, and substance use (MNS) disorders.

Cited by 270 publications

References 27 publications

Model for Service Delivery for Developmental Disorders in Low-Income Countries

Model for Service Delivery for Developmental Disorders in Low-Income Countries

Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study

Evidence-based mental health care and implementation science in low- and middle-income countries

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