Integrating mental health in primary healthcare in low-income countries: changing the future for people with mental disorders

Sørensen, Carina Winkler; Bæk, Ole; Kallestrup, Per; Carlsson, Jessica

doi:10.1080/08039488.2016.1245784

Cited by 13 publications

(20 citation statements)

References 41 publications

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“…The reviewed literature mostly discussed WHO policies related to NCDs in terms of the policies’ implementation and effectiveness. Key policies include the WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases [ 19 ], WHO Global NCD Action Plan 2013–2020 [ 2 , 21 – 26 ], WHO’s Framework Convention on Tobacco Control [ 1 , 21 , 27 – 31 ], WHO Mental Health Action Plan and Mental Health Gap [ 22 , 32 – 34 ], WHO Strategy to Reduce Harmful Alcohol Consumption [ 26 ], WHO Best Buys [ 35 ], WHO Package of Essential NCDs Interventions for Primary Healthcare [ 35 – 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…To date, the literature has studied global actors’ NCD-related investment and policies separately. Concerning global actors’ NCD policies, the literature has predominantly focused on WHO policies related to NCDs, indicating a need to broaden the policy discussion [ 1 , 2 , 19 , 22 , 26 , 29 , 32 – 35 , 37 , 68 – 70 ]. Policies of other bilateral and multilateral actors have received little attention.…”

Section: Discussionmentioning

confidence: 99%

“…In NCD tackling efforts, NGOs have contributed to policy development and interactions between various actors, technical support, capacity building, and resource mobilisation [ 8 , 18 , 24 , 26 , 27 , 29 , 81 – 83 ]. At the national level, NGOs, especially local ones, are involved in providing NCD services, including mental health, particularly to disadvantaged groups [ 22 , 27 , 84 – 87 ]. However, NGOs involved in NCDs and health systems struggle with sustainability as the local government structures still lack funding and the capacity to take over their activities [ 88 ].…”

Section: Discussionmentioning

confidence: 99%

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An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries

et al. 2021

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Background Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prevention and management. However, the policies of key global actors (bilateral, multilateral, and not-for-profit organisations) have been understudied. Methods This study aimed to map the key global actors investing in action regarding NCDs and review their policies to examine the articulation of priorities regarding NCDs. Narrative synthesis of 70 documents and 31 policy papers was completed, and related to data collated from the Global Health Data Visualisation Tool. Results In 2019 41% of development assistance for health committed to NCDs came from private philanthropies, while that for other global health priorities from this source was just 20%. Through a range of channels, bilateral donors were the other major source of NCD funding (contributing 41% of NCD funding). The UK and the US were the largest bilateral investors in NCDs, each contributing 8%. However, NCDs are still under-prioritised within bilateral portfolios – receiving just 0.48% of US funding and 1.66% of the UK. NGOs were the key channels of funding for NCDs, spending 48% of the funds from donors in 2019. The reviewed literature generally focused on NCD policies of WHO, with policies of multilateral and bilateral donors given limited attention. The analysis of policies indicated a limited prioritisation of NCDs in policy documents. NCDs are framed in the policies as a barrier to economic growth, poverty reduction, and health system sustainability. Bilateral donors prioritise prevention, while multilateral actors offer policy options for NCD prevention and care. Even where stated as a priority, however, funding allocations are not aligned. Conclusion The growing threat of NCDs and their drivers are increasingly recognised. However, global actors’ policy priorities and funding allocations need to align better to address these NCD threats. Given the level of their investment and engagement, more research is needed into the role of private philanthropies and NGOs in this area.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries

et al. 2021

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“…The model looks beyond symptom management by providing service users with tools for recovery (Compton et al, 2020) and enabling individuals with mental illness to have satisfying and meaningful lives in the community (Kerman et al, 2019). Despite the World Health Organization's (WHO's) advocacy of a recovery-based approach (Sorensen et al, 2017), this has rarely been used in low-income and middle-income countries (LMICs) (Pahwa et al, 2020), where mental health services are limited and continue to be heavily focused on the institutionalization of individuals with mental illness. Lack of public awareness and resources are among the factors explaining the poor state of mental health services in LMICs (Patel et al, 2018a).…”

Section: Introductionmentioning

confidence: 99%

“…Meanwhile, more than 80% of people experiencing mental disorders and substance abuse live in LMICs (Patel and Prince, 2010). Research on recovery from mental health issues in LMICs is scarce (Sorensen et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Understanding perceptions of recovery from psychological distress in Sierra Leone through qualitative comparative analysis

Jailobaeva

Horn

Bah

et al. 2021

Humanit Soc Sci Commun

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Qualitative comparative analysis (QCA) is a relatively new method that examines causal complexity. Its use in mental health research is nascent. In low-income and fragile settings, with weak mental health service provision, identifying pathways of recovery from psychological distress can inform the appropriate deployment of scarce community and public resources. This paper examines the use of QCA to identify predictors of recovery in Sierra Leone. Our study explored lay perceptions of the signs of recovery from psychological distress caused by such events as the loss of a family member, severe sickness, and loss of a relationship. The data drew upon 75 interviews with women and men, across four districts of Sierra Leone, who described the signs of recovery from psychological distress they have observed in one person known to them. The truth table generated through QCA software indicated two signs of recovery— work/study and healthy relations—to be the most prevalent across different combinations of predictive factors. Further analysis of the truth table and sub-set relations suggested that work/study and healthy relations frequently served as sufficient conditions for reported recovery from distress to occur. QCA provided a means to identify sufficient predictive factors for recovery from psychological distress to occur. The findings suggest that to enable recovery from psychological distress, support needs to be broad and bring together services that will enable individuals to improve their social and relational wellbeing. Responses to distress need to involve a wide range of community-based stakeholders who will help individuals to engage in constructive activity and strengthen relations with their family members, friends, and the broader community. QCA is potentially well-positioned to unpack complexity in mental health research.

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Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries

Ginneken

Chin

Lim

et al. 2021

Cochrane Database of Systematic Reviews

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Background Community‐based primary‐level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low‐ and middle‐income countries. Objectives To evaluate the effectiveness of PW‐led treatments for persons with mental health symptoms in LMICs, compared to usual care. Search methods MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). Selection criteria Randomised trials of PW‐led or collaborative‐care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non‐health professionals (CPs). Data collection and analysis Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality‐of‐life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1‐6 months), T3 ( >6 months) post‐intervention. Main results Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. “Probably”, “may”, or “uncertain” indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW‐led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD ‐0.59, 95%CI ‐1.01 to ‐0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD ‐0.47, 95%CI ‐0.8 to ‐0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative‐care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little‐or‐no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly red...

show abstract

Integrating mental health in primary healthcare in low-income countries: changing the future for people with mental disorders

Cited by 13 publications

References 41 publications

An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries

An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries

Understanding perceptions of recovery from psychological distress in Sierra Leone through qualitative comparative analysis

Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries

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