Scaling up services for mental and neurological disorders in low-resource settings

Abstract

SummaryMental and neurological disorders (MNDs) account for a large, and growing, burden of disease in low- and middle-income countries. Most people do not have access to even basic health care for these disorders. Recent evidence shows that task-shifting to non-specialist community health workers is a feasible and effective strategy for delivery of efficacious treatments for specific MND in low-resource settings. New global initiatives, such as the WHO's mental health Gap Action Program, are utilizing this evidence to devise packages of care for specific MNDs. This paper describes a plan that seeks to integrate the evidence on the treatment of specific MNDs, based on a task-shifting paradigm, for scaling up services for MNDs at the level of a defined population. The plan was developed by a state government in India in collaboration with technical partners, as a model District Mental Health Program for India's National Mental Health Program.

Alcohol use and health care utilization in rural Liberia: Results of a community-based survey for basic public health indicators

“…This possibility is consistent with other studies, where alcohol use has been associated with nearly 4% of all-cause mortality; furthermore, the attributable disease burden is most prominent among marginalized populations (Casswell & Thamarangsi, 2009; In the last decade, recognition of alcohol use and mental illness as neglected public health issues in low-resource countries has led to a call for action (Patel et al, 2009). In Liberia, several studies estimate a high prevalence of mental illness (Galea et al, 2010;Johnson et al, 2008).…”

“…Alcoholism, along with mental illness, is among the most neglected global health problems in the developing world (Bass et al, 2010;Patel, Goel, & Desai, 2009). After a prolonged civil war, Liberia has the second lowest per capita GDP in the world (World Economic Outlook Database International Monetery Fund, 2011), and is recovering from widespread destruction of health infrastructure.…”

Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol

“…Rather than using specialised care settings to address mental disorders, integrated primary care settings optimise health worker interventions for mental health through 'task-sharing'-delegating tasks and responsibilities from more specialised mental health clinicians to less specialised health workers. 2 Although integrating mental healthcare into primary care settings has the potential to significantly reduce the burden of mental disorders, 3-6 few real-world models exist to show how evidence-based mental healthcare can be implemented in primary healthcare settings in resource-limited areas, especially for severe mental disorders. The WHO has created mental healthcare implementation guidelines for non-specialist providers, 7 yet most primary care personnel in low-resource settings have had little or no training in the delivery of mental health services.…”

“…We hypothesise that service users will experience at least a 25% improvement in symptoms and functioning from baseline after MESH MH programme participation. To understand any outcome improvements under the intervention, we will evaluate programme processes using (1) quantitative analyses of routine service utilisation data and supervision checklist data and (2) qualitative semistructured interviews with primary care nurses, service users and family members.…”

Expanding the Pipeline: The New York University School of Medicine–University of Ghana School of Medicine and Dentistry Psychiatric Education Initiative

“…The twinning process , wherein institutions in high income countries (HIC) and LAMICs partner to address common goals by sharing their resources and time has been proposed as one such model to addressing global disparities [5]. Much of the work in global capacity building to date has focused on training lay persons and paraprofessionals [4, 6, 7]; however, there is a role for training high level professionals, including medical students, residents, and psychiatrists [5]. …”