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Overcoming impediments to community mental health in low- and middle-income countries 

Overcoming impediments to community mental health in low- and middle-income countries
Overcoming impediments to community mental health in low- and middle-income countries
Oxford Textbook of Community Mental Health

Benedetto Saraceno

, Mark van Ommeren

, and Rajaie Batniji


As discussed in Chapter 6 by Wang and colleagues, the prevalence of mental disorders across the world — and across low- and middle-income countries (LAMIC) — is high. The median rate across the world of having at least one mental disorder in the last year is 10 % (WHO WMHS Consortium, 2004). The impact of these disorders on disability, other aspects of health, and development is substantial. Yet, the vast majority of people with a mental disorder are not in contact with services that offer mental health care (Wang et al., Chapter 6, this volume), Importantly, the association between severe mental disorder and human rights violations is strong (WHO, 2001). Even among people with severe mental disorders, few people receive adequate, humane care (WHO, 2001) and discrimination is pervasive (Thornicroft, 2006). It is clear that there is an urgent need to act.

The World Health Organization (WHO, 2003) developed a mental health policy and planning package to help countries to develop services that provide access to adequate care for people with mental disorder. This package was preceded and followed by evidence-informed and evidence-based advocacy through major publications — such as World Health Report 2001 on mental health (WHO, 2001), the World Mental Health Report (Desjarlais et al., 1995), Neurological, Psychiatric, and Developmental Disorders (Institute of Medicine, 2001), Disease Control Priorities related to Mental Neurological, Developmental and Substance Abuse Disorders (WHO and Disease Control Priorities Project, 2006), the 2007 Lancet Series on Global Mental Health, and the 2008 mental health Gap Action Plan (WHO, 2008 ). Although most research evidence on interventions comes from specialized care settings in high-income countries, fortunately there are good indications that much of this evidence generalizes to LAMIC (Patel, 2007).

A naïve observer would perhaps expect that with this amount of burden, human rights violations, high-level advocacy, technical guidance, and evidence for interventions, that mental health service development in LAMIC is flourishing. Indeed, it should be. Although it is true that some countries have made major strides, the reality however has been that mental health service development in most LAMIC has been a challenge. This chapter will address some key impediments in developing mental health services in LAMIC and will offer strategies to address these impediments.

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