scholarly journals Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative

2020 ◽  
pp. 1-13
Author(s):  
Daniel Fernández ◽  
Daniel Vigo ◽  
Nancy A. Sampson ◽  
Irving Hwang ◽  
Sergio Aguilar-Gaxiola ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Mental Healthcare ◽  
High Income ◽  
Drop Out ◽  
World Health ◽  
Dropout Rates ◽  
Financial Protection ◽  
Middle Income ◽  
Training Support

Abstract Background There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. Methods Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. Results Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. Conclusions Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.

scholarly journals Disability and treatment of specific mental and physical disorders across the world

2008 ◽  
Vol 192 (5) ◽  
pp. 368-375 ◽  
Author(s):  
Johan Ormel ◽  
Maria Petukhova ◽  
Somnath Chatterji ◽  
Sergio Aguilar-Gaxiola ◽  
Jordi Alonso ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
High Income ◽  
World Health ◽  
Role Functioning ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Physical Disorders ◽  
Low And Middle Income

BackgroundAdvocates of expanded mental health treatment assert that mental disorders are as disabling as physical disorders, but little evidence supports this assertion.AimsTo establish the disability and treatment of specific mental and physical disorders in high-income and low- and middle-income countries.MethodCommunity epidemiological surveys were administered in 15 countries through the World Health Organization World Mental Health (WMH) Survey Initiative.ResultsRespondents in both high-income and low- and middle-income countries attributed higher disability to mental disorders than to the commonly occurring physical disorders included in the surveys. This pattern held for all disorders and also for treated disorders. Disaggregation showed that the higher disability of mental than physical disorders was limited to disability in social and personal role functioning, whereas disability in productive role functioning was generally comparable for mental and physical disorders.ConclusionsDespite often higher disability, mental disorders are under-treated compared with physical disorders in both high-income and in low- and middle-income countries.

scholarly journals Drop out from out-patient mental healthcare in the World Health Organization's World Menta Health Survey initiative

2013 ◽  
Vol 202 (1) ◽  
pp. 42-49 ◽  
Author(s):  
J. Elisabeth Wells ◽  
Mark Oakley Browne ◽  
Sergio Aguilar-Gaxiola ◽  
Ali Al-Hamzawi ◽  
Jordi Alonso ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Mental Healthcare ◽  
Income Group ◽  
Drop Out ◽  
World Health ◽  
Health Treatment ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World

BackgroundPrevious community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada.AimsTo explore mental health treatment drop out in the World Health Organization World Mental Health Surveys.MethodRepresentative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted.ResultsOverall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/ lower/middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit.ConclusionsDrop out needs to be reduced to ensure effective treatment.

scholarly journals Stemming the tide: promoting mental health and preventing mental disorders in low- and middle-income countries

2015 ◽  
Vol 2 ◽  
Author(s):  
W. A. Tol
Keyword(s):  
Mental Health ◽  
Health Promotion ◽  
Mental Disorders ◽  
Global Mental Health ◽  
Action Plan ◽  
Mental Health Promotion ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

The first World Health Organization's global action plan for mental health recognizes the importance of mental health promotion and prevention of mental disorders, through the inclusion of one of four objectives focused on this crucial area of research and practice. This paper aims to provide an ‘aerial view’ of the field of mental health promotion and prevention of mental disorders with a focus on low- and middle-income countries. Starting with reasons why promotion and prevention need to take center stage in global mental health efforts, the paper provides a framework and four general principles to guide such efforts: a socio-ecological perspective (place); an inter-sectoral and interdisciplinary approach (collaboration), a developmental perspective (timing), and a participatory and empowerment approach (strengths), or PaCTS. Evidence-based examples of mental health promotion, universal, selective, and indicated prevention are described.

scholarly journals Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

2016 ◽  
Vol 208 (s56) ◽  
pp. s13-s20 ◽  
Author(s):  
Rahul Shidhaye ◽  
Sanjay Shrivastava ◽  
Vaibhav Murhar ◽  
Sandesh Samudre ◽  
Shalini Ahuja ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Action Plan ◽  
Mental Healthcare ◽  
Theory Of Change ◽  
World Health ◽  
Care Workers ◽  
Care Models ◽  
Health Organization

BackgroundThe large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.AimsTo operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.MethodMixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility.ResultsThe MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.ConclusionsThere are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.

Poverty and mental illness: An unbreakable cycle?

2011 ◽  
Vol 26 (S2) ◽  
pp. 577-577
Author(s):  
M. Santos ◽  
A.E. Ribeiro
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Economic Status ◽  
Meta Analysis ◽  
World Health ◽  
Mental Condition ◽  
Middle Income ◽  
Poverty Indicators ◽  
Health Organization

Mental condition is determined by a multiplicity of factors, such as biological, individual, social, economic and environmental. Mental and behavioural disorders are estimated to account for 13% of the global burden of disease, according to the World Health Organization. Despite this evidence, mental health is a neglected and an under-researched area of public health, particularly in low-and-middle-income-countries (LMICs).Recent studies found an association between common mental disorders (CMD), such as depression and anxiety, and poverty. However, investigation on several specific poverty indicators has revealed a much more complex scenario.A recent meta-analysis showed that variables such as education, food insecurity, housing, social class, socio-economic status and financial stress are consistently and strongly associated with CMD. In turn, the disabling effects of mental disorders impair the ability of persons to self-sustain, reflecting a relationship between poverty and mental disorders that has been likened to a vicious cycle.The authors emphasize the need for improvement of LMICs mental health policies.

scholarly journals Global mental health in high-income countries

2016 ◽  
Vol 209 (1) ◽  
pp. 3-5 ◽  
Author(s):  
S. P. Sashidharan ◽  
Ross White ◽  
Roberto Mezzina ◽  
Stefan Jansen ◽  
Darius Gishoma
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Global Mental Health ◽  
Scale Up ◽  
Mental Healthcare ◽  
Cost Effective ◽  
High Income ◽  
Middle Income ◽  
Poor Countries

SummaryOver the past decade there have been significant efforts to scale-up mental health services in resource-poor countries. A number of cost-effective innovations have emerged as a result. At the same time, there is increasing concern in resource-rich countries about efficacy, efficiency and acceptability of mental health services. We consider two specific innovations used widely in low- and middle-income countries, task-sharing and a development model of mental healthcare, that we believe have the potential to address some of the current challenges facing mental health services in high-income countries.

scholarly journals Human resources for mental health – challenges and opportunities in developing countries

2005 ◽  
Vol 2 (7) ◽  
pp. 5-7 ◽  
Author(s):  
R. Srinivasa Murthy
Keyword(s):  
Mental Health ◽  
Developing Countries ◽  
Human Resources ◽  
Mental Healthcare ◽  
Developed Countries ◽  
World Health ◽  
World Health Report ◽  
Middle Income ◽  
Health Report ◽  
Health Organization

Human resources for mental health are a challenge in all countries. In countries rich and poor, there is a big gap between the need for mental health services and the availability of those services. In an unusual way, the barriers to mental healthcare appear to be universal, which is not true of non-psychiatric healthcare. Nonetheless, the World Health Report 2001 and the World Health Organization's Atlas project have recorded extremely low levels of service in most developing countries (World Health Organization, 2001a,b). The recruitment of consultant psychiatrists from low- and middle-income countries, discussed in the October 2004 issue of International Psychiatry (Ndetei et al, 2004; Jenkins, 2004), raises a number of challenges for both developing and developed countries.

Traditional herbalists’ methods of treating mental disorders in Ghana

2018 ◽  
Vol 56 (1) ◽  
pp. 250-266 ◽  
Author(s):  
Lily N. A. Kpobi ◽  
Leslie Swartz ◽  
Cephas N. Omenyo
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Traditional Medicine ◽  
Mental Health Professionals ◽  
Specific Treatment ◽  
Mental Healthcare ◽  
Traditional Healers ◽  
Structured Interviews ◽  
Middle Income ◽  
Traditional Herbalists

The use of traditional medicine for the treatment of various disorders is not a new practice. Indeed, various categories of traditional healers form a large part of the healthcare workforce in many low- and middle-income countries, and given the paucity of mental health professionals in these countries, traditional and complementary medicine practitioners are utilised even more so for mental disorders. In Ghana, efforts have been made to formalise and standardise the work of traditional medicine practitioners. This goal is still mostly unmet, partly due to the lack of scientific knowledge of their beliefs, methods, and practices in mental healthcare. Very few studies have documented this knowledge. In this article, we report on some of the methods that are used by traditional Ghanaian herbalists in treating mental disorders. Eight herbalists working within the Greater Accra Region, who specialised in mental health, were interviewed through individual semi-structured interviews. Thematic analysis showed that traditional herbalists’ work in treating mental disorders revolved around four key themes: the method of diagnosis; the treatment methods used; the mode of administering the treatment; and the purpose of the specific treatment. These themes are discussed with reference to their potential implications for patients’ care and outcomes.

scholarly journals The future of psychiatry

10.17816/cp63 ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 3-7
Author(s):  
Norman Sartorius
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Human Rights ◽  
Mental Disorders ◽  
Mental Health Problems ◽  
Health Workers ◽  
Mental Healthcare ◽  
Past Century ◽  
Middle Income ◽  
Adequate Treatment

Since the Second World War mental health programmes and psychiatry have made significant advances. Countries, as well as the United Nations, have recognized the magnitude and severity of mental health problems, and numerous national programmes have been launched to deal with them. Technology relating to the treatment of mental disorders has advanced and significant progress has been made in terms of knowledge regarding the functioning of the brain. The awareness of the need to protect the human rights of those with mental illness has increased. National and regional programmes against stigma and the consequent discrimination of those with mental illness, have been launched in many countries. Associations bringing together those who have experienced mental illness and their relatives, have come into existence in many countries. While these are great steps forward, more work is necessary to complete these advances. In low- and middle-income countries, the vast majority of people with mental disorders do not receive adequate treatment. Even in highly industrialized countries, a third of people with severe forms of mental illness are not receiving the appropriate therapy. Laws concerning mental health are outdated in many countries. The protection of the human rights of the mentally ill is incomplete and imperfect. The emphasis on economic gain and the digitalization of medicine in recent years has not helped. On occasions, this has even slowed down the development of mental health services, and the provision of mental healthcare. Thus, psychiatry must still deal with the challenges of the past century, while facing new demands and tasks. Among the new tasks for psychiatry are undoubtedly reforms which will allow (i) the provision of appropriate care of people with comorbid mental and physical disorders, (ii) the application of interventions leading to the primary prevention of mental and neurological disorders, and (iii) a radical reform of the education of psychiatrists and other mental health workers, dealing with mental illness. Collaboration with other stakeholders in the field of mental health and medicine, will be of crucial importance in relation to all these tasks.

scholarly journals Mental Health Gap Action Programme training in Nigeria: reflections for progressive learning among primary care workers

2021 ◽  
pp. 1-3
Author(s):  
Alvina Ali ◽  
Nandini Chakraborty
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Knowledge Base ◽  
Mental Healthcare ◽  
World Health ◽  
Middle Income ◽  
Care Workers ◽  
The World ◽  
Health Gap ◽  
Action Programme

In the majority of low- and middle-income countries, mental healthcare is delivered by primary care workers. Often, they are the only contact for patients and their families. Although their knowledge base can be limited, they are expected to manage complex cases with few resources. The authors describe their experience of partnership with mental health centres set up by the Nigeria Health Care Project, and training their primary care workers based on the World Health Organization's Mental Health Gap Action Programme. Although the programme was very effective in helping to upskill their knowledge and experience, a need for continued professional development was highlighted. Based on their feedback, multiple evidence-based options are explored, including the use of remote learning and social media (increased significantly around the world because of the COVID-19 pandemic), to help primary care workers improve their knowledge base and maintain their competencies with the limited resources available.

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