Ethics of Public Mental Health in Developing Societies

2015 ◽  
Author(s):  
Buddhika Lalanie Fernando ◽  
Athula Sumathipala
Keyword(s):  
Mental Health ◽  
Public Mental Health ◽  
Psychiatric Research ◽  
Ethical Perspective ◽  
Middle Income ◽  
Ethics Framework ◽  
Middle Income Countries ◽  
Curative Care ◽  
Resource Setting ◽  
Low Resource Setting

Half of the world’s population lives in countries with one psychiatrist to serve 200,000 people and in low and middle income countries (LAMICs), even most people with severe mental disorders remain untreated. As curative care is prioritized, public mental health is inundated with deep-seated problems, primarily due to the lack of funding. From an ethical perspective, such underlying issues in public mental health exist regardless of income levels; they are, however, further exacerbated by the lack of resources and awareness in LAMICs. Ironically, the ethics of public mental health have received much less attention than that of psychiatric research. We therefore use a public health ethics framework to broaden the ethical perspective in public mental health and examine it from a low-resource setting viewpoint. Next, we examine public mental health from a social justice perspective. Third, we examine issues critical to ensuring better access to mental health services in LAMICs.

scholarly journals Advancing Age in Africa, the Urgent Need for Institutional Geriatric Care in a Low Resource Setting: A Case Report

2021 ◽  
Vol 12 (2) ◽  
pp. 416-420
Author(s):  
Emmanuel Kobina Mesi Edzie ◽  
Klenam Dzefi-Tettey ◽  
Philip Narteh Gorleku ◽  
Frank Naku Ghartey ◽  
Madison Adanusa ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Geriatric Care ◽  
Health Concern ◽  
Healthcare Personnel ◽  
Healthcare Industry ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low And Middle Income

Background: The demand for geriatric care has been on the increase throughout the world, especially in the developing, low- and middle-income countries (LMICs), due to increasing life expectancy, improvement in technology in healthcare industry coupled with increasing numbers of healthcare personnel. Nonetheless, these increases in the resources to the healthcare industry are still woefully inadequate in the developing and LMICs, compared to the high demand for such services, thereby exposing the drastic challenges and gaps in geriatric services in these countries. Case Presentation: A 74-year-old woman apparently well, who was relocated from the rural area by her biological daughter, with the intention of giving her better care in a comfortable city environment. She was initially appreciative of the relocation. However, the situation went sour when her daughter and son-in-law resumed work after their annual leave period. They started locking her up in a well-furnished mansion with everything she may need until they returned from work. Consistently for eight working days, she was kept under lock and key because they did not want her to roam around the community, they thought was not familiar to her with the intention of keeping her safe. Everything was fine until they returned from work one day to find that she had soiled the house with her excrement, apparently as a protest against her consistent lock-up. This necessitated their visit to the hospital. A diagnosis of social isolation was made after clinical and mental state examination and appropriate interventions were instituted. The patient consequently became fine in the new environment. Conclusion: This case has been presented in order to emphasize the need to improve the systems for geriatric care which is of public health concern, especially as the life expectancy of the developing, low- and middle-income countries keep improving.

scholarly journals Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis

2021 ◽  
Vol 6 (6) ◽  
pp. e005190
Author(s):  
Chanel van Zyl ◽  
Marelise Badenhorst ◽  
Susan Hanekom ◽  
Martin Heine
Keyword(s):  
Content Analysis ◽  
Scoping Review ◽  
Qualitative Content Analysis ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low Middle Income Countries

IntroductionThe effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle-income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings.MethodsA systematic scoping review was undertaken to start unravelling the term ‘low-resource setting’. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to ‘low-resource setting’ and ‘rehabilitation’. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used.ResultsA total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term ‘low-resource setting’. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices.ConclusionThe emerging themes may assist with (1) the groundwork needed to unravel ‘low-resource settings’ in health-related research, (2) moving away from assumptive umbrella terms like ‘low-to-middle-income countries’ or ‘low/middle-income countries’ and (3) promoting effective knowledge transfer between settings.

scholarly journals The future of psychiatry in low- and middle-income countries

2009 ◽  
Vol 39 (11) ◽  
pp. 1759-1762 ◽  
Author(s):  
V. Patel
Keyword(s):  
Mental Health ◽  
Health Workers ◽  
Public Mental Health ◽  
Leadership Role ◽  
Treatment Gap ◽  
Middle Income ◽  
Middle Income Countries ◽  
Effective Interventions ◽  
Health Leadership ◽  
Low And Middle Income

The great shortage, and inequitable distribution, of psychiatrists in low- and middle-income countries is one of the key reasons for the large treatment gap for people with mental disorders. Psychiatrists need to play a public mental health leadership role in increasing the coverage of mental health care through task shifting of effective interventions to non-specialist health workers. Psychiatrists' new roles should include designing and managing such programmes, building clinical capacity, supervision and quality assurance, providing referral pathways and research.

Policy and public mental health in low- and middle-income countries

2018 ◽  
pp. 539-548
Author(s):  
Laura Shields ◽  
Soumitra Pathare ◽  
Pallavi Karnatak ◽  
Keshav Desiraju
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Mental Health Policy ◽  
Public Mental Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Inclusive Policy ◽  
Low And Middle Income

Low- and middle-income countries (LAMICs) often struggle with the development and implementation of mental health policy. Mental health policy is a complex concept affected by social, political and economic factors, and influenced by the third sector, patient and family organisations. A challenge is ensuring regular review of policies to reflect changing demographics and contextual factors. Many non-governmental organizations, researchers, implementation specialists, and advocates contributed and supported the development, implementation, customization, and evaluation of mental health policy documents in LAMICs. These developments keep public mental health and prevention of mental disorders central to the policy-making process. The development of a good mental health policy requires (a) defining goals and specific targets, (b) establishing an inclusive policy process which involves all stakeholders involved in or affected directly or indirectly by mental ill-health (c) setting a time frame for the implementation of policies and also for review and renewal.

Tropical Medicine for Anaesthetists

2020 ◽  
pp. 297-318
Author(s):  
Victoria Howell
Keyword(s):  
Clinical Features ◽  
Tropical Medicine ◽  
Tropical Diseases ◽  
Middle Income ◽  
Low Resource ◽  
Middle Income Countries ◽  
High Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Significant Burden

Many tropical diseases will be unfamiliar to anaesthetists from high-resource settings but are common in low- and middle-income countries. They lead to a significant burden of morbidity and mortality, and some knowledge of the commonly presenting ones and how they might impact on conduct of anaesthesia is essential to anaesthetists practising in these settings. The chapter covers the essentials of several tropical diseases including malaria, tuberculosis, cholera, and typhoid. The chapter outlines for each disease the aetiology, pathophysiology, clinical features, diagnosis, management, and anaesthetic implications. Diseases that are also found in high-resource settings, such as diarrhoea and HIV, are also covered on the basis that they are much more likely to be encountered in a low-resource setting.

scholarly journals Mental health and psychosocial support in humanitarian settings: a public mental health perspective

2015 ◽  
Vol 24 (6) ◽  
pp. 484-494 ◽  
Author(s):  
W. A. Tol ◽  
M. Purgato ◽  
J. K. Bass ◽  
A. Galappatti ◽  
W. Eaton
Keyword(s):  
Mental Health ◽  
Psychosocial Support ◽  
Public Mental Health ◽  
Public Health Approach ◽  
International Consensus ◽  
Middle Income ◽  
Humanitarian Settings ◽  
Middle Income Countries ◽  
Humanitarian Interventions ◽  
International Consensus Guidelines

Aims.To discuss the potential usefulness of a public health approach for ‘mental health and psychosocial support’ (MHPSS) interventions in humanitarian settings.Methods.Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries.Results.A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between ‘mental health’ and ‘psychosocial’ practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology.Conclusions.The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.

scholarly journals Psychiatric Research in Nepal

2019 ◽  
Vol 8 (1) ◽  
pp. 1-2
Author(s):  
P. Sharma ◽  
S. Subedi
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Disorders ◽  
Burden Of Disease ◽  
Health Resources ◽  
Psychiatric Research ◽  
Global Burden ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disease Study

The Global Burden of Disease study ranks mental disorders and substance use disorders as the fifth-placed group based on global burden and ranks them first based on years living with disability. There is a gross imbalance between the burden of disease and mental health resources especially in low and middle income countries (LMICs). Research in this field can and should play a substantial role in improving these situations.

Depression in the Developing World

2017 ◽  
Author(s):  
Harry Minas
Keyword(s):  
Mental Health ◽  
International Development ◽  
Social Services ◽  
Development Programs ◽  
Middle Income ◽  
Health And Social Services ◽  
Middle Income Countries ◽  
Culturally Informed ◽  
Global Understanding

This chapter provides an overview of what is known about prevalence, social determinants, treatment, and course and impact of depression in developing, or low- and middle-income, countries. The importance of culture in depression and in the construction and application of diagnostic classifications and in health and social services is highlighted, with a particular focus on the applicability of ‘Western’ diagnostic constructs and service systems in developing country settings. The role of international organizations, such as WHO, and international development programs, such as the SDGs, in improving our understanding of depression and in developing effective and culturally appropriate responses is briefly examined. There is both a need and increasing opportunities in developing countries for greater commitment to mental health of populations, increased investment in mental health and social services, and culturally informed research that will contribute to improved global understanding of mental disorders in general and depression in particular.

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