Scaling up mental health care and psychosocial support in low-resource settings: a roadmap to impact

Epidemiol Psychiatr Sci. 2020 Nov 26:29:e189. doi: 10.1017/S2045796020001018.

Abstract

Aims: Despite recent global attention to mental health and psychosocial support services and a growing body of evidence-support interventions, few mental health services have been established at a regional or national scale in low- and middle-income countries (LMIC). There are myriad challenges and barriers ranging from testing interventions that do not target priority needs of populations or policymakers to interventions that cannot achieve adequate coverage to decrease the treatment gap in LMIC.

Method: We propose a 'roadmap to impact' process that guides planning for interventions to move from the research space to the implementation space.

Results: We establish four criteria and nine associated indicators that can be evaluated in low-resource settings to foster the greatest likelihood of successfully scaling mental health and psychosocial interventions. The criteria are relevance (indicators: population need, cultural and contextual fit), effectiveness (change in mental health outcome, change in hypothesised mechanism of action), quality (adherence, competence, attendance) and feasibility (coverage, cost). In the research space, relevance and effectiveness need to be established before moving into the implementation space. In the implementation space, ongoing monitoring of quality and feasibility is required to achieve and maintain a positive public health impact. Ultimately, a database or repository needs to be developed with these criteria and indicators to help researchers establish and monitor minimum benchmarks for the indicators, and for policymakers and practitioners to be able to select what interventions will be most likely to succeed in their settings.

Conclusion: A practicable roadmap with a sequence of measurable indicators is an important step to delivering interventions at scale and reducing the mental health treatment gap around the world.

Keywords: Community mental health; evidence-based psychiatry; health service research; minority issues and cross-cultural psychiatry; quality of care.

MeSH terms

  • Community Mental Health Services / statistics & numerical data*
  • Culturally Competent Care*
  • Evidence-Based Medicine
  • Health Services Accessibility
  • Humans
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Mental Health / statistics & numerical data*
  • Poverty
  • Psychosocial Support Systems*
  • Psychotherapy*
  • Quality of Health Care