Academic journal article Bulletin of the World Health Organization

The Mental Health Workforce Gap in Low- and Middle-Income Countries: A Needs-Based approach/Manque De Personnel De Sante Mentale Dans Les Pays a Revenu Faible Ou Intermediaire: Une Approche Basee Sur Les besoins/La Diferencia En La

Academic journal article Bulletin of the World Health Organization

The Mental Health Workforce Gap in Low- and Middle-Income Countries: A Needs-Based approach/Manque De Personnel De Sante Mentale Dans Les Pays a Revenu Faible Ou Intermediaire: Une Approche Basee Sur Les besoins/La Diferencia En La

Article excerpt

Introduction

Mental, neurological, and substance abuse (MNS) disorders account for an increasing proportion of the global burden of disease. The World Health Organization (WHO) attributes to these disorders 14% of all of the world's premature deaths and years lived with disability. (1) In addition to imposing high costs on the health system, mental and neurological disorders and substance abuse also lead to lost worker productivity, impaired functioning, personal stigma, caregiver burden on family members, and, in some instances, to human rights violations. (2-4)

Although several cost-effective strategies reportedly reduce the disability associated with mental and neurological disorders and substance abuse, (5-8) the fraction of those affected who receive appropriate treatment remains disturbingly low. (9) This treatment gap appears especially wide in countries classified as low- or middle-income by The World Bank, where around 85% of the world's population resides. In such countries, treatment rates for these disorders are suboptimal and range from 35% to 50%. (9-11)

Researchers, policy-makers and international agencies have issued calls for low- and middle- income countries (LMICs) to scale up the mental health components of their health systems. (12-14) To accomplish this, they need to increase their workforces, (14) particularly the number of trained professionals who can provide good mental health services. Although primary health-care professionals can provide the bulk of care, mental health professionals, namely psychiatrists, nurses and experts in psychosocial health, are needed to manage those patients who are referred for specialized care and to deliver training, support and supervision to non-specialists. Without these mental health professionals, LMICs will not have enough human resources to meet their populations' mental health treatment requirements. (15)

The lack of reliable data on mental health systems in LMICs greatly hinders workforce planning efforts. Almost one-fourth of the world's LMICs have no system for reporting basic mental health information. (16) Even among LMICs that have such a system, many suffer from lack of accountability in reporting or from the inability to measure workforce capacity. Without information of this kind, countries cannot assess the scope and magnitude of the gap between the number of mental health workers needed and the number that is available.

We aim to provide health planners, policy researchers and government officials with country-specific estimates of the human resources that are required in the area of mental health to adequately care for the population in need of mental health care. We have focused on eight priority problems as defined by WHO: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders (conduct or behavioural, intellectual and emotional disorders of childhood). (13) For each of these disorders we used epidemiological information published by WHO as of July 2010, (17) in conjunction with the health services data available for 58 LMICs that had recently completed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS). For a detailed description of the validity and measurement properties of WHO-AIMS, please refer to Saxena et al. (18)

Methods

Current mental health workforce

To assess the size of the current workforce devoted to mental health care in the study countries, we retrieved data from WHO-AIMS, an assessment tool designed for LMICs that provides a comprehensive summary of each country's mental health system. WHO-AIMS, described in detail by Saxena et al., (18) includes 155 indicators covering six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public education and monitoring and research. …

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