‘Mental healthcare in low and middle income countries should not replicate the inefficient, inaccessible, and insensitive Western model’, says an editorial in this week’s BMJ (29 November 2014).

The full text is available here (restricted access):

http://www.bmj.com/content/349/bmj.g7086

Below are the citation and selected extracts.

CITATION: Drake R et al. Mental healthcare in low and middle income countries

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g7086 (Published 25 November 2014)

Cite this as: BMJ 2014;349:g7086

‘Low and middle income countries could develop alternative behavioural health systems by emphasising a few strategies. They should start by listening to people and empowering citizens, families, traditional supports, lay health workers, cultures, and communities to define their needs and design systems they want. Well informed patients and families can express preferences and participate in creating systems of care, including technology tools, that respond to personal and community needs.6 Mental health should be for everyone: all people benefit from maternal and child health, strong families, education, stress management training, social support, meaningful work, and self management.7 Local stakeholders understand context and prefer spending limited resources on these local services. Local learning communities could monitor outcomes, learn from data, engage in continuous quality improvement, and perhaps prevent medical fraud…

‘Finally, low and middle income countries should embrace new technologies that can provide education, prevention, assessment, treatment of acute illnesses, and management of long term illnesses.10 These tools extend the reach of healthcare workers and are often effective by themselves—generally as effective as well trained mental health professionals.10 Most people with mental disorders accept and value these tools highly; the tools can be translated to other languages and cultures; and the mobile phone infrastructure to deliver them broadly exists already.’

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