Mental healthcare in low and middle income countries

Drake, Robert E.; Binagwaho, Agnès; Martell, H Castillo; Mulley, Albert G.

doi:10.1136/bmj.g7086

Cited by 18 publications

(14 citation statements)

References 11 publications

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“…Few studies originated from the local setting and were referenced and less than half met the criteria to be considered culturally adapted. This assumption of transferability between settings by some studies disregards the importance of cultural relevance (Drake et al, 2014;Rathod and Kingdon, 2014) and evidence that local concepts of stigma are complex (Weiss et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Core components of mental health stigma reduction interventions in low- and middle-income countries: a systematic review

Clay

Eaton

Gronholm

et al. 2020

Epidemiol Psychiatr Sci

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Aims To identify and categorise core components of effective stigma reduction interventions in the field of mental health in low- and middle-income countries (LMICs) and compare these components across cultural contexts and between intervention characteristics. Methods Seven databases were searched with a strategy including four categories of terms ('stigma’, ‘mental health’, ‘intervention’ and ‘low- and middle-income countries’). Additional methods included citation chaining of all papers identified for inclusion, consultation with experts and hand searching reference lists from other related reviews. Studies on interventions in LMICs aiming to reduce stigma related to mental health with a stigma-related outcome measure were included. All relevant intervention characteristics and components were extracted and a quality assessment was undertaken. A ‘best fit’ framework synthesis was used to organise data, followed by a narrative synthesis. Results Fifty-six studies were included in this review, of which four were ineffective and analysed separately. A framework was developed which presents a new categorisation of stigma intervention components based on the included studies. Most interventions utilised multiple methods and of the 52 effective studies educational methods were used most frequently (n = 83), and both social contact (n = 8) and therapeutic methods (n = 3) were used infrequently. Most interventions (n = 42) based their intervention on medical knowledge, but a variety of other themes were addressed. All regions with LMICs were represented, but every region was dominated by studies from one country. Components varied between regions for most categories indicating variation between cultures, but only a minority of studies were developed in the local setting or culturally adapted. Conclusions Our study suggests effective mental health stigma reduction interventions in LMICs have increased in quantity and quality over the past five years, and a wide variety of components have been utilised successfully – from creative methods to emphasis on recovery and strength of people with mental illness. Yet there is minimal mention of social contact, despite existing strong evidence for it. There is also a lack of robust research designs, a high number of short-term interventions and follow-up, nominal use of local expertise and the research is limited to a small number of LMICs. More research is needed to address these issues. Some congruity exists in components between cultures, but generally they vary widely. The review gives an in-depth overview of mental health stigma reduction core components, providing researchers in varied resource-poor settings additional knowledge to help with planning mental health stigma reduction interventions.

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Section: Discussionmentioning

confidence: 99%

Core components of mental health stigma reduction interventions in low- and middle-income countries: a systematic review

Clay

Eaton

Gronholm

et al. 2020

Epidemiol Psychiatr Sci

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show abstract

“…Families and patients have traditionally played a passive recipient role, which has unfortunately been compounded by the stigma and discrimination associated with mental and substance use disorders. To overcome stigma and achieve social inclusion will require meaningful participation and empowerment at different levels of the mental health care system, including policy planning (Drake et al 2014).…”

Section: Opportunities For Psychiatry Rehabilitationmentioning

confidence: 99%

Psychiatric rehabilitation in Latin America: challenges and opportunities

Uribe-Restrepo

Escobar

Cubillos

2016

Epidemiol Psychiatr Sci

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Comprehensive psychiatric rehabilitation programs in Latin America have been designed across several countries in the region without yet achieving full implementation. Facing an increasing burden of disease due to mental disorders, including alcohol and substance use disorders, the region has responded unevenly to the challenge. Moreover, low priority for mental health in national policies and insufficient funding for mental health services are common barriers for the much-needed mental health services reforms. Reestablishing a primary care community-based model of care has been a shared aspiration for most countries during the last two decades. Comprehensive models of psychiatric rehabilitation developed predominantly in high-income countries need to be culturally adapted to local contexts, while strengthening health systems research will provide evidence on the efficiency of locally designed interventions and on the critical milestones to succeed in the scaling up strategies. Increasing participation of patients and their families in the mental health delivery system is another key factor in order to ensure comprehensive patient-centred psychosocial rehabilitation programs in Latin America.

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“…Suicide-the second most common cause of death among young people globally; Nepal has seventh highest suicide rate in the world-mostly among girls and woman of reproductive age [2]. Additionally, the aftermath of an earthquake on April 25, 2015, have raised the burden of post-traumatic stress disorders among the survivors exponentially [3][4][5].…”

Section: Introductionmentioning

confidence: 99%