Resources for mental health: scarcity, inequity, and inefficiency

Saxena, Shekhar; Thornicroft, Graham; Knapp, Martín; Whiteford, Harvey

doi:10.1016/s0140-6736(07)61239-2

Cited by 1,491 publications

(1,194 citation statements)

References 89 publications

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“…If the resulting intervention is found to be cost‐effective, then this has major implications for alcohol treatments in low resource settings. In LMIC, the gap between those who could benefit from mental health interventions and those who receive such care is very large, in particular for AUD (Saxena et al., 2007; WHO World Mental Health Survey Consortium, 2004). A contextually adapted intervention like CAP which can be delivered by nonspecialists has the potential of being scaled up in low resource settings, thus helping reduce the treatment gap.…”

Section: Discussionmentioning

confidence: 99%

The Systematic Development and Pilot Randomized Evaluation of Counselling for Alcohol Problems, a Lay Counselor‐Delivered Psychological Treatment for Harmful Drinking in Primary Care in India: The PREMIUM Study

Nadkarni

Velleman

Dabholkar³

et al. 2015

Alcohol Clin Exp Res

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BackgroundDespite harmful drinking causing a significant burden on global health, there is a large treatment gap, especially in low‐ and middle‐income countries. A major barrier to care is the lack of adequately skilled human resources to deliver contextually appropriate treatments. This paper describes the systematic process used to develop Counselling for Alcohol Problems (CAP), a brief psychological treatment (PT) for delivery by lay counselors in routine primary care settings to men with harmful drinking in India.MethodsCAP was developed using a methodology involving 3 sequential steps: (i) identifying potential treatment strategies; (ii) developing a theoretical framework for the treatment; and (iii) evaluating the acceptability and feasibility of the treatment.ResultsCAP is a 3‐phase treatment delivered over 1 to 4 sessions based on a motivational interviewing (MI) stance and involves the following strategies: assessment and personalized feedback, family engagement, drink refusal skills, skills to address drinking urges, problem‐solving skills and handling difficult emotions, and relapse prevention and management. Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment, for example expansion of the target group to include alcohol‐dependent patients and the extension of the delivery settings to include home‐based delivery. There was preliminary evidence of the effectiveness of CAP.ConclusionsCAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a randomized controlled trial based in primary care in Goa, India.

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Section: Discussionmentioning

confidence: 99%

The Systematic Development and Pilot Randomized Evaluation of Counselling for Alcohol Problems, a Lay Counselor‐Delivered Psychological Treatment for Harmful Drinking in Primary Care in India: The PREMIUM Study

Nadkarni

Velleman

Dabholkar³

et al. 2015

Alcohol Clin Exp Res

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“…This is particularly challenging for LMIC, which are home to over 80% of the global population, but utilize less than 20% of the mental health resources (Saxena, Thornicroft, Knapp, & Whiteford, 2007). Worldwide there exists a troubling cycle of disadvantage, social exclusion, and mental disorders.…”

Section: The Essential Role Of Public Health Policiesmentioning

confidence: 99%

Trauma is a public health issue

Magruder

McLaughlin

Borbon

2017

European Journal of Psychotraumatology

193

134

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Exposure to trauma is pervasive in societies worldwide and is associated with substantial costs to the individual and society, making it a significant global public health concern. We present evidence for trauma as a public health issue by highlighting the role of characteristics operating at multiple levels of influence – individual, relationship, community, and society – as explanatory factors in both the occurrence of trauma and its sequelae. Within the context of this multi-level framework, we highlight targets for prevention of trauma and its downstream consequences and provide examples of where public health approaches to prevention have met with success. Finally, we describe the essential role of public health policies in addressing trauma as a global public health issue, including key challenges for global mental health and next steps for developing and implementing a trauma-informed public health policy agenda. A public health framework is critical for understanding risk and protective factors for trauma and its aftermath operating at multiple levels of influence and generating opportunities for prevention.

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“…Indeed, Saraceno et al, and Saxena et al showed that in LAMI countries the prevailing health agendas, which do not include MN health as a priority, lead governments to spend far less than needed on MN issues. 8,9 This, in turn, leads to a critical shortfall of human and infrastructure resources that could be overcome with political willingness.…”

Section: Discussionmentioning

confidence: 99%