Strengthening mental health systems in low- and middle-income countries: the Emerald programme

BMC Medicine

Graham Thornicroft¹  Rahul Shidhaye⁹  Inge Petersen⁵  Crick Lund²  Heidi Lempp^1,10  Fred Kigozi⁶  Mark Jordans⁷  Charlotte Hanlon⁴  Oye Gureje^1,11  Dan Chisholm⁸  Jose Luis Ayuso-Mateos³  Atalay Alem⁴  Sara Evans-Lacko¹  Maya Semrau¹ 

[1]King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK

[2]Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa

[3]Department of Psychiatry, Universidad Autonoma de Madrid, IIS-IP, CIBER, Calle Arzobispo Morcillo 4, Madrid, 28029, Spain

[4]Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, Ethiopia

[5]School of Applied Human Sciences, University of KwaZulu-Natal, Mazisi Kunene Avenue, Durban, 4001, South Africa

[6]Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda

[7]Department of Research and Development, HealthNet TPO, Lizzy Ansinghstraat 163, Amsterdam, 1072 RG, Netherlands

[8]Department of Mental Health and Substance Abuse, World Health Organization, Avenue Appia 20, Geneva 27, 1211, Switzerland

[9]Center for Chronic Conditions and Injuries, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi 122002, NCR, India

[10]King’s College London, Faculty of Life Sciences and Medicine, Academic Rheumatology, Clinical Trials Group, Weston Education Centre, 10, Cutcombe Rd., London SE5 9RJ, UK

[11]Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, Oritamefa, PMB 5116, Ibadan, Nigeria

关键词: Mental health;    Health care systems;    Delivery of health care;   

Others  :  1160620
DOI  :  10.1186/s12916-015-0309-4

 received in 2014-10-16, accepted in 2015-03-03,  发布年份 2015

【 摘 要 】

There is a large treatment gap for mental health care in low- and middle-income countries (LMICs), with the majority of people with mental, neurological, and substance use (MNS) disorders receiving no or inadequate care. Health system factors are known to play a crucial role in determining the coverage and effectiveness of health service interventions, but the study of mental health systems in LMICs has been neglected. The ‘Emerging mental health systems in LMICs’ (Emerald) programme aims to improve outcomes of people with MNS disorders in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda) by generating evidence and capacity to enhance health system performance in delivering mental health care. A mixed-methods approach is being applied to generate evidence on: adequate, fair, and sustainable resourcing for mental health (health system inputs); integrated provision of mental health services (health system processes); and improved coverage and goal attainment in mental health (health system outputs). Emerald has a strong focus on capacity-building of researchers, policymakers, and planners, and on increasing service user and caregiver involvement to support mental health systems strengthening. Emerald also addresses stigma and discrimination as one of the key barriers for access to and successful delivery of mental health services.

【 授权许可】

   
2015 Semrau et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization. Q&As: Health systems. http://www.who.int/topics/health_systems/qa/en/index.html.
• [2]United Nations General Assembly. Convention on the rights of persons with disabilities. UN, A/RES/61/106; 2006.
• [3]Wolff J: The human right to health. W.W. Norton & Company, Inc., New York; 2012.
• [4]Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al.: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet. 2012, 380:2197-223.
• [5]World Health Organization. Global Health Estimates (GHE). http://www.who.int/healthinfo/global_burden_disease/en/.
• [6]Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ, et al.: Mental health systems in countries: where are we now? Lancet. 2007, 370:1061-77.
• [7]Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al.: Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004, 291:2581-90.
• [8]Callard F, Sartorius N, Arboleda-Florez J, Bartlett P, Helmchen H, Stuart H, et al.: Mental illness, discrimination and the law: fighting for social justice. Wiley Blackwell, London; 2012.
• [9]Gutierrez-Recacha P, Chisholm D, Haro JM, Salvador-Carulla L, Ayuso-Mateos JL: Cost-effectiveness of different clinical interventions for reducing the burden of schizophrenia in Spain. Acta Psychiatr Scand Suppl. 2006, 432:29-38.
• [10]Chisholm D, van Ommeren M, Ayuso-Mateos JL, Saxena S: Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder. Br J Psychiatry. 2005, 187:559-67.
• [11]Chisholm D, Sanderson K, Ayuso-Mateos JL, Saxena S: Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions. Br J Psychiatry. 2004, 184:393-403.
• [12]World Health Organization, World Health Report: Mental health: new understanding, new hope. WHO, Geneva; 2001.
• [13]Horton R. Launching a new movement for mental health. The Lancet. 2007, doi:10.1016/S0140-6736(07)61243-4. http://www.globalmentalhealth.org.
• [14]World Health Organization: mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP). WHO, Geneva; 2010.
• [15]Dua T, Barbui C, Clark N, Fleischmann A, van Ommeren M, Poznyak V, et al.: Evidence based guidelines for mental, neurological and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Med. 2011, 8:1-11.
• [16]Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al.: Grand challenges in global mental health. Nature. 2011, 475:27-30.
• [17]Collaborative Hubs for International Research in Mental Health. http://www.nimh.nih.gov/about/organization/gmh/globalhubs/index.shtml.
• [18]World Health Assembly: Comprehensive mental health action plan 2013–2020. Document WHA66.8. WHO, Geneva; 2013.
• [19]Lund C, Tomlinson M, De Silva M, Fekadu A, Shidhaye R, Jordans M, et al.: PRIME: A programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med. 2012, 9:e1001359.
• [20]PRIME: PRogramme for Improving Mental health carE. http://www.prime.uct.ac.za.
• [21]Thornicroft G, Tansella M: The balanced care model for global mental health. Psychol Med. 2013, 43:849-63.
• [22]Emerald: Emerging mental health systems in low- and middle-income countries. www.emerald-project.eu.
• [23]World Health Organization: Dollars, DALYs and decisions: economic aspects of the mental health system. WHO, Geneva; 2006.
• [24]World Health Organization: Mental Health Atlas. WHO, Geneva; 2011.
• [25]World Health Organization and Ministry of Health: WHO-AIMS report on mental health system in Nepal. WHO, Kathmandu; 2006.
• [26]Avenir Health. OneHealth tool. http://www.futuresinstitute.org/onehealth.aspx.
• [27]World Health Organization. Health statistics and information systems. SAGE longitudinal multi-country study. http://www.who.int/healthinfo/sage/cohorts/en/index2.html.
• [28]Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, et al.: Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy. 2009, 90:13-25.
• [29]Department of Health: Best research for best health. A new national health research strategy. Department of Health, London; 2007.
• [30]National Health and Medical Research Council. Strategic Plan 2000–2003. Commonwealth of Australia. http://www.nhmrc.gov.au/guidelines/publications/nh132.
• [31]Canadian Arthritis Network Advisory Council Partnership. http://www.arthritisnetwork.ca/.
• [32]Ennis L, Wykes T: Impact of patient involvement in mental health research: longitudinal study. Br J Psychiatry. 2013, 203:381-6.
• [33]Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, et al.: Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet. 2012, 381:55-62.
• [34]Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M: Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet. 2009, 373:408-15.
• [35]Evans-Lacko S, Brohan E, Mojtabai R, Thornicroft G: Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychol Med. 2012, 42:1741-52.