Five promising mental health interventions in low and middle income countries
Diagnosing and treating mental health conditions is a huge challenge in low- and middle-income countries, where resources are scarce. Dr Dixon Chibanda is a Wellcome researcher at the University of Zimbabwe, and has a DELTAS Africa award to tackle the gap in provision for mental health disorders in sub-Saharan Africa.
He describes five cost-effective projects he thinks could have a big impact.
More than 10% of the total disease burden in low and middle income countries (LAMIC) is due to mental health disorders, yet they receive less than 1% of many of these countries’ health budgets. A striking example of this is in Zimbabwe, where only 12 psychiatrists serve a national population of 15.3 million.
Considering this huge under-investment, a key question is how to provide support for people suffering from mental ill health when resources are scarce.
These five collaborative, low-cost care packages – delivered by lay people who are trained and supervised by professionals – all have the potential to close the treatment gap, and improve the mental health of hundreds of thousands of people.
In Kenya the Africa Mental Health Foundation’s TEAM project enlisted African traditional healers, faith healers and community health workers to detect mental illness, and refer cases to clinicians. Referrals of people suspected of having mental illness rose from zero to 1,593. 494 went on to be clinically diagnosed with a mental health disorder.
The Government of Makueni County has now committed to scale up the project, from two to 20 facilities. They anticipate identifying 6,000 more suspected cases of mental illness, and for 2,000 people to be diagnosed within the year.
In rural Pakistan Wellcome helped to fund the Thinking Healthy Programme, which screened 4,000 pregnant women and identified 903 as having perinatal depression. 42 Community Health Workers were trained to deliver 16 sessions of an evidence based “talking therapy” until a year after their babies were born.
The intervention cost led to recovery in three-quarters of women treated, and cost less than £7 per woman each year.
In Goa Wellcome funded MANAshanti Sudhar Shodh (MANAS), led by Professor Vikram Patel, which trained non-specialist health workers to deliver psychosocial interventions, including psychoeducation, yoga and interpersonal therapy.
They ran a trial of 2,796 people with common mental disorders and found 65.9% of those who were treated with a collaborative care approach, including psychosocial interventions, recovered after 6 months, compared to just 42.5% in the control group.
In the Nashik district of India the Atmiyata programme is training 15,000 people from self-help groups and farmers clubs, alongside doctors and social workers, to work together to identify mental illness cases in the community.
The people trained receive smartphones which help them identify mental health problems, and are uploaded with videos, including a myth-busting Q&A with a psychiatrist in the local language.
In Zimbabwe benches have been placed outside health clinics, which people visit for treatment of all kinds of conditions including HIV and AIDS. Lay health workers, known as Golden Ladies or ‘Grandmothers’, are trained to deliver low-intensity cognitive behaviour therapy to anyone referred to the benches by clinicians.
To date over 15,000 people have used the Friendship bench. The project has already shown promising results, and is being scaled up to 60 clinics in the 3 cities, where it’s hoped up to 50,000 people will have access.
WHO and World Bank’s recent ‘Out of the Shadows: Making Mental Health a Global Development Priority’ event made a strong case for mental health to move up the global development agenda. Now is the time for LAMIC governments to invest in scaling up cost-efficient, highly effective interventions. The cost of inaction is just too high.