Improving access to psychological treatments: Lessons from developing countries

“The challenges to implementing evidence-based PTs are enormous: several barriers have been identified ranging from inadequate investments in mental health care to stigma associated with mental illness (Saraceno et al., 2007).”

“We have based our observations on the experiences of three randomized controlled trials from three LMIC in Africa and Asia which sought to improve access to the WHO approved PTs for depression, viz., cognitive behaviour therapy-based (CBT-based) or interpersonal psychotherapy (IPT) (World Health Organisation, 2010).”

“A rapidly growing evidence testifies to the large burden and adverse impact of mental illness in the global context and the efficacy and cost-effectiveness of specific treatments and delivery systems in low resource settings (Patel et al., 2007; Patel & Thornicroft, 2009).”

“…deliver PTs will only address a tiny fraction of the treatment gap and task-shifting these interventions to more available and affordable members of the health workforce or community is widely acknowledged to be the only sustainable way of addressing this barrier (Patel, 2009; Patel et al., 2010a).”

“All three trials have published their primary results (Bolton et al., 2003; Patel et al., 2010b; Rahman, Malik, Sikander, Roberts, & Creed, 2008) as well as the methods to adapt the PT for the local context (Chatterjee et al.”

“There is a growing evidence base in HIC on improving access to PTs for ethnic minority groups who have traditionally been under-represented in PT services (Miranda et al., 2005).”

“…deliver PTs will only address a tiny fraction of the treatment gap and task-shifting these interventions to more available and affordable members of the health workforce or community is widely acknowledged to be the only sustainable way of addressing this barrier (Patel, 2009; Patel et al., 2010a).”

“A rapidly growing evidence testifies to the large burden and adverse impact of mental illness in the global context and the efficacy and cost-effectiveness of specific treatments and delivery systems in low resource settings (Patel et al., 2007; Patel & Thornicroft, 2009).”

“Put bluntly, relying on mental health professionals to deliver PTs will only address a tiny fraction of the treatment gap and task-shifting these interventions to more available and affordable members of the health workforce or community is widely acknowledged to be the only sustainable way of addressing this barrier…”

“…groups with purposively sampled 24 Lady Health Workers, and key-informant interviews with six primary care staff; and examination of data from an epidemiological study in which the investigators had explored psychosocial risk factors for perinatal depression in the same community (Rahman, 2007).”

“All three trials have published their primary results (Bolton et al., 2003; Patel et al., 2010b; Rahman, Malik, Sikander, Roberts, & Creed, 2008) as well as the methods to adapt the PT for the local context (Chatterjee et al., 2008; Rahman, 2007; Verdeli et al., 2004).”

“It is widely accepted that, just as with the classification and measurement of mental illnesses, mental health interventions also need cross-cultural adaptation to ensure the acceptability and appropriateness to the particular context (Patel, 2000).”

“The models we reviewed address many of the delivery challenges surrounding physical health care and have begun to be extended to mental health care (e.g., Belkin et al., 2011; Patel et al., 2010; Patel et al., 2011).”