Barriers to improvement of mental health services in low-income and middle-income countries

Saraceno, Benedetto; van Ommeren, Mark; Batniji, Rajaie; Cohen, Alex; Gureje, Oye; Mahoney, John; Sridhar, Devi; Underhill, Chris

doi:10.1016/s0140-6736(07)61263-x

Cited by 1,088Mental Health Treatment and AccessPsychiatric care and mental health servicesHistorical Psychiatry and Medical Practices

Barriers to improvement of mental health services in low-income and middle-income countries

Saraceno, Benedetto, van Ommeren, Mark, Batniji, Rajaie, Cohen, Alex, Gureje, Oye, Mahoney, John, Sridhar, Devi, Underhill, Chris·2007·The Lancet

DOI 10.1016/s0140-6736(07)61263-x

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Abstract

Despite the publication of high-profile reports and promising activities in several countries, progress in mental health service development has been slow in most low-income and middle-income countries. We reviewed barriers to mental health service development through a qualitative survey of international mental health experts and leaders. Barriers include the prevailing public-health priority agenda and its effect on funding; the complexity of and resistance to decentralisation of mental health services; challenges to implementation of mental health care in primary-care settings; the low numbers and few types of workers who are trained and supervised in mental health care; and the frequent scarcity of public-health perspectives in mental health leadership. Many of the barriers to progress in improvement of mental health services can be overcome by generation of political will for the organisation of accessible and humane mental health care. Advocates for people with mental disorders will need to clarify and collaborate on their messages. Resistance to decentralisation of resources must be overcome, especially in many mental health professionals and hospital workers. Mental health investments in primary care are important but are unlikely to be sustained unless they are preceded or accompanied by the development of community mental health services, to allow for training, supervision, and continuous support for primary care workers. Mobilisation and recognition of non-formal resources in the community must be stepped up. Community members without formal professional training and people who have mental disorders and their family members, need to partake in advocacy and service delivery. Population-wide progress in access to humane mental health care will depend on substantially more attention to politics, leadership, planning, advocacy, and participation.

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Nigeria's Mental Health Policy was poorly implemented due to insufficient training and supervision of primary care workers, funding, and political will.
“This policy, however, was poorly implemented due to insufficient training and supervision of primary care workers, funding, and political will [32].”
From Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project (2022) · cites this paper as [32]
In LMICs, as in much of the world, mental health is consistently relegated to a secondary or even tertiary concern.
“In LMICs, as in much of the world, mental health is consistently relegated to a secondary or even tertiary concern [1, 100, 101]”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [100]
Mental health integration into general health settings in Nigeria has not been fully implemented due to funding, training, and supervision factors.
“Despite these long-standing, well-articulated policy goals, mental health integration into general health settings in Nigeria has not been fully implemented due to factors related to funding, training and supervision of trained nonmental health specialists (Saraceno et al., 2007; Petersen et al., 2019).”
From Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of the <i>HAPPINESS</i> intervention (2024) · cites this paper as Saraceno et al., 2007
Lack of mental health resources in LMICs takes a number of forms, including limits in basic mental health infrastructure, budget, and personnel, particularly in humanitarian settings.
“Lack of resources takes a number of forms, including limits in basic mental health infrastructure, budget, and personnel, particularly in humanitarian settings [7].”
From World Health Organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead (2014) · cites this paper as [7]
The most common barriers for mental health care utilization include low perceived needs, stigma and discrimination associated with mental illness, inability to afford the treatment cost, poor identification and referral system, and shortage of human resources.
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From Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal (2021) · cites this paper as [6]

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Authors: Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., Sridhar, D., & Underhill, C.
Affiliations: World Health Organization (CH)
University of Oxford (GB)
Harvard University (US)
University of Ibadan (NG)
Corresponding author: Saraceno, Benedetto
ORCID: Saraceno, Benedetto
Cohen, Alex
Gureje, Oye
Sridhar, Devi
Venue: The Lancet
Publisher: Elsevier BV
Published: 2007-09
Volume: 370
Issue: 9593
Pages: 1164-1174
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(07)61263-x
OpenAlex: W2087727383
Cited by: 1,088
References: 36
Citations by year: 2026: 36 · 2025: 65 · 2024: 58 · 2023: 75 · 2022: 61 · 2021: 84 · 2020: 78 · 2019: 76 · 2018: 64 · 2017: 66 · 2016: 70 · 2015: 71 · 2014: 70 · 2013: 41 · 2012: 46
FWCI: 3.44
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
Keywords: mental health services, low- and middle-income countries, mental health funding, primary care mental health, community mental health services, mental health professionals, training and supervision, mental health leadership, advocacy, political will, mental health policy
MeSH terms: Workforce, Developing Countries, Health Priorities, Health Services Needs and Demand, Humans, Mental Health Services, Public Health, Global Health

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Barriers to improvement of mental health services in low-income and middle-income countries

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