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Cited by 8Mental Health Treatment and AccessPsychiatric care and mental health servicesHistorical Psychiatry and Medical Practices

Mental health services in low- and middle-income countries

Murthy, R. Srinivasa·2011·Oxford Textbook of Community Mental Health
DOI 10.1093/med/9780199565498.003.0177
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Abstract

Community psychiatry in low- and middle-income countries (LAMIC) is nearly four decades old (German, 1975; Swift, 1972; WHO, 1975). The beginnings of organized mental health care in LAMIC can be traced to the important Sixteenth World Health Organization (WHO) Expert Committee meeting held at Addis Ababa, Ethiopia, in 1974 titled ‘Organization of mental health care in developing countries’ (WHO, 1975). This meeting is important as it not only reviewed the mental health situation in developing countries but outlined a road map for development of services. These guidelines have largely influenced the developments of the last four decades. The important recommendations of this meeting were: ‘Basic mental health care should be integrated with general health services and be provided by non-specialized health workers, at all levels; … countries should, in the first instance carry out one or more pilot programmes to test the practicability of including basic mental health care in an already established programme of health care in a defined rural or urban population; … training programmes, including simple manuals of instructions for training of health workers should be devised and evaluated.’ (WHO, 1975.) The LAMIC faced the challenge of providing mental health care with very limited psychiatric beds in ancient and custodial care institutions, with limited trained mental health professionals, a general population having very limited knowledge about mental disorders, and persons with mental disorders experiencing stigma and discrimination. Fortunately for the LAMIC, the planning of mental health services occurred around the time of the discovery of antipsychotics and antidepressants and the global recognition of the values of community mental health care. Professionals in LAMIC have addressed the mental health needs of the population using innovative approaches, centred around greater emphasis on use of community resources rather than an emphasis on the highly trained mental health professionals. These innovations have included greater partnership with the families of the persons with mental disorders, use of general hospital psychiatry units, integration of mental health with general health care, and using non-specialist personnel for focused interventions like suicide prevention, disaster and conflict mental health care, life skills education, and rehabilitation. The result of these initiatives have been, from a situation of nearly no services for the majority of the persons with mental disorders, to today where there is a developing framework for mental health care in the public, private, and voluntary sectors in a large number of LAMIC. In these developments, LAMIC have been influenced by the local situation as well as international developments. For example, in the initial phase, the existing general health care infrastructure was the primary focus of integration of mental health services. Soon, the increased use of family members, volunteers, counsellors, mentally ill persons, survivors of disasters, parents of children with mental disorders, and the education system occurred. In this way the three principles of community psychiatry — meeting population based needs, use of range of resources, and accessibility — were partially addressed (Thornicroft and Szmukler, 2001). In this chapter, the progress in LAMIC, from the last 40 years of psychiatric services are reviewed towards identification of issues for the future in terms of the priorities, processes, problems, and prospects.

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  • In LMICs, not only are there limited mental health services available, utilization of existing services is also poor for a multitude of reasons, including geographic, cultural, and financial access barriers.

    “In LMICs, not only are there limited mental health services available, utilization of existing services is also poor for a multitude of reasons, including geographic, cultural, and financial access barriers”

    From Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence (2017) · cites this paper as Murthy, 2011

  • Mental health service delivery is highly context-specific with culturally defined interpretations of stigma, trust, and utility affecting success and impact.

    “Mental health service delivery is highly context-specific with culturally defined interpretations of stigma, trust, and utility affecting success and impact”

    From Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence (2017) · cites this paper as Murthy, 2011

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Authors
Murthy, R. S.
Corresponding author
Murthy, R. Srinivasa
Venue
Oxford Textbook of Community Mental Health
Publisher
Oxford University PressOxford
Published
2011-08
Pages
325-336
DOI
10.1093/med/9780199565498.003.0177
OpenAlex
W2477830885
Cited by
8
References
52
Citations by year
2025: 1 · 2021: 1 · 2018: 1 · 2017: 2 · 2016: 1 · 2015: 1 · 2012: 1
FWCI
1.24
Type
book chapter
Language
en
Open access
closed
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
community mental health services, mental health services, low- and middle-income countries, non-specialist mental health workers, family involvement in mental health care, psychiatric rehabilitation, stigma and discrimination, mental health policy, mental health professionals, mental health funding, mental health service planning, life skills education

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