Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization
Abstract
Since 2008 the World Health Organization (WHO), through its mental health Gap Action Programme, has attempted to revitalize efforts to integrate mental health into non-specialized (e.g. primary) healthcare. While this has led to renewed interest in this potential method of mental health service delivery, it has also prompted criticism. Some concerns raised are that it would contribute to the medicalization of social and psychological problems, and narrowly focus on primary care without sufficient attention given to strengthening other levels of the healthcare system, notably community-based care and care on district levels. This paper discusses seven elements that may be critical to preventing inadvertently contributing to increasing a narrow biomedical approach to mental healthcare when integrating mental health into non-specialized healthcare: (1) using task shifting approaches within a system of stepped care, (2) ensuring primary mental healthcare also includes brief psychotherapeutic interventions, (3) promote community-based recovery-oriented interventions for people with disabling chronic mental disorders, (4) conceptualizing training as a continuous process of strengthening clinical competencies through supervision, (5) engaging communities as partners in psychosocial interventions, (6) embedding shifts to primary mental healthcare within wider health policy reforms, and (7) promoting inter-sectoral approaches to address social determinants of mental health.
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Task-shifting and decentralising psychiatric care were central to the proposal to integrate mental health into primary health services, which promised feasibility of extending mental health coverage to rural and under-served areas in low-resource settings and beyond psychiatric institutions.
“Notions of 'task-shifting'the process of delegating tasks usually performed by specialists to health workers with different (and generally lower) levels of training -and the goal of decentralising psychiatric care were central to this proposal; incorporating mental health services into primary health services promised the possibility and feasibility of extending mental health coverage to rural and”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Ventevogel 2014
The idea of integrating mental health into primary health care has been at the core of primary health approaches since the 1970s and gained renewed traction with the growth of global mental health, which incorporated it into its agenda.
“While the idea has been at the core of primary health approaches since the 1970s (Ventevogel 2014), it gained renewed and significant traction with the growth of the field of global mental health, which promptly incorporated it in its agenda (Bemme and D'Souza 2014).”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Ventevogel 2014
Seven elements have been highlighted as critical to ensuring that misplaced emphasis on a narrow biomedical approach is not adopted in efforts to carry out integration.
“seven elements have been highlighted as critical to ensuring that misplaced emphasis on a narrow biomedical approach is not adopted in efforts to carry out integration [13].”
From Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action programme intervention guide (2015) · cites this paper as [13]
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- Authors
- Ventevogel, P.
- Affiliations
- Office of the United Nations High Commissioner for Refugees (CH)
- Corresponding author
- Ventevogel, Peter
- ORCID
- Ventevogel, Peter
- Venue
- International Review of Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2014-12
- Volume
- 26
- Issue
- 6
- Pages
- 669-679
- ISSN
- 0954-0261 (ISSN-L)
- 1369-1627
- OpenAlex
- W2150872117
- Cited by
- 105
- References
- 28
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 11 · 2020: 11 · 2019: 17 · 2018: 9 · 2017: 11 · 2016: 8 · 2015: 4
- FWCI
- 11.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Review of Psychiatry (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
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- mental health integration, primary care, medicalization, Mental Health Gap Action Programme, task shifting, stepped care, brief psychotherapy, community-based care, recovery-oriented interventions, clinical supervision, community participation, psychosocial interventions, health policy reform, social determinants of mental health, low-income countries
- MeSH terms
- Developing Countries, Humans, Mental Health Services, Primary Health Care, Delivery of Health Care, Integrated, Medicalization
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