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In many low-income countries, mental illness has traditionally been seen as a low priority area, both in terms of clinical resources and emphasis in the training of healthcare professionals.The psychiatrist are essential part of every health care system, but their training should response to the needs of the community.
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Guillermo Rivera, MD, PhD.Associate Professor of Psychiatry
University of Santa Cruz
WHO, 2007.
WHO, 2007.
World 1 HIV/AIDS2 Depression3 Ischaemic heart dis.
High-income countries1 Depression 2 Ischaemic heart disease
3 Alzheimer
Middle-income countries 1 HIV/AIDS2 Depression 3 Cerebrovascular
Low-income countries 1 HIV/AIDS2 Perinatal 3 Depression
2030 rankings:The leading causes of DALYs lost
WHO, 2010.
7 |
ScarcityHuman Resources
(N=157 to 183 countries)
ScarcityHuman Resources
(N=157 to 183 countries)
Human resources for Mental Health per 100,000 populationWHO, Mental Health Atlas, 2005.
Mental health resources in the USA◦ 300 million people◦ 50,000 psychiatrists
Mental health resources in India ◦ 1.1 billion people◦ 3000 psychiatrists
◦ WHO Mental Health Atlas 2005
9
WHO World Mental Health Consortium, JAMA, June 2nd 2004
Gap in treatment:Serious cases receiving no treatment during the last 12 months
0
10
20
30
40
50
60
70
80
90
Developed countries Developing countries
Lower range Upper range Lower range Upper range
35%
50%
76%
85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Schizophrenia n =50 Mood disorders n=28
COVERAGE TREATMENT GAP
Treatment
Gap
69%
Treatment
Gap
98%
COVERAGECOVERAGE
Most resources concentrated in urban areas
Many resources in private sector with high out-of-pocket costs
80% 83%
37%
20% 17%
63%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Proportion ofexpenditures
Proportion ofbeds
Proportion ofhuman
resources
Other facilitiesMental hospitals
Mental Health Services (WHO, 2003)
FREQUENCY
OF NEED
COST
LOWHIGH
HIGH LOW
SELF CARE
INFORMAL COMMUNITY CARE
Mental Health Services through PHC
CommunityMental Health
Services
PsychiatricServices in
GeneralHospitals
Specialist Services
17
Scaling up services for people with mental disorders based on evidence
and human rights protection
“increasing the coverage of services based on the evidence derived from experimental research, leading to improve health outcomes in the
target population”
18
19
Building capacity in stakeholders
Supporting community and primary care intervention programs
Implementing priority mental health research
Advocacy to raise mental health literacy
In many low-income countries, mental illness has traditionally been seen as a low priority area, both in terms of clinical resources and emphasis in the training of healthcare professionals.
The psychiatrist are essential part of every health care system, but their training should response to the needs of the community.
