Mental Health Care Models in Low-and Middle-Income Countries

Abstract

Global mental health applies the principles of global health to the field of mental health. Over the years, global mental health has advocated the cause of increasing access to mental health care through promoting the prioritization of mental health in global development goals, documenting the enormous disparities in mental health by framing the disparity in terms of the treatment gap, and responding to the treatment gap through innovative and evidence-based interventions. The prevalence of mental health and substance use disorders has not declined across the world over the past 25 years. Additionally, the treatment gaps for a range of mental health conditions remains high, more so in low-income and middle-income countries across the world. The conventional models of mental health care have been singularly limited in reducing the treatment gap as they remain plagued by several demand- and supply-side barriers such as geographic inaccessibility, inadequate funding and leadership, human resource shortages, lack of public health perspective, algorithm-driven diagnoses that ignore explanatory models, and stigma associated with seeking or receiving treatment for mental ill health. In this chapter complementary models of care which seek to overcome such barriers through innovative solutions are described, such as responding to distress or dimensional formulations of mental ill health, task-sharing approaches, collaborative stepped care, integration of care into alternative platforms, and rights-based care. Despite the success of these models, several challenges persist, and future work needs to vigorously explore systematic implementation at scale, transdiagnostic approaches, digital solutions, differentiated service delivery, promotion and prevention interventions, and effective responses to global emergencies such as the COVID-19 pandemic.