April 03, 2018
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Collaboration, integration key to addressing global mental health inequalities

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Global mental health interventions that emphasize community collaboration in delivering mental health care and integrate mental health care into primary care settings are key to addressing health disparities between lower- and higher-income countries, according to research published in Psychiatric Annals.

“Early research conducted by cultural psychiatrists had limited public health and clinical application in international settings due to lack of economic and political support and was mainly used to develop interventions for refugees living in high-income countries,” Anna Fiskin, MD, MSc, assistant clinical professor in the department of psychiatry at University of California San Francisco, and colleagues wrote.

Although representatives of the U.N. signed the Millennium Development Goals to fight disease, cut child mortality and improve maternal health by 2015, mental health was not prioritized. Therefore, global strategies and interventions to improve the mental health of people living in underserved and lower-income places around the world are needed.

“This lack of inclusion has been highly criticized, as mental illness has been found to disproportionately affect the poor and marginalized and have a profound effect on maternal well-being and childhood failure to thrive,” Fiskin and colleagues wrote. “Global mental health advocates have argued that stigma against mental illness among all levels of society has been a major barrier to implementing mental health policy to improve overall health outcomes for both developing and developed countries.”

Interventions that use an integrated collaborative care delivery model — in which a stepped-care approach is delivered in community and primary care settings — offer the most effective way to bridge the treatment gap, according to the authors. Sharing tasks with nonspecialists, such as nurses and primary care providers, increases affordability and accessibility to mental health care. Robust evidence has shown that community health workers in low- to middle-income countries can deliver good mental health interventions for depressive and anxiety disorders, schizophrenia and dementia.

“An important component of integrated collaborative care is that the majority of care should be delivered outside of specialty mental health care settings and focus on homes, schools, work, or primary care centers,” the authors explained. “Additionally, interventions should actively involve patients and families in their design and implementation, and mental health care should be integrated with social and economic interventions.”

In addition, strategies developed to improve health in low- to middle-income countries may help serve the mental health needs in marginalized populations living in higher income countries, according to the researchers. Underserved communities can be positively impacted by approaches that support community-based organizations, leadership within the community, use technology to improve access, link clinical care with public health and social services, and join health with economic development.

“Repeated funding cuts for community mental health efforts in the U.S. have resulted in a fragmented mental health system in which a large proportion of care has been transferred from asylums to other institutions, such as residential facilities and prisons,” Fiskin and colleagues wrote.

Using existing methods developed by global mental health supporters can improve mental health care for vulnerable people living in the United States, according to the authors. Methods that highlight collaboration on the local level within the community can help fix social and economic factors that impact mental health. Psychiatrists and other mental health professionals should continue to research effective task-sharing approaches that consider the needs of those at the local level, they wrote.

“The lessons learned from global mental health efforts in [low- and middle-income countries] are highly relevant to addressing health disparities and improving care for vulnerable populations in [high-income countries],” the authors wrote. “These interventions stress community collaboration in designing and delivering mental health care, integration of mental health into primary care settings, and engagement of trained and supervised nonspecialist health workers in care delivery.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.