Improving Mental Health Care
Goals, Strategies, and Factors to Consider
The World Health Organization (WHO) recommends an “optimal mix of services pyramid,” in which the cheapest and most frequently used mental health care services are at the bottom of the pyramid, while more expensive services (e.g., long-term inpatient care facilities) are at the top. The WHO suggests that countries build this mix of services by:
- Reduce the number of mental institutions
- Developmental health services in the community
- Increase the availability of mental health care in regular hospitals.
- Integrate mental health and primary care services
- Create informal mental health services in the community.
- Encourage self-care.
The WHO has proposed several methods to improve mental health care delivery through its Mental Health Global Action Programme (mhGAP). The mhGAP’s four basic strategies are as follows:
- To improve country capability, expand and enhance information for decision-making and technology transfer.
- We raise awareness of mental illnesses through education and activism to promote greater human rights respect and reduce stigma.
- Assisting countries in developing comprehensive and effective mental health policies and services.
- In developing countries, local public mental health research capacity is being built.
The global health community, including governments, funders, multilateral agencies, and consumer groups, will need to invest in implementing the WHO’s recommendations. Chisholm et al. (2007) studied the amount of money needed to scale up mental health care in 12 countries that had data from the WHO’s Assessment Instrument for Mental Health Systems (AIMS). Four low-income nations, seven lower-middle-income countries (Albania, China, Iran, Morocco, Paraguay, Thailand, and Ukraine), and one upper-middle-income country (Ukraine) were included in the study (Chile). The researchers set improvement goals based on levels of service coverage for mental illness achieved in high-income countries; the plans were set at an 80 percent increase in range for people with schizophrenia and bipolar affective disorder, a 25% increase in coverage for hazardous alcohol use services, and a 33% increase in coverage for depression services. To meet these goals in ten years, total expenditures in low-income nations would have to increase tenfold, to around $2 per person per year by 2015, and total spending in lower-middle-income countries would have to climb between three and sixfold, to about $3-4 per person per year. This would necessitate an “initial period of large-scale investment,” with an increase in spending of $0.300-0.50 per person per year, followed by a gradual increase of $0.100-0.25 per person each year. Although this model lacks targets for scaling up treatment for childhood mental disorders and is based on data from a small number of countries, other nations can use it to drive mental health care expenditure.
Mental health indicators must be carefully chosen to monitor the scaling-up process, according to Chisholm et al. (2007), so that countries may quantify their progress and compare their mental health care status to that of other countries. Chisholm et al. (2007) propose 11 markers for measuring progress toward four mental health objectives:
- Mental health care requires adequate planning and investment.
- Enough personnel to provide mental health treatments
- Inputs and processes in mental health care are consistent with best practices and human rights protection.
- People with mental illnesses have better outcomes.
Furthermore, the scaling-up process must be accompanied by research funding to determine the efficacy and efficiency of mental illness treatment and preventative initiatives. Chisholm et al. (2007) argue that research efforts should be focused on “developing and assessing interventions for people with mental disorders that do not require the delivery of mental health professionals, and assessing how health systems can scale up such feasible and effective interventions across all routine-care settings.” Integrating mental health care into primary care services is one option for scaling up mental health interventions in routine care settings. Blending components of mental health care into primary care is expected to give a more holistic approach to health care, allow for early detection and treatment of mental disease, promote ease of access to mental health care, and lessen the stigma associated with obtaining psychiatric care. Integration of mental health care into primary care services must be accompanied by enough resources and specialized education and training for primary health care practitioners to offer effective and high-quality mental health treatment.
While the WHO’s recommendations for scaling up health care provide a broad set of options for development, countries should use culturally appropriate strategies to provide the best mental health care. In Japan, for example, where deinstitutionalization began in the mid-2000s, family members have traditionally played a key role in caring for relatives with severe mental illness. Assertive community treatment (ACT) has been advocated as an essential component of enhancing mental health care in Japan due to the large engagement of family members in mental health care. This is partly because ACT provides complete mental health care to patients, easing the burden of care on families while allowing relatives to remain involved in their care.
To summarise, scaling up mental health care services must be closely monitored, sensitive to a cultural context, accompanied by substantial research, and supported by enough money to increase worldwide access to mental health care.