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Cost of scaling up mental healthcare in low-and middle-income countries

  • Dan Chisholm (a1), Crick Lund (a2) and Shekhar Saxena (a3)

Abstract

Background

No systematic attempt has been made to calculate the costs of scaling up mental health services in low-and middle-income countries.

Aims

To estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006–2015).

Method

A core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low-and middle-income countries were established using the WHO–AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.

Results

The cost per capita of providing the core package attarget coverage levels (in US dollars) ranged from $1.85 to $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18–0.55 per capita.

Conclusions

Although significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.

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Copyright

Corresponding author

Dr Dan Chisholm, Department of Health Systems Financing (HSF), World Health Organization, 1211 Geneva, Switzerland. Email: ChisholmD@who.int

Footnotes

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Declaration of interest

None.

Footnotes

References

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Cost of scaling up mental healthcare in low-and middle-income countries

  • Dan Chisholm (a1), Crick Lund (a2) and Shekhar Saxena (a3)

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Cost of scaling up mental healthcare in low-and middle-income countries

  • Dan Chisholm (a1), Crick Lund (a2) and Shekhar Saxena (a3)
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eLetters

A response to Cost of scaling up mental health care in low- and middle - income countries

Prof K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Professor of Psychiatry
25 April 2008

The article on Cost of scaling up mental healthcare in low- and middle- income countries by Chisholm D et al (2007) was read with interestand the contents are very relevant to resource constrained countries like Sri Lanka.In order to achieve the World Health Report’s objective of adequate access to effective and humane treatment for those who suffer from mental illness human, social and financial resources are needed (WHO. World health report 2001. ). However, the WHO’s Atlas project shows widespread, systematic and long term neglect of resources in the low and middle income countries in the area of mental health ( WHO Mental Health Atlas 2005) .A majority of the world’s population lives Low and Middle Income Countries (LAMICs). There is scarcity of mental health resources, inequityin resource distribution, inefficiency of use, and evidence related to theeffectiveness of interventions for the treatment and prevention of mental disorders in these countries.Although mental health policies and plans are essential for proper coordination of services, about a third of all countries in the world haveno such policy or plan(( WHO Mental Health Atlas 2005) and only about a half of the countries in the African continent seem to have mental health policies (Saxena S et al 2007)Almost a third of countries do not have specified budget for mental health. In Africa andSoutheast Asia, most countries spend less than 1% of their small health budgets on mental health services (Saxena S et al 2007).Inadequate human resources are a limiting factor in providing mental health services in Asian and African countries. This scarcity of human resources is accentuated by large scale migration of mental health professionals to countries with high income.Therefore in these countries, there is an overwhelming need to increase the overall quality of services provided to treat people with mental illnesses.In order to achieve this, existing mental health policies and plans shouldbe updated appropriately and policy makers should be made more aware of the existing problems in the field of mental health service development. Mental health research is needed for advocacy, policy development, establishment of mental health services and expansion of the existing services in these countries.Mental health services can be integrated into the existing community and primary health care services, which are rather well established in the lowand middle income countries until a proper community mental health serviceis developed. Increasing the exposure in medical students to Psychiatry, during their medical school career can be used to increase the awareness about symptomsof mental illnesses and with regard to the gravity of the mental health burden, may lead to an increase in the identification of mental disorders in the primary health care setting. This is already happening in some medical schools in Sri Lanka like the Colombo and Kelaniya medical faculties.Improving the mental health services in low, middle income countries will need an enormous investment but it is high time to overcome the barriers to progress in improvement of the mental health services by generating support of the governments as well as other supporting agencies.

References

Chisholm D, Lund C, Saxena S. Cost of scaling up mental healthcare inlow- and middle-income countries. British Journal of Psychiatry.2007; 191:528-535

World health report 2001. Mental health: new understanding, new hope.Geneva, Switzerland: World Health Organization; 2001.

Mental health atlas. Geneva, Switzerland: World HealthOrganization, 2005.

Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370: 878–89
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