Feature

More than three-quarters of people in the developing world who have mental, neurological or substance abuse disorders receive no treatment at all, according to the World Health Organization. Now WHO is working to change that.

The organization has launched an effort to bridge the gap between what's needed and what's available. The six-year Mental Health Gap Action Programme targets eight conditions—depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to the use of alcohol, those due to the use of illicit drugs and mental disorders in children—in low- and middle-income countries. The goal: To spread the use of cost-effective interventions that have been proven to work.

Several barriers have kept countries from addressing such disorders, says psychiatrist Shekhar Saxena, MD, program manager in WHO's Department of Mental Health and Substance Abuse.

For one, policymakers and others often don't understand these conditions, says Saxena. "They don't know that mental disorders are so frequent and don't know that they cause so much disability and economic cost," he explains. "They don't know that something very substantial can be done about them."

Even when they do recognize the importance of treating these conditions, he adds, they typically don't know how to go about it. As a result, these conditions keep slipping down the public health agenda.

With the Mental Health Gap Action Programme, WHO is making them a priority. The program emphasizes both the development of political commitment and policies and appropriate clinical interventions.

A team of psychologists, psychiatrists and other experts is now scouring the scientific literature for psychosocial and pharmacological interventions that are both effective and cost-effective that are suited for use in primary and secondary care settings in developing countries.

By year's end, WHO plans to have compiled recommended intervention packages for all eight conditions. Countries or regions will then adapt the interventions based on local conditions, such as cultural beliefs.

"The program is very psychology-friendly," says psychologist Geoffrey M. Reed, PhD, a senior project officer in WHO's Department of Mental Health and Substance Abuse. "What WHO doesn't want to do is come out with a program telling everybody which drugs they ought to prescribe. They want to identify and develop intervention packages that emphasize psychological interventions."

Integrating such services into primary care will be key, adds Saxena, pointing to the dearth of psychologists and other mental health specialists in the developing world. "We are conscious of the fact that the limitations of the personnel's time and skill levels are very significant," he says. "We're looking for interventions that are effective but require an investment in terms of time, training and cost that is realistic in these countries."

Psychologists and other specialists will have a supervisory role, he adds.

In addition to helping develop the interventions, psychologists will also help put the program into action, says Reed. The International Union of Psychological Science (IUPsyS) and national psychological associations in the targeted nations can be key players during the implementation phase. National associations in high-income countries, like APA, will not be directly involved in implementation, but "APA participates actively in a range of international collaborations, including through IUPsyS," says Reed.

For more information, visit www.who.int/mental_health/mhgap/en.


Rebecca A. Clay is a writer in Washington, D.C.