Mental health in low and middle income countries (Article Sample)

Mental Health in Low and Middle-Income Countries: Influencing Factors and Prospective Solutions The prevalence of mental health crises in low and middle-income countries is substantiated by factors such as inadequate resources, underprivileged healthcare systems, and burgeoning population numbers. Presently, about 85% of the global population resides in the 153 countries categorized as low and middle-income, of which approximately 80% grapple with mental health issues. The gap between available resources and treatment requirements stands at around 90%. Conditions such as depression, schizophrenia, bipolar disorder, and alcohol use disorder rank among the top 10 causes of health-related disabilities. Depression, specifically, is the third leading contributor to disease burden in low-income nations and the second highest in middle-income nations, affecting an estimated 300 million individuals. This aligns with an alarming rise in suicidal tendencies, as the link between mental illnesses and suicide risk becomes increasingly pronounced. Annually, this connection results in a staggering 80,000 deaths, primarily among those aged 15 to 29. To address these challenges, the Mental Health Action Plan 2013-2020 emphasizes attaining sustainable development goals to ensure comprehensive well-being and healthy lives for all, regardless of age or country. This underscores the imperative to rectify the numerous gaps in mental health care prevalent in low and middle-income countries. Against this backdrop, the purpose of this editorial is to explore the reasons behind subpar mental health reforms in lower and lower-middle-income nations and propose potential solutions to overcome these underlying obstacles. The primary challenges have been synthesized under the following categories: (i) ineffective legislation, leadership, and national health policies, (ii) resource and healthcare workforce imbalances, (iii) cultural beliefs and stereotypes, (iv) natural and man-made disasters, (v) mental health information systems and evidence-based interventions, and (vi) socio-demographic factors. Key Factors Impacting Mental Health in Low and Middle-Income Countries: 1 Ineffective Legislation, Leadership, and National Health Policies: Inadequate legislation, lackluster public health leadership, and the scarcity of effective mental health reforms continue to impede progress in developing countries. Insufficient prioritization on both national and international public health agendas correlates with a lack of consensus among stakeholders. While many developing countries have established legislation, its scope and content often fall short of addressing local and global mental health needs. For example, these nations tend to adopt mental health agendas outlined by the World Health Organization (WHO), which may not align with local requirements. The replication of costly agendas from higher-income countries, such as the US, further exacerbates the issue. This is compounded by a dearth of training for public health leadership in these regions. In Pakistan, implementation and subsequent evaluation of mental health policies have been lacking. Past evidence illustrates prolonged delays in drafting, approving, and implementing legislation. Moreover, inter-sectoral collaborations are absent in devising unified and sustainable mental health plans. Despite a meager 2% of the health budget allocated, only 0.4% is dedicated to mental health. 2 Maldistribution of Resources and Healthcare Workforce: Resource allocation for the development of mental health services is a persistent challenge in each low and middle-income country (LMIC). The majority of LMICs, including 15 out of 19 African nations, allocate less than 1% of their health budgets to address mental illnesses. Moreover, there are limited incentives for mental health specialists to practice in rural areas, leading many to seek opportunities abroad or opt for private practices. Insufficient compensation discourages individuals from pursuing careers in mental health. The glaring disparity between demand and availability stands at approximately 90%. The ratio of available healthcare workforce fails to meet global requirements. Research indicates that low middle-income countries necessitate approximately 239,000 mental health workers for adequate care, yet the current ratio is only 1 per 100,000 individuals. To illustrate, Nigeria has a mere 150 psychiatrists for a population of 186 million, while Nepal's mental health services are disproportionately centered in urban areas, with 0.22 psychiatrists and 0.06 psychologists per 100,000 residents. Similarly, populous developing nations like India, Pakistan, Nigeria, and Ethiopia have ratios of 0.301, 0.185, 0.06, and 0.04 mental health professionals respectively, creating a substantial treatment gap. Additionally, services tend to be concentrated in urban locales, leaving rural districts underserved. In Pakistan, there are only 21 psychiatric beds per 100,000 individuals, with a mere 7% allocated for pediatric care. With fewer than 500 psychiatrists and just four major psychiatric hospitals, the country faces significant challenges in addressing its mental health crisis over the long term. 3 Cultural Beliefs and Stereotypes: Cultural and religious beliefs exert a significant influence on help-seeking behaviors and outcomes related to mental health. Many individuals initially turn to religious figures for assistance, reflecting reduced faith in medical practitioners. In numerous Asian developing nations, therapeutic techniques aimed at improving mental health are often perceived as Western-centric and contradictory to religious beliefs. Furthermore, mental illnesses are sometimes attributed to karma or divine retribution for past misdeeds. Stereotypes and attitudes, such as coercion or dismissive phrases like "man up," "stop acting childish," and "such is life," contribute to the perpetuation of mental health issues. Stigma further fosters discriminatory behavior, often leading to the exclusion and mistreatment of individuals grappling with mental illnesses. In these developing countries, where familial bonds are strong, much of the stigma originates from within families and relatives. These cultural beliefs deter individuals from seeking mental health services, intensifying their isolation, loneliness, and non-adherence to treatment plans. Research conducted in Poland revealed that 95% of employers would not hire an individual with schizophrenia for any position. Similarly, many people feel ashamed to share their experiences, hindering their recovery process. Recent reports highlight instances of inhumane treatment within mental health services, particularly in isolation and detention settings. Consequently, treating ...