Capacity Building in Mental Health Research: The Way Forward

Abstract

Byline: K. Shaji Introduction Mental illnesses constitute of 14% of the overall burden due of disease [sup][1] as measured by the disability adjusted life years (DALYs). According to the World Health Report (2001), about 28% of non-communicable disease burden is secondary to mental illnesses. Conditions such as depression, alcohol use and schizophrenia are leading causes of the global burden due to disease. The strong association between mental disorders and social disadvantage, especially poverty, violence, gender disadvantage, conflicts and disasters is well-recognized. [sup][2] Intimate relationships exist between physical health problems and mental disorders. One can fuel the other and adversely impact each other's outcome. This leads to the slogan health without mental [sup][3] There is an evidence of efficacy and cost-effectiveness of a number of pharmacological and non-pharmacological treatments for managing mental disorders. [sup][3] These treatments are now available in the low and middle income countries (LAMICs). We have made considerable advances in the discovery of new effective treatments, but the delivery of these interventions remains poor. The implementation of science has not progressed much. Most people with mental illnesses receive no effective treatment. This exists across the developed and the developing world. In India, not even half of those with serious mental disorders receive the treatment they deserve. [sup][2] Treatment gap for other mental health are likely to be huge and can be as high as 90% for like dementia. [sup][4] This large treatment gap in LAMICs prompted the publication of the Lancet series on global mental health. [sup][3] The articles were on burden and impact of mental disorders, the evidence on the effective treatments, unmet needs in LAMICs, serious shortage of mental health resources and barriers for scaling up of services. A call to action for scaling up of services was also made based on the available evidence. [sup][5] The authors recommended that such scaling up shall be necessarily based on two principles: Evidence on cost-effectiveness and respect for human rights. They have also called for greater investment in building the evidence to guide the process of scaling up of services. Good evidence comes from good quality research. Research capacity in mental health should be strengthened. We need home-grown to address issues which concern us most. In the year 2008, WHO launched a landmark initiative called Mental Health Gap Action Program (mhGAP) to develop evidence based guidelines for managing mental, neurological and substance use disorders by non-specialist health-care professionals working in LAMICs. Many mental health professionals, including some of us from India, contributed to the development of guidelines for eight groups of priority conditions namely depression, schizophrenia and other psychotic disorders (including bipolar disorder); suicide prevention; epilepsy; dementia; disorders due to alcohol and other illicit drugs and mental disorders in children. The mhGAP - Intervention Guide (mhGAPIG) was released in the year 2010. This guide is an example of synthesis of evidence to decide should be scaled up. The logical next question would be how can we scale up these interventions? The Research Gap We need a different set of information to develop and deliver population based services. If information is unavailable or inadequate, becomes necessary. Research generated information is crucial to establish the health needs in a given setting and to propose culturally acceptable, cost-effective interventions. The gap refers to the difference between the information that is needed to develop the best possible services in a given setting and what is currently available. [sup][6] To bridge this gap WHO launched a program called research for change. …