Abstract
BackgroundMental health policy can be an essential and powerful tool to improve a population’s mental health. However, around one third of countries do not possess a mental health policy, and there are large disparities in population coverage rates between high- and low-income countries. The goal of this study is to identify the transition and implementation challenges of mental health policies in both high-income countries (HICs) as well as middle- and low-income countries (MLICs).MethodsPubMed, Cochrane Library and Campbell Library were searched from inception to 31 December 2017, for studies on implemented mental health policies at the national level. s and the main texts of papers were double screened, and extracted data were analysed through thematic synthesis.ResultsA total of 93 papers were included in this study, covering 24 HICs, 28 MLICs and 5 regions. Studies on mental health policies, especially those of MLICs, kept increasing, but MLICs were still underrepresented in terms of publication quantity and study frequency. Based on the included studies, nine policy domains were summarized: service organizing, service provision, service quality, human resources, legislation and human rights, advocacy, administration, surveillance and research, and financing and budgeting. HICs incrementally enriched their policy content in all domains over centuries of development; following HICs’ experience, mental health policies in MLICs have boomed since the 1990s and quickly extended to all domains. Implementation problems in HICs were mainly related to service organizing and service provision; for MLICs, more severe implementation problems converged on financing and budgeting, administration and human resources.ConclusionsMental health policy developments in both HICs and MLICs present a process of diversification and enrichment. In terms of implementation, MLICs are faced with more and greater challenges than HICs, especially in funding, human resources and administration. Therefore, future efforts should not only be made on helping MLICs developing mental health policies, but also on promoting policy implementation under MLICs’ local context.
Highlights
Mental health policy can be an essential and powerful tool to improve a population’s mental health
Compared to high-income countries (HICs), there was a quick increase of middle- and low-income countries (MLICs) studies after 2000 (Table 1, Fig. 2)
The experience of HICs is accumulated through centuries of development and their current practices are based on well-established mental health systems
Summary
Mental health policy can be an essential and powerful tool to improve a population’s mental health. Around one third of countries do not possess a mental health policy, and there are large disparities in population coverage rates between high- and low-income countries. The goal of this study is to identify the transition and implementation challenges of mental health policies in both high-income countries (HICs) as well as middle- and low-income countries (MLICs). Mental health policy is a government statement specifying values, principles and objectives for mental health. It can be implemented in the forms of mental health plans, programmes, strategies and legislation at multiple levels [1]. If properly formulated and implemented, mental health policy can be an essential and powerful tool for countries to improve mental health and reduce the burden of mental disorders. Mental health legislation covers 92% of people living in high-income countries, whereas only 36% are covered in low-income countries [6]
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