Strengthening mental health systems in low- and middle-income countries: the Emerald programme.

Maya Semrau,Inge Petersen,Heidi Lempp,Charlotte Hanlon,Sara Evans-Lacko,Graham Thornicroft,Crick Lund,Oye Gureje,Rahul Shidhaye,Jose Luis Ayuso-Mateos,Fred Kigozi,Mark Jordans,Atalay Alem,Dan Chisholm

doi:10.1186/s12916-015-0309-4

Abstract

There is a large treatment gap for mental health care in low- and middle-income countries (LMICs), with the majority of people with mental, neurological, and substance use (MNS) disorders receiving no or inadequate care. Health system factors are known to play a crucial role in determining the coverage and effectiveness of health service interventions, but the study of mental health systems in LMICs has been neglected. The ‘Emerging mental health systems in LMICs’ (Emerald) programme aims to improve outcomes of people with MNS disorders in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda) by generating evidence and capacity to enhance health system performance in delivering mental health care. A mixed-methods approach is being applied to generate evidence on: adequate, fair, and sustainable resourcing for mental health (health system inputs); integrated provision of mental health services (health system processes); and improved coverage and goal attainment in mental health (health system outputs). Emerald has a strong focus on capacity-building of researchers, policymakers, and planners, and on increasing service user and caregiver involvement to support mental health systems strengthening. Emerald also addresses stigma and discrimination as one of the key barriers for access to and successful delivery of mental health services.

Highlights

Introduction to mental and neurological disorders2.1 Mental health epidemiology3.1 Stigma and discrimination1.2 Health systems concepts and approaches
They are overstretched in low- and middle-income countries (LMICs), due to the higher overall burden of disease in
Often in LMICs the existing health systems are more orientated to acute conditions, which results in fragmented care, erratic medication supplies, resource problems, or lack of sustainability of services for long-term disorders

Summary

Background

A health system can be defined as “the sum total of all the organizations, institutions, and resources whose primary purpose is to improve health” [1]. Often in LMICs the existing health systems are more orientated to acute conditions, which results in fragmented care, erratic medication supplies, resource problems, or lack of sustainability of services for long-term disorders It is these issues at the health-system level that the Emerald programme is committed to address. [18], the three overarching objectives of Emerald are to address: i) adequate, fair, and sustainable resourcing for mental health (health system inputs); ii) integrated provision of mental health services (health system processes); and iii) improved coverage and goal attainment in mental health (health system outputs) In addition to these three health system objectives, fundamental to Emerald is the enhancement of in-country capacities and skills to plan, implement, evaluate, and sustain system improvements. Due to the diversity of the sites, for instance, with regard to their geographical, economic, socio-cultural, and urban/ rural contexts, this may increase the programme’s relevance to a range of other LMIC settings

Activities and methods

Findings

2.10 Survival skills for researchers