Mental Health Human Resources Research Articles

Development of mental health human resources for mental well-being.

Development of mental health human resources for mental well-being.

Global Mental Health Considers the Structure of the Mental Health System in the World

The World Health Organization defines mental health as a state of well-being in which each person realizes their potential and can cope with the normal stresses of life, work productively and fruitfully, and can contribute to their community. Global mental health refers to the international perception of different aspects of mental health. Taking into account cultural differences and country-specific conditions, it deals with the epidemiology of mental disorders in different countries, their treatment options, mental health education, political and financial aspects, the structure of the mental health system, and mental health human resources and human rights issues. The general goal of the field of Global Mental Health is to strengthen mental health throughout the world, providing information on the mental health situation in all countries and identifying mental health needs in order to develop economic procedures that will address these specific needs.

The Decision Of Pasar Jiwa Innovation Adoption In The Early Prevention Of Mental Health Issues At The Bubakan Health Center, Pacitan Regency

The research aims to analyze the stages of adopting the PaSar Jiwa innovation in the early prevention of mental health issues to address treatment gaps and social stigma. The method used is qualitative descriptive with the data analysis technique of the Miles and Huberman model. Data validity through triangulation technique, using data collection methods such as interviews, observations, and documentation. Research informants are doctors, nurses, and community health workers in the Bubakan Health Center area, selected through purposive sampling. Meanwhile, the informants for innovation adopters are selected using the accidental tal sampling technique. The research findings are as follows: Knowledge stage: 1) Indicator of knowledge about the existence of innovation. This indicator is influenced by two variables: individuals and communication behavior. The individual variable includes knowledge of solving mental health problems and cost savings. The communication behavior variable involves insufficient socialization to reach all community members. 2) Indicator of knowledge in using the innovation correctly. This indicator is influenced by individual variables indicating that handling is going well, while communication behavior is still limited due to a lack of human resources. 3) Indicator of knowledge about the functional principles of how and why the innovation works. This indicator is influenced by individual variables, where the implementers follow guidelines in carrying out the functions of the innovation. Persuasion stage: Characteristics of the innovation are influenced by four variables: 1) Relative advantage: measures comfort and satisfaction. The PaSar Jiwa innovation affects patient quality, making it advantageous. 2) Compatibility: measures consist of consistthe ency of values and adopters' needs for patient healing solutions.3) Trialability: influenced by the extent to which the innovation is gradually tested, facilitating adoption. 4) Observability: influenced by how visible the innovation is to others. Demonstrated through patient improvements, motivating adoption. Complexity does not affect this stage. Decision stage: Partial adoption of the innovation occurs, leading to quicker acceptance as adopters decide to receive the innovation. Implementation stage: The innovation is gradually tested despite uncertainty. Confirmation stage: Support and attitude of implementers/adopters confirm the sustainability of the innovation. Research suggests developing alternative methods to address the lack of mental health human resources. This could involve group discussions for adopters/patients, organized in each village with the involvement of community health workers and family members. Family support as listeners is crucial for individuals experiencing mental health disorders.

Mental Health Issues of Adolescents In Pakistan: A Cry For Help

Globally, Anxiety and Depression are leading contributors affecting adolescents’ mental health. 1 in 4 adolescent goes through mental health issues that require immediate attention. 1 It is also well documented that many mental health disorders emerge in late childhood and early adolescence and they exacerbate to the burden of these disorders in youth and later in life. 2 In severe cases of anxiety and depression sufferer may commit suicide, it is reported that every 40 seconds one person dies of suicide.3 Globally, suicide is the fourth leading cause of mortality among youth between the ages of 15 to 29 after road traffic accidents. Among teens between 15-19 years, suicide is the second leading cause of death among girls (after maternal and reproductive issues) and the third leading cause of death in boys (after road traffic accidents and interpersonal violence). 4 Pakistan is a developing country with an estimated population of 220 million, of which 50% of the population is between 12- 25 years. A recent study conducted in Pakistan, on 400 high school going adolescents (15-18 years), identified the prevalence of anxiety and depression around 53% among the adolescents enrolled in high school going in Pakistan. 5 The rates of anxiety and depression among adolescent population are alarming in the context of Pakistan; where the mental health human resources are scare. There are only few child and adolescents’ psychiatrists, and hardly any specialized mental health nurses and formalized mental health services for children and adolescents in Pakistan that can be considered at par with the developed world. However, the encouraging news is that if an early preventive intervention in the forms of cognitive behavior therapy are done, it can help and empower children and adolescents to identify their triggers and manage anxiety and depression effectively. 6 Non-specialist preventive mental health strategies may work as alternate options for reducing anxiety and depression, in resource constrained settings like Pakistan. The effectiveness of Cognitive Behaviour Therapy based intervention are already established by non-specialists (Community Health Workers) to reduce postpartum depression among women. 7 These evidences are encouraging and can be replicated to reduce Anxiety and Depression among children and adolescents at schools. Schools are vital pillar to promote children’ cognitive, social, emotional, behavioral and intellectual attainment. Academic institutions are well positioned to implement preventive mental health strategies. Thus, school-based mental health prevention programme can be cost effective well positioned interventions for a LMIC country like Pakistan. 8 Mental health issues of young people require immediate attention. Many of these issues are easily manageable. However, it is challenging to access and provide them mental health services at their convenience. Therefore, it is important to engage main stream academic institutions, to access children and youth to include them for early interventions to address their mental health issues such as anxiety and depression. There is also a need to establish evidence-based interventions to promote mental health and prevent anxiety, depression, and suicidal ideation among youth.

Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

IntroductionMental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as ‘early-adopter’ countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative.MethodsWe used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health.ResultsEach country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment.ConclusionsThis rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India.

Task-shifting is an important means to address the barrier of inadequate specialist human resources for mental health in countries such as India. This paper aims to report the impact of one such task-shifting initiative. Twenty-two non-specialist Medical Officers of Bihar, an eastern Indian state were engaged in a ten-month long hybrid (a 15-days onsite orientation to psychiatry and periodic online mentoring in primary care psychiatry) training program to enable them to identify commonly presenting psychiatric disorders in their respective clinics. 20 online sessions (hub and spoke ECHO model) occurred over the next 10months. Apart from didactic topics, 75 cases covering severe mental disorders, common mental disorders and substance use disorders were discussed (case presentations by the primary care doctors (PCDs)) and moderated by a specialist psychiatrist and clinical psychologist). 12 successive self-reported monthly reports (comprising of the number and nature of psychiatric cases seen by the trainee PCDs) were analyzed. The mean (SD) number of sessions attended was 9 (8.0) and median was 13 (Range: 0-20). Mean number of cases (per PCD) discussed was 3.4 (3.4) (Median: 4; Range: 0-10). Total 20,909 patients were cared for in the 12months after initiation of the training program. Increasingly, a greater number of patients were cared for as the training progressed. This pattern was mainly driven by more identifications of severe mental disorders (SMDs), common mental disorders (CMDs), dementias and substance use disorders. Mean (SD) number of patients seen per month before and after training was 1340.33 (86.73) and 1876.44 (236.51) (t = - 3.5, p < 0.05) respectively. A hybrid model of training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community. Prospective, well designed studies are essential to demonstrate the effectiveness of this model.

Chhattisgarh community mental healthcare tele-mentoring program (CHaMP): Digitally driven initiative to reach the unreached.

Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings (n = 2150). The objective of this article is to give a brief overview of the initiative. CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.

Mediational Intervention for Sensitizing Caregivers to Improve Mental Health Outcomes in Orphaned and Vulnerable Children

ABSTRACT Objective There is an urgent need to equip community-based careworkers with the skills to address the mental health needs of orphans and vulnerable children (OVC) as an essential response to shortages in human resources for mental health in Sub-Saharan Africa. We conducted a quasi-experimental feasibility trial in South Africa to adapt and evaluate an established year-long semi-structured, manualized video-feedback caregiver intervention (the Mediational Intervention for Sensitizing Caregivers; MISC) for community-based organizations (CBOs). Methods Following a year-long iterative cross-cultural adaptation of MISC, we recruited 88 OVC (ages 7–11; 45.5% girls) and their CBO careworkers (N = 18; 94.4% female). Two CBOs (45 children; 9 CBO careworkers) received 12 months of MISC, and two CBOs (43 children; 9 CBO careworkers) received treatment as usual. Child mental health and quality of caregiving were assessed at 6 months into the intervention and at completion through multi-informant questionnaires and video-recordings of careworker-child interactions. Qualitative interviews were conducted to evaluate feasibility and acceptability. Results MISC-CBO was acceptable and feasible in terms of attendance and post-intervention interviews. MISC improved child mental health, as well as the quality of careworker caregiving in terms of interactive effects for affective and cognitive (Expanding) components of MISC, and main effects for the cognitive components of Rewarding and Provision of meaning. MISC components did not mediate the effects of the intervention. Conclusions The current study shows that laypersons with no tertiary education and virtually no prior training who undergo MISC training can improve caregiving quality and the mental health of OVCs.

Barriers to the provision of community-based mental health services at primary healthcare level in northern Nigeria – A mixed methods study

This study examined the barriers associated with the level of community-based mental health services in three selected States in northern Nigeria. Both quantitative and qualitative data were collected from a convenient sample of 191 primary healthcare (PHC) service providers and a purposive sample of 13 primary healthcare system administrators and managers at both State and Local government levels through a WHO/WFMH 10-factor questionnaire and literature-derived guide for in-depth interviews (IDIs). Quantitative data analysis was undertaken using simple descriptive measures (with the use of IBM Statistical Product and Service Solutions (SPSS) 23.0) while the qualitative data was thematically analysed to complement the quantitative data. Results show that in all the study States, poor funding, lack of skilled mental health human resource and inadequate training of available personnel were identified as the major barriers to provision of mental health services at the community level. Socio-cultural factors such as community rejection of the services, stigma and misconceptions were reported as second-grade barriers. It is concluded that PHC administrators, coordinators and service providers agree that fallouts of policy failure and lack of political will at Federal, State and Local government levels and socio-cultural dynamics constitute barriers to community based mental health services. Efforts towards improving the provision of these services need to focus more on healthcare policy issues and political machinery of the governments while motivating available service providers to increase community psycho-education in their respective centres and host communities. This should be done as short-, medium- and long-term measures.

Embracing Technology for Capacity Building in Mental Health: New Path, Newer Challenges.

Technology driven capacity building initiatives are the way to break the barrier of shortage of mental health human resources in India. This new path, while is a welcome step, comes with its own set of challenges. In one prototypic project that is being implemented in Ramanagara District of Karnataka, a south Indian state, we encountered many such issues. They ranged from issues related to availability of dedicated space to set up the hub-studio, inconsistent internet connectivity (particularly in remote areas) and inadequate digital literacy among the grassroot community health workers who hail from villages. This article summarises these challenges and ends by looking into ways and means of overcoming them.

The value of hope: development and validation of a contextual measure of hope among people living with HIV in urban Tanzania a mixed methods exploratory sequential study

BackgroundHope or hopefulness enhances coping and improves quality of life in persons with chronic or incurable illnesses. Lack of hope is associated with depression and anxiety, which impact negatively on quality of life. In Tanzania, where HIV prevalence is high, the rates of depression and anxiety are over four times higher among people living with HIV (PLH) compared to persons not infected and contribute annual mortality among PLH. Tanzania has a shortage of human resources for mental health, limiting access to mental health care. Evidence-based psychosocial interventions can complement existing services and improve access to quality mental health services in the midst of human resource shortages. Facilitating hope can be a critical element of non-pharmacological interventions which are underutilized, partly due to limited awareness and lack of hope measures, adapted to accommodate cultural context and perspectives of PLH. To address this gap, we developed and validated a local hope measure among PLH in Tanzania.MethodsTwo-phased mixed methods exploratory sequential study among PLH. Phase I was Hope-related items identification using deductive, inductive approaches and piloting. Phase II was an evaluation of psychometric properties at baseline and 24 months. Classical test theory, exploratory, confirmatory factor analysis (CFA) were used.ResultsAmong 722 PLH, 59% were women, mean age was 39.3 years, and majority had primary school level of education. A total of 40 hope items were reduced to 10 in a three-factor solution, explaining 69% of variance at baseline, and 93% at follow-up. Internal consistency Cronbach's alpha was 0.869 at baseline and 0.958 at follow-up. The three-factor solution depicted: positive affect; cognition of effectiveness of HIV care; and goals/plans/ future optimism. Test-retest reliability was good (r = 0.797) and a number of indices were positive for CFA model fit, including Comparative Fit Index of 0.984.ConclusionThe developed local hope scale had good internal reliability, validity, and its dimensionality was confirmed against expectations. The fewer items for hope assessment argue well for its use in busy clinical settings to improve HIV care in Tanzania. Hope in this setting could be more than cognitive goal thinking, pathway and motivation warranting more research.Trial registrationThe intervention was registered in USA ClinicalTrials.gov on September 26, 2012, Registration number: NCT01693458.

Study on the integration of mental health support into primary health care in Guinea

Introductionla faible couverture des services spécialisés et la pénurie en ressources humaines en santé mentale représentent d´immenses défis pour les systèmes de santé en Afrique. L'intégration de la santé mentale dans les soins de santé primaires constitue un complément substantiel et faisable aux services spécialisés. Cette étude rassemble et analyse les données générées dans 5 Centres de santé (CS) ayant intégrés ce paquet de soins en Guinée.Méthodesl'étude descriptive porte sur les nouveaux cas de santé mentale entre 2012 et 2017. Les motifs de consultations et les diagnostics posés ont été répertoriés et analysés sur la base des registres de consultation et des dossiers médicaux individuels.Résultatsau total 4995 patients ont consulté pour un problème de santé mentale, ce qui représente 2,8% des consultations générales (de 0,5 à 7,7% selon les centres). La moyenne d'âge des patients était de 27,9 ans (± 16,1). Les motifs de consultations les plus fréquents étaient les insomnies: 44,4% (n = 2081), les crises convulsives: 39% (n = 1827), les troubles du comportement: 31,9% (n = 1263) et les hallucinations: 26,1% (n = 1224). Les diagnostics les plus fréquemment posés étaient l'épilepsie : 36,8% (n = 1773) et les troubles psychotiques: 33,5% (n = 1613). 88,4% (n = 4418) des patients ont reçu un traitement médicamenteux, le plus souvent combiné avec un soutien psychologique.Conclusionl´étude montre que dans le contexte guinéen où l´accès aux soins spécialisés en santé mentale est très limité, les malades mentaux, même atteints de pathologies lourdes, peuvent être suivis dans des Centres de santé par un personnel non spécialiste mais formé en santé mentale.

Mental health system costs, resources and constraints in South Africa: a national survey.

The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system scale-up embedded into wider universal health coverage-related health system transformations, require detailed and locally derived estimates on existing mental health system resources and constraints. The absence of these data has limited scale-up efforts to address the burden of mental disorders in most LMICs. We conducted a national survey to quantify public expenditure on mental health and evaluate the constraints of the South African mental health system. The study found that South Africa’s public mental health expenditure in the 2016/17 financial year was USD615.3 million, representing 5.0% of the total public health budget (provincial range: 2.1–7.7% of provincial health budgets) and USD13.3 per capita uninsured. Inpatient care represented 86% of mental healthcare expenditure, with nearly half of total mental health spending occurring at the psychiatric hospital-level. Almost one-quarter of mental health inpatients are readmitted to hospital within 3 months of a previous discharge, costing the public health system an estimated USD112 million. Crude estimates indicate that only 0.89% and 7.35% of the uninsured population requiring care received some form of public inpatient and outpatient mental healthcare, during the study period. Further, mental health human resource availability, infrastructure and medication supply are significant constraints to the realization of the country’s progressive mental health legislation. For the first time, this study offers a nationally representative reflection of the state of mental health spending and elucidates inefficiencies and constraints emanating from existing mental health investments in South Africa. With this information at hand, the government now has a baseline for which a rational process to planning for system reforms can be initiated.

The care crisis in Spain: an analysis of the family care situation in mental health from a professional psychosocial perspective

ABSTRACTThe aim of this article is to investigate the importance of family care in mental health and identify the shortcomings of the Spanish model of health care for the mentally ill. The empirical process comprised three qualitative procedures involving 37 experts from different regions of Spain. In order to guarantee the rigor of the data, a social worker discussion group was set up to create an interview script. Interviews were then carried out with 22 professionals who take care of people with mental illness in various public facilities throughout the country. A second focal group met three times to validate the categorizations analyzed in the interviews. The results of the empirical process indicate a need to remodel the mental health care system, which can be described with reference to five critical characteristics: 1) a lack of financial and human resources for mental health, 2) a lack of effective coordination among all the institutions and authorities involved, 3) a lack of quality resources aimed at rehabilitation and social reintegration as alternatives to institutionalization, 4) a lack of integrated care, and 5) a lack of a common healthcare framework for all professional workers in all the regions. A remodeling of the system is necessary to enable the rehabilitation, recovery, empowerment and development of people with SMD and thus ease the burden and improve the quality of life of family caregivers.

A customized adherence enhancement program combined with long-acting injectable antipsychotic medication (CAE-L) for poorly adherent patients with chronic psychotic disorder in Tanzania: A pilot study methodological report

Chronic psychotic disorders (CPDs) occur worldwide and cause significant burden including reduced quality of life and functional impairment. Care for CPD includes psychosocial and pharmacologic interventions (i.e. antipsychotic drugs) and ongoing health monitoring. This is challenging in resource-limited settings where staff are sparse and/or undertrained. Importantly, mental health human resource needs predict continued deficits compounded by increasing disease burden. A U.S. team recently developed and tested a CPD treatment approach that combines the use of long-acting antipsychotic medication (LAI) with a brief and practical customized adherence enhancement behavioral intervention (CAE-L). This report describes the methodological details of an ongoing, first-ever refinement and preliminary testing of CAE-L in poorly adherent patients with CPD in Tanzania. Additional innovative elements include: 1) a manualized curriculum that targets specific barriers and facilitators to medication adherence in Tanzanians with CPD, and 2) targeting known, high-risk individuals with CPD (those who miss ≥20% of prescribed antipsychotic medication). The study procedures are intended to pave the way for implementing a large-scale intervention trial for CPD in the Tanzanian setting. An important component of this project is capacity building to help form the next generation of care providers. Visit exchanges modeled on a successful NIH-funded Medical Education Partnership Initiative (MEPI) template will also use the U.S. and Tanzanian teams to share expertise, problem-solve, and plan iterative refinements of project deliverables. Taken together, this project has potential to advance the care of people with CPD in Tanzania and has high generalizability to Sub-Saharan Africa and other lower-resource settings.

Using Peer Support in Developing Empowering Mental Health Services (UPSIDES): Background, Rationale and Methodology.

Background:Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health.Objectives:To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research.Methods:UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders’ perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact:UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.

Survey of the European Psychiatric Association on the European status and perspectives in early detection and intervention in at-risk mental state and first-episode psychosis.

Early detection/early intervention (ED/EI) programmes have been inconsistently implemented throughout Europe. We evaluated the ED/EI service distribution in European Psychiatric Association (EPA) member countries, considering indicators of socio-economic development, human and financial resources allocated in mental health (MH) as well as presence of a national branch of the Early Intervention in MH (IEPA). Contextually, we evaluated the duration of untreated psychosis (DUP) in relation to ED/EI service implementation. EPA section "Prevention of Mental Disorders" conducted the cross-sectional survey administering the 16-item questionnaire to the representatives of its National Psychiatric Associations (NPAs). The survey addressed the Service status and profile, national guidelines, education and policy, DUP and IEPA national branch status. The data were analysed in relation to the indices of economic parameters and MH resources. Neither the national economic parameters, nor indices of MH financial resources were significantly associated with variables related to ED/EI implementation. However, more MH human resources per country were associated with shorter DUP. In comparison to countries without a national branch of IEPA, all of these with the branch had more MH human resources, ED/EI chapters in the national guidelines and services involving both adolescents and adults. An unequal development of ED/EI services and related academic activities appears throughout Europe. The current results, besides providing a useful starting point to set the agenda for harmonizing ED/EI services, reveal that their implementation was more likely to be influenced by the IEPA membership status, rather than by country-specific financial and human resources allocated to MH.

South Africa’s rural mental health human resource crisis: a situation analysis and call for innovative task-shifting

South Africa’s rural mental health human resource crisis: a situation analysis and call for innovative task-shifting

Mental health service availability and delivery at the global level: an analysis by countries' income level from WHO's Mental Health Atlas 2014.

The World Health Organization (WHO)'s Mental Health Atlas series has established itself as the single most comprehensive and most widely used source of information on the global mental health situation. The data derived from the latest Mental Health Atlas survey carried out in 2014 describes the availability and delivery of mental health services in the WHO's Member States, focussing on differences by country's income level. The data contained in this paper are mainly derived from questions relating to mental health service availability and uptake, as well as on financial and human resources for mental health. Results are presented as median values and analysed by World Bank income group. Interquartile ranges are also provided as measures of statistical dispersion. In total, 171 out of WHO's 194 Member States were able to at least partially complete the Atlas questionnaire. The results highlight a wide gap between high and low-medium income countries in a number of areas: for example, high-income countries have 20 times more beds in community-based inpatient units and 30 times more admissions; the rate of patients cared by outpatient facilities is 40 times higher; and there are 66 times more community outpatient contacts and 15 times more mental health staff at outpatient level. Overall resources for mental health are not distributed efficiently: globally about 60% of financial resources and over two-thirds of all available mental health staff are concentrated in mental hospitals, which serve only a small proportion of patients. Results indicate that outpatient care is the only effective means of increasing the coverage for mental disorders and is expanding, but it is strongly influenced by country income level. Two elements of the network of mental health facilities are particularly scarce in low- and middle-income countries: day treatment facilities and community residential facilities. The WHO Mental Health Atlas 2014 survey provides basic mental health information at the level of WHO's Member States, concerning mental health resources and activities. Atlas promotes the use of information, usually underestimated not only in low- and middle-income countries but also in high-income countries. Information is needed not only for monitoring the scaling up of the mental health system at country level, but also for improving transparency and accountability for users, families and the public.

Addressing shortages in human resources for mental health: Developing an undergraduate psychiatry training program in Botswana

Addressing shortages in human resources for mental health: Developing an undergraduate psychiatry training program in Botswana