Docsity
Inicia sesiónRegístrate
Docsity
Prepara tus exámenes
Prepara tus exámenes

Prepara tus exámenes y mejora tus resultados gracias a la gran cantidad de recursos disponibles en Docsity

Consigue puntos base para descargar
Consigue puntos base para descargar

Gana puntos ayudando a otros estudiantes o consíguelos activando un Plan Premium

Orientación Universidad
Orientación Universidad
Vende en Docsity
Vende en Docsity
Inicia sesiónRegístrate

Prepara tus exámenes

Prepara tus exámenes y mejora tus resultados gracias a la gran cantidad de recursos disponibles en Docsity

Busca documentos

Prepara tus exámenes con los documentos que comparten otros estudiantes como tú en Docsity

Busca documentos en el Store

Los mejores documentos en venta realizados por estudiantes que han terminado sus estudios

Video Cursos

Estudia con lecciones y exámenes resueltos basados en los programas académicos de las mejores universidades

Quiz

Responde a preguntas de exámenes reales y pon a prueba tu preparación

Busca entre todos los recursos para el estudio
Docsity AINEW

Resume tus documentos, hazles preguntas, conviértelos en quiz y mapas conceptuales

Ver preguntas

Despeja tus dudas leyendo las respuestas a las preguntas que realizaron otros estudiantes como tú

Consigue puntos base para descargar

Gana puntos ayudando a otros estudiantes o consíguelos activando un Plan Premium

Compartir documentos
download point icon20 Puntos

Por cada documento subido

Responde a las preguntas
download point icon5 Puntos

por cada respuesta dada (máx. 1 al día)

Todos los modos para conseguir puntos gratis
Consigue puntos de inmediato

Elige un plan Premium con todos los puntos que necesitas.

Oportunidades de estudio

Elige tu próximo programa de estudio

Ponte en contacto inmediatamente con las mejores universidades del mundo. Busca entre miles de universidades en todo el mundo. Busca entre miles de universidades partner oficiales

Comunidad

Pregúntale a la comunidad

Pide ayuda a la comunidad y resuelve tus dudas de estudio

Ranking de las universidades

Descubre las mejores universidades de tu país según los usuarios de Docsity

Ebooks gratuitos

¡Nuestros e-books salva-estudiantes!

Descarga nuestras guías gratuitas sobre técnicas de estudio, métodos para controlar la ansiedad y consejos para la tesis preparadas por los tutores de Docsity

Del blog

Actualidad
Becas y ayuda
Ve al blog

Déficit de profesionales de salud mental en países de ingresos bajos y medios: enfoque en , Guías, Proyectos, Investigaciones de Psicología

Universidad de San Buenaventura (USB) - MedellínPsicología
Prof. David Herrera

Un estudio que busca estimar el déficit de profesionales de salud mental en países de ingresos bajos y medios (lmics). El estudio utiliza datos de la organización mundial de la salud (oms) y una aproximación hipotética de un paquete de atención de salud mental para estimar el número de profesionales de salud mental necesarios para atender a la población total de los países estudiados. Los 58 lmics analizados necesitarían aumentar su fuerza laboral de salud mental en 239.000 profesionales equivalentes a tiempo completo para abordar el déficit actual.

Tipo: Guías, Proyectos, Investigaciones

2020/2021

Subido el 11/03/2024

luis-javier-tobon-restrepo
luis-javier-tobon-restrepo 🇨🇴

1 documento

1 / 12

Toggle sidebar

Esta página no es visible en la vista previa

¡No te pierdas las partes importantes!

bg1
I
Research
The mental health workforce gap
in
low- and middle-income
countries:
a
needs-based approach
Tim
A
Bruckner,^ Richard
M
Scheffier," Gordon
Shen,^
Jangho
Yoon,"^
Dan Chishoim,^ Jodi Morris,^ Brent
D
Fulton,'
Mario R Dai Poz^
&
Shekhar Saxena'^
Objective To estimate the shortage
of
mental heaith Professionals
in low-
and middle-income countries (LMICs).
Methods We used data from the World Health Organization's Assessment Instrument
for
Mental Health Systems (WHO-AIMS) from
58 LMICs, country-specific information
on the
burden
of
various mental disorders and
a
hypothetical core service delivery package
to estimate
how
many psychiatrists, nurses and psychosocial care providers would
be
needed
to
provide mental health care
to the
total population
of
the countries studied. We focused on the following eight problems,
to
which WHO has attached priority: depression,
schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related
to
the use
of
alcohol and illicit drugs,
and paediatric mental disorders.
Findings All low-income countries and 59%
of
the middle-income countries in our sample were found
to
have far fewer professionals
than they need
to
deliver
a
core
set of
mental health interventions. The
58
LMICs sampled would need
to
increase their total mental
health workforce
by
239000 full-time equivalent professionals
to
address the current shortage.
Conclusion Country-specific policies are needed
to
overcome the large shortage
of
mental health-care staff and services throughout
LMICs.
Abstracts in
^¿^,
4"
it, Français, PyccKMw and Español at the end
of
each article.
Introduction
psychosocial health, are needed
to
manage those patients who
are referred for specialized care and
to
deliver training, support
Mental, neurological,
and
substance abuse (MNS) disorders and supervision to non-specialists. Without these mental health
account
for an
increasing proportion
of
the global burden
of
professionals, LMICs will not have enough human resources
to
disease. The World Health Organization (WHO) attributes
to
meet their populations' mental health treatment requirements."
these disorders 14%
of
all
of
the world's premature deaths and -jjjg
[^j-jç
of reliable data on mental health systems in LMICs
years lived with disability.'
In
addition
to
imposing high costs greatly hinders workforce planning efforts. Almost one-fourth
on
the
health system, mental
and
neurological disorders
and of
the world's LMICs have
no
system
for
reporting basic men-
substance abuse also lead to lost worker productivity, impaired j^j health information."' Even among LMICs that have such
functioning, personal stigma, caregiver burden on family mem-
^
system, many suffer from lack
of
accountability
in
reporting
bers,
and,
in
some instances,
to
human rights violations.^'
QJ.
f^Q^n
the
inability
to
measure workforce capacity. Without
Although several cost-effective strategies reportedly reduce information of this kind, countries cannot assess the scope and
the disability associated with mental and neurological disorders magnitude
of
the
gap
between
the
number
of
mental health
and substance
abuse,^'
^
the fraction of those affected who receive workers needed and the number that is available,
appropriate treatment remains disturbingly low.' This treatment •\j(/é ^im
to
provide health planners, policy researchers and
gap appears especially wide
in
countries cla.ssified
as
low-
or
government officials with country-specific estimates of the hu-
middle-income by The World Bank, where around 85%
of
the f^jj^ resources that are required
in the
area
of
mental health
to
world's population resides. In such countries, treatment rates for adequately care for the population in need oi mental health care,
these disorders are suboptimal and range from 35%
to
50%.'
"
We have focused on eight priority problems
as
defined
by
WHO:
Researchers, policy-makers and international agencies have depression, schizophrenia, psychoses other than schizophrenia,
issued calls
for
low-
and
middle- income countries (LMICs) suicide, epilepsy, dementia, disorders related to the use of alcohol
to scale
up the
mental health components
of
their health and illicit drugs, and paediatric mental disorders (conduct or be-
systems.'-"'*
To
accomplish this, they need
to
increase their havioural, intellectual and emotional disorders of childhood)."
workforces," particularly
the
number
of
trained professionals For each of these disorders we used epidemiological information
who can provide good mental health services. Although primary published by WHO
as
ofjuly 2010,
in
conjunction with
the
health-care professionals can provide
the
bulk
of
care,
mental health services data available
for 58
LMICs that
had
recently
health professionals, namely psychiatrists, nurses and experts in completed the WHO Assessment Instrument for Mental Health
13
'
Department
of
Pubiic Heaith and Pianning, Poiicy and Design, university
of
Caiifornia, 202 Sociai Ecoiogy i, irvine, CA 92697-7075, United States
of
America (USA).
"
Department
of
iHeaitii Poiicy, Schooi
of
Pubiic Heaith, iJniversity
of
Caiifornia, Beri<eiey, USA.
'
Jiann-Ping Hsu Coiiege
of
Pubiic Heaith, Georgia Southern University, Statesboro, USA.
"
Department
of
Healtti Systems Financing, Worid Health Organization, Geneva, Switzerland.
'
Department
of
Mentai Heaith and Substance Abuse, Worid Health Organization, Geneva, Switzerland.
'
Giobal Center for Health Economics and Policy Research, University
of
California, Berkeley, USA.
,
«
Department
of
Human Resources
for
Health, World Heaith Organization, Geneva, Switzeriand.
Correspondence to Tim A Bruckner (e-maii: tim.bruckner@uci.edu).
(Submitted: 13 September
2010-
Revised version received:
4
November
2010
-Accepted:
8
November
2010-
Published online:
22
November 2010)
184
Bull
World
Health Organ 2011:89:184-194
I
doi:10.2471 /BLT.10.082784
pf3
pf4
pf5
pf8
pf9
pfa

Vista previa parcial del texto

¡Descarga Déficit de profesionales de salud mental en países de ingresos bajos y medios: enfoque en y más Guías, Proyectos, Investigaciones en PDF de Psicología solo en Docsity!

I

Research

The mental health workforce gap in low- and middle-income

countries: a needs-based approach

Tim A Bruckner,^ Richard M Scheffier," Gordon Shen,^ Jangho Yoon,"^ Dan Chishoim,^ Jodi Morris,^ Brent D Fulton,'

Mario R Dai Poz^ & Shekhar Saxena'^

Objective To estimate the shortage of mental heaith Professionals in low- and middle-income countries (LMICs).

Methods We used data from the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) from

58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package

to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the

total population of the countries studied. We focused on the following eight problems, to which WHO has attached priority: depression,

schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs,

and paediatric mental disorders.

Findings All low-income countries and 59% of the middle-income countries in our sample were found to have far fewer professionals

than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental

health workforce by 239000 full-time equivalent professionals to address the current shortage.

Conclusion Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout

LMICs.

Abstracts in ^¿^, 4" i t , Français, PyccKMw and Español at the end of each article.

Introduction psychosocial health, are needed to manage those patients who

are referred for specialized care and to deliver training, support

Mental, neurological, and substance abuse (MNS) disorders and supervision to non-specialists. Without these mental health

account for an increasing proportion of the global burden of professionals, LMICs will not have enough human resources to

disease. The World Health Organization (WHO) attributes to meet their populations' mental health treatment requirements."

these disorders 14% of all of the world's premature deaths and -jjjg [^j-jç of reliable data on mental health systems in LMICs

years lived with disability.' In addition to imposing high costs greatly hinders workforce planning efforts. Almost one-fourth

on the health system, mental and neurological disorders and of the world's LMICs have no system for reporting basic men-

substance abuse also lead to lost worker productivity, impaired j^j health information."' Even among LMICs that have such

functioning, personal stigma, caregiver burden on family mem- ^ system, many suffer from lack of accountability in reporting

bers, and, in some instances, to human rights violations.^' QJ. f^Q^n the inability to measure workforce capacity. Without

Although several cost-effective strategies reportedly reduce information of this kind, countries cannot assess the scope and

the disability associated with mental and neurological disorders magnitude of the gap between the number of mental health

and substance abuse,^' ^ the fraction of those affected who receive workers needed and the number that is available,

appropriate treatment remains disturbingly low.' This treatment •\j(/é ^im to provide health planners, policy researchers and

gap appears especially wide in countries cla.ssified as low- or government officials with country-specific estimates of the hu-

middle-income by The World Bank, where around 85% of the f^jj^ resources that are required in the area of mental health to

world's population resides. In such countries, treatment rates for adequately care for the population in need oi mental health care,

these disorders are suboptimal and range from 35% to 50%.' " We have focused on eight priority problems as defined by W H O :

Researchers, policy-makers and international agencies have depression, schizophrenia, psychoses other than schizophrenia,

issued calls for low- and middle- income countries (LMICs) suicide, epilepsy, dementia, disorders related to the use of alcohol

to scale up the mental health components of their health and illicit drugs, and paediatric mental disorders (conduct or be-

systems.'-"'* To accomplish this, they need to increase their havioural, intellectual and emotional disorders of childhood)."

workforces," particularly the number of trained professionals For each of these disorders we used epidemiological information

who can provide good mental health services. Although primary published by W H O as ofjuly 2010, in conjunction with the

health-care professionals can provide the bulk of care, mental health services data available for 58 LMICs that had recently

health professionals, namely psychiatrists, nurses and experts in completed the W H O Assessment Instrument for Mental Health

' Department of Pubiic Heaith and Pianning, Poiicy and Design, university of Caiifornia, 202 Sociai Ecoiogy i, irvine, CA 92697-7075, United States of America (USA).

" Department of iHeaitii Poiicy, Schooi of Pubiic Heaith, iJniversity of Caiifornia, Beri<eiey, USA.

' Jiann-Ping Hsu Coiiege of Pubiic Heaith, Georgia Southern University, Statesboro, USA.

" Department of Healtti Systems Financing, Worid Health Organization, Geneva, Switzerland.

' Department of Mentai Heaith and Substance Abuse, Worid Health Organization, Geneva, Switzerland.

' Giobal Center for Health Economics and Policy Research, University of California, Berkeley, USA. ,

« Department of Human Resources for Health, World Heaith Organization, Geneva, Switzeriand.

Correspondence to Tim A Bruckner (e-maii: tim.bruckner@uci.edu).

(Submitted: 13 September 2010- Revised version received: 4 November 2010 -Accepted: 8 November 2010- Published online: 22 November 2010)

Bull World Health Organ 2011:89:184-194 I doi:10.2471 /BLT.10.

Tim A Bruckner et ai.

Research I

Mental health workforce gap in low- and middle-income countries |

Systems (WHO-AIMS). For a detailed

description of the validity and measure-

ment properties of WHO-AIMS, please

refer to Saxena et al."*

Methods

Current mental health workforce

To as.sess the size of the current workforce

devoted to mental health care in the study

countries, we retrieved data from WHO-

AIMS, an assessment tool designed for

LMICs that provides a comprehensive

summary of each country's mental health

system. WHO-AIMS, described in

detail by Saxena et al.," includes 155

indicators covering six domains: policy

and legislative framework, mental health

services, mental health in primary care,

human resources, public education and

monitoring and research. We retrieved

workforce data from the human resources

domain, where LMICs were asked to

report the "number of staff working in

or for mental health facilities or private

practice".'' Respondents provided a count

of professionals of various types, whom

we grouped into three broad professional

categories: psychiatrists, nurses and psy-

chosocial care providers. Nurses included

general nursing staff providing mental

health services and psychiatric nurses;

psychosocial workers included psycholo-

gists, social workers and occupational

therapists. Our rationale for grouping

these categories together was that in

LMICs these professionals often carry

out the same range of tasks. They have

all received formal training in psychol-

ogy, social work or occupational therapy

from a recognized university or technical

school and are responsible for delivering

psychosocial interventions within the

mental health system.

We included in the analysis 58

WHO Member States and territories,

as well as provinces and states within a

country, that were invited to complete

a WHO-AIMS assessment between

February 2005 and June 2009. They were

chosen based on their ability to collect

the required information and their will-

ingness to participate in the study, so in

essence they represented a convenience

sample. For brevity, we shall refer to all

these entities as countries throughout

the paper, but they are not all countries

strictly speaking. We note, however, that

two assessments that were performed at

the regional level (i.e. Hunan, China, and

Uttarakhand, India) were not extrapo-

lated to the respective countries as a whole

and therefore should not be considered

nationally representative.

Needs-based mental health

workforce targets

In its 2008 report, WHO's Mental health

Gap Action Programme (mhGAP)

specified eight problems that LMICs

should prioritize, since they account for

75% of the global burden ot mental and

neurological conditions and substance

abuse disorders. They are depression,

schizophrenia, psychoses other than

schizophrenia, suicide, epilepsy, demen-

tia, the abuse of alcohol and use of illicit

drugs, and paediatric mental disorders."

To meet the priority definition, the

condition must impose substantial dis-

ability, morbidity or mortality, lead to

high economic expenditure or be associ-

ated with violations of human rights.

The mhGAP report contains the best

available scientific and epidemiological

evidence surrounding mental, neurologi-

cal and substance abuse disorders, and the

ones prioritized by WHO have been

common wherever prevalence has been

measured. Moreover, the disorders that

are prioritized are those that substantially

undermine childrens' learning skills and

adults' ability to function within the fam-

ily and in broader society. Because these

conditions are highly prevalent and cause

impairment, they contribute substantially

to the total burden of disease. We refer

the reader to the mhGAP report for more

information."

We used population-based estimates

of the prevalence of these disorders to

make needs-based estimates ofworkforce

requirements. We then applied to this

target population the recommended

health-care service delivery models and

multiplied appropriate staffing ratios

(both adapted from Chisholm et al.)'' to

the expected volume of inpatient and out-

patient services to yield target counts of

psychiatrists, nurses and psychosocial care

providers. Our focus on these workers

led us to exclude all health professionals

outside the sphere of mental health (e.g.

paediatricians and educational system

support staff) and of workers in "mixed

practice". In addition, we did not include

neurologists in the workforce analysis,

as primary care proiessional« in LMICs

where resources are scarce are increasingly

expected to diagnose and treat epilepsy.'"

Prevalence of priority disorders

Since most LMICs do not routinely

conduct their own population-based

surveys, we used sub-regional prevalence

estimates generated as part of the 2004

WHO Global Burden of Disease (GBD)

Project, whose figures come from com-

prehensive reviews and syntheses of the

available epidemiological evidence.' For

the two priority disorders not included

in the 2004 GBD Project (e.g. illicit

substance abuse and paediatric mental

disorders) we obtained population-based

prevalence rates from the peer-reviewed

epidemiologic literature.-'"'' To calculate

the approximate prevalence of suicidal

ideation, we multiplied the GBD rate

of deaths from suicide by a factor of 20,

which is the estimated number of suicidal

ideations per suicide." '"^

Table 1 shows the mean prevalence

of each of the eight priority mhGAP

conditions in the six WHO regions. We

classified illicit substance abuse disorders

and paediatric mental disorders into sub-

categories having distinct requirements in

terms of care and human resource levels.

We multiplied the estimated prevalence

in all the age groups affected by each

disorder to estimate the actual numbers

implicated in each country. This calcula-

tion yielded the total number of cases

meeting the definition given in the ICD-

10 classification oj mental and behavioural

¿/«Ww (Table 1)."-"

Treatment coverage targets

Target treatment coverage rates for each

disorder were determined on the basis of

three factors: the severity of the disorder,

the ability to detect cases in the popula-

tion and the probability that identified

cases will seek care. Based on these con-

siderations and consistent with estimates

from the literature,'' we established the

following conservative target coverage

rates: 80% for schizophrenia, suicidal

ideation, epilepsy, and dementia; 50% for

use of opioids and other illicit drugs; 33%

for depression; 25% for alcohol abuse;

and 20% for paediatric mental disorders.

We assigned a high treatment coverage

target to schizophrenia because of the

large disability burden attached to it and

the intensity of the symptoms. In contrast,

we set a treatment coverage target of 20%

for paediatric mental disorders since it is

the coverage level normally attained in the

wealthiest high-income countries."'''''

Bull World Health Organ 2011 ;89:184-194 I doi:10.2471/BLT.10.082784 185

Tim A Bruci<ner et al.

Research I

Mental health workforce gap in low- and middie-inconne countries

e»

I

•s

o

S

.a

o

I

S.

OÍ
'S

o,

o

•i -S

< m

^

J§

o o CO

o CD CM

o

CM
CD
en

180

180

o o

CM CO
CM Ln CD
CM o
CM CM CO
CD
CO
CM
CD
CD
Ln
CM
CD

Ln

CD

O

O

CO
CO
CD
CD
CD
un
CM
C 3
CD
CO
Ln
CM
CD
CO
CD
Ln
CM
CD
CD
Ln
CM
CD

o

o CD o Ln c)

^ Q o

s

— o. - ^= -i-i tand

)atien

i/isits

carei

100

100

m

CM
CD
CM
CD
LO

jtpatient

CO

o

CO

to

CD
CO

i

.a E

S f

. - m s

"s P

g S

f

o

5

.t— o ^ ë "

*-^ 7- 5 o

•s s S E

UJ TO g ^

l i s t

â5 "

&«

.ii ™ CO

•lí Ä 2 'S

Su// _WorldHealffi Organ2Q_ 1 ;89;184-194 I doi:10,2471/BLT10.082784 (^) 187

I Research

I Mental health workforce gap in low- and middle-income countries Tim A Bruckner et al.

o <A

O)
CI

u

« (O

S, s

£

ë

O

g I

S

ë

•s

il'

S

g

egi

o

b

o

rit

ter

c D c o c D c o u n c o c o h -
u n Tn oo co o r rc j c o c o

C D t n C N J O O C M

c \ j c o c o
CTÎCDŒ)
o CM CM

co LO f— ^ f ^ m CD co <D c o ^ C D 1 ^ ^ 1 — CCJ C D in h^ CD N ^ I—

I I I I I I I
I CD T—

u n CN| CNJ Ö (=> h ^

CD cz> t— un c o CNJ o CNJ CO CM T—

-t— O C D i —

CD r r

in

co

CD
^—

un co o

CNJ
CM
CD
[^
CD

co un

CD
CD
CD
CM
& CM

un co

o

CD
CM
O T— ^ CD O CD CD 1 ^

C N J - r ^ C s j i n ^ C O C M C D

I I I I I I

r^ o 1 — i n CM

CNJ CNJ CD CNJ in
co CNJ CD co co
I I I CM I

o

COCO

1

un

1

o

CD

1

CO

1

CD
CD
CNJ
CO
CO
CD

1

CD

unCCJ

CD CD C=> CD T—

CO '^ CO r^ CO CO
•<— CO o 05 • .— o
1— co -1— CT) T— "^

en

CM
CD
CO
.._:

un o

CD
CO
CO
CD
CO

en

CD
1^
CM

ci

co m

r ^ c o c D c o

O C O C D T — C D C M C O

C M u n C O T — CD C J

C N J c C S u r i c D C D C O C N l C D u n c O C O - ^ C D

co

T— O O C O C D C O C D i — E C M C T n Z C D C M

oo oo co co

CO CO u n r ^ ^ f— c o CD CD 1— c7> r ^ CD - ^ CD cNJ - ^ T-:

un
M n ^
  • » — C N J 1 — - i — T—
co CD CJÎ CM co CD CD
1— N- co CM co r^ un
O.J o co CD co co
C\i 1^ CM co "J-
CO
CM
CD
CO
CM
CO

1

CD
CM
CO

S

co

o

co
un co
1— co
1— CD

1 1

CM
CD
CM
CD
CD

1

5:

in

un co 1

CD
CD

r-- 1

CD
CM
CM

1

un co

1

CD

1

C)

co co 1

un CD
T- un

1 1

un

1

CM
CM
1 ^
1— CO
CD 1—

1 1

CD
CM

1

in CD
en CM
CM CM

un

CD
CD
(D
CD
(D
CD
CD
CD
CO
in

1

un

CD
CO

1

C D i n c D r ^ C D C D C D
  • ^ c p c D c o c o i n c D c o
CD CX) CX) co co CD I— o
C O C O C D C D C O O O t n c O ^ C M t ^ C M C D C M -. — o
c o c o c q c p c o c N j c D ' ^ c q c o - ^ i - ~ - r - - T - ^ C N J c o c T )
C D C O C O C a Ó C D L O u r i u r i c N J C D C O C D - r ^ C D - ^ C D C N J

T— T— 1 — 1 — 1 — T— 1 — 1 — •»— 1 — 1 — 1 — 1 — 1 — - I — T— CM

o CM ( D c o CD o CD CNJ CD ^ - u n CD >-• - ^ CD CD 1-^ cS CNJ CD CD

  • I — C M O C O C D - t — C D C O t —T r i o i n
( D i D C O C p
i ^ j ^
  • I — C O C M C O O C O u n - i — C O C O C D C D
c p c D t — c M ^ u n i n f ^ c o u n c D c p

T— o CM T— CD CM CD 1— " ^ 1— c o CD CD^ CD^ CM o

C D ^ - N - t ^ C D O i — 1— C D C D C M C O u n ' ^ T — CD CD CM CM c o

j C D ^ t c o CX 3 CD r ^ c o CX5 CX 3 C D C J C D C n c b c D

I I I I I I
CDCD

II

c Ö C D Ö c Ö C D
l i l i l í I I

o t--^ CM co^ o^ <D^ co^ CD

CD r-- CM 1^ o o i n
I I I I

< D T — 1— C D C M u n C O C O T— O i — C D c n i — C D C M O O C D O O O O C D

CD CD CD in CD co i— CD I— CO CM CO • >— f— T — un CD

C N j c p c D c p c D C D u n c o u n u n c o - i — c D - ^ c o - ^ c o C D C D - r ^ - ^ C O C N J C N J - r - ' o Ö c b i - ^ C D C O - v - ^ T - ^ C D

o o o o o o o o o o o o o o o o o

T— CO
CD CO
CD CD

o o o o o o o

s. ^ 1

rea

.Tz
LU

çg ^

LU 2

CO
  • 0

0 1 (^0) co

n

u ~

co
CÜ
ro
;> a¿

•5 E Ou 0

ce

co

"Ë

Q

»||glilil|Ji

o —. ^ ^ ^ c o ~ ce ce ^ lllliill

= ) U J < : Q

"o iz o ^-

188 Bull World Health Organ 2011 ;89:184-1941 doi: 10.2471/BLT 10.

I Research

I Mental health workforce gap in iow- and middle-income countries Tim A Bruckner et al.
Fig. 1 Mental health workforce shortages in 58 low- and middle-income countries^
Mental health workforce shortage
(per 100 population)
I I No data available for analysis
I i No shortage (surplus FTE staff)
^M 0-10 more FTE staff needed
^M 11-20 more FTE staff needed
^M > 20 more FTE staff needed
FTE, full-time-equivalent.
' Data for India and China are from oniy one province (Uttarakhand province and Hunan province, respectively).

for each disorder, treatment setting (e.g.

hospital outpatient) and World Bank

country income classification.

To estimate the full-time-equivalent

staff required to meet inpatient service

targets, we used estimated bed-days as the

starting input. We assumed that hospitals

operate at 85% capacity and applied this

correction factor to obtain the targeted

number of inpatient beds. To calculate the

number of full-time-equivalent inpatient

staff needed to manage the population

affected by each disorder, we multiplied

staff:bed ratios for LMICs extracted from

the literature''''' '- by the targeted number

of inpatient beds.

Workforce shortage or surplus

We summed the needs-based inpatient

and outpatient full-time-equivalent staff

to arrive at a single targeted total, which

we then subtracted from the current staff-

ing levels given in WHO-AIMS. The

difference reflects the magnitude of the

global mental health workforce shortage

(if a negative value) or surplus (if a posi-

tive value).

Results

Current and target staffing levels for

mental health professionals vary widely

both across and within WHO regions

(Table 3). LMICs in the African Region

and the South-East Asia Region report

fewer psychiatrists than the Region of

the Americas or the European Region.

Large within-region variations are

highlighted by the 20-fold difference in

the number of psychiatrists per 100 000

population between the Sudan and the

Islamic Republic of Iran, two middle-

income countries in the Region of the

Eastern Mediterranean (0.06 in the Su-

dan versus 1.19 in the Islamic Republic

of Iran). For all three categories of mental

health professionals, middle-income

countries routinely report a larger

number of staff per population than do

low-income countries.

Across the 58 LMICs in this study,

the estimated number of mental health

professionals required is 362 000 (20 000

psychiatrists, 195 000 nurses and 147000

psychosocial care providers). This repre-

sents an average of 22.3 mental health

professionals per 100 000 population

in low-income countries and of 26.

professionals per 100000 population in

middle-income countries.

The column labelled "difference " in

Table 3 shows the mental health work-

force shortage (—) or surplus (-I-) for each

country. Of the 58 study countries, 67%

showed a shortage of psychiatrists, 95% a

shortage of nurses and 79% a shortage of

psychosocial care providers. In absolute

figures, these workforce deficits amounted

to a total shortage of approximately

11 000 psychiatrists, 128 000 nurses and

100 000 psychosocial care providers.

Thus, an additional 239 000 full-time-

equivalent staff would be needed globally

to treat the current burden of the eight

mental, neurological and substance abuse

problems that WHO has prioritized.

Fig. 1 maps the shortage (or surplus)

for all LMICs in the analysis. Of the

58 countries included, 51 show a short-

age and 9 require at least 20 additional

mental health professionals per 100000

population to meet the needs-based target

levels of care.

190 Bull World Health Organ 2011 ;89:184-194 I doi: 10,2471 /BLII 0,

Tim A Bruckner et al.

Research

Mental health workforce gap in low- and middle-income countries j

Fig 2. Impact of changes in target coverage, resource utilization and case workioad

on mental health workforce shortage estimates in 58 low- and middle-income

countries

j2 ^^.^

FTE slation

IS targetlOOpopu

minilOOC

liurrei

(pe

10-

0 -

-10-

-20-

  • 3 0 -
  • 4 0 -
Baseiine Coverage 1 ' Resource i ' ' Resource 2"^ Resource S** Etticiency 1'^ Etticiency 2'

Year

FTE, full-time equivalent; LMICs. iow-and-middle-income countries.
The vertical lines represent the range ot values tor the shortages tound in the 58 LMiCs analysed; the diamonds
represent the average shortage, A negative vaiue indicates a shortage.
' Coverage 1 ; reduce treatment coverage rates tor ail disorders; schizophrenia and bipoiar disorder, suicidai
ideation and epiiepsy (trom 80% to 50%); dementia, use ot opioids and use ot other iiiicit drugs (trom 50% to
40%); depression (trom 33% to 25%); alcohol abuse (trom 25% to 20%); paediatric disorders (trom 20% to
' Resource 1 ; increase tbe iength ot inpatient stay (acute and residentiai care) by 25%,
'• Resource 2; decrease the length ot inpatient stay (acute and residentiai care) by 25%,
" Resource 3; reduce the target coverage rate tor outpatient services by tO%; increase the target coverage rate tor
primary-health-care services by 10%.
' Etticiency 1 ; reduce daily outpatient consuitation capacity by 20%,
' Etticiency 2; increase daiiy outpatient consuitation capacity by 20%,

We conducted a series of sensitivity

analyses to determine how the shortage/

surplus for each of the 58 LMICs re-

.sponded to changes in three key inputs:

target treatment coverage level, rates of

inpatient and outpatient service utilization

and daily case workload (Fig. 2). A reduc-

tion in target treatment coverage rates

affected workforce estimates more than

changes in service utilization rates or in

workload capacity. When target treatment

coverage for all disorders was substantially

reduced, the mean workforce gap dropped

from 11 to 4 additional mental health

professionals per 100000 population. In

contrast, changes in workforce efficiency

(raising or lowering outpatient consulta-

tion capacity by 20%) did not substantially

alter the shortage estimates from baseline

levels (see efficiency scenarios 1 and 2).

Of the countries classified as low-income,

only one showed a workforce surplus in at

least one of the six scenarios; 43 of the 58

LMICs (74%) showed a workforce short-

age in all scenarios.

Discussion

We have capitalized on current workforce

estimates to provide the first in-depth

evaluation of mental health staffing

shortages in LMICs. Our needs-based

analysis of 58 such countries has re-

vealed substantial deficits in the mental

health workforce. All of the low-income

countries and 59% of the middle-income

countries included in this study experi-

ence a needs-based shortage, which points

to an inability to provide appropriate

care to their populations afflicted with

mental, neurological and substance abuse

disorders. Overall, LMICs would need

to increase their workforces by an esti-

mated 239 000 full-time-equivalent staff

(psychiatrists, nurses and psychosocial

care providers) to satisfactorily address

the current burden of priority disorders.

For over 30 years, international

organizations have been recommending

that countries increase their mental health

workforce, and W H O s call for a scale-up

in the mhGAP report makes the task all

the more u r g e n t. " ' ' " Unfortunately,

progress in achieving parity in the work-

force for the care of physical and mental

ailments has been slow, perhaps owing to

the absence of clear, quantitative bench-

marks to guide the prudent allocation of

human resources in mental health.'""^

Our report attempts to fill this void. We

provide government officials and health-

care planners with quantitative estimates

that will help them to "scale up" the hu-

man resources required to meet the men-

tal health care needs of their populations.

The reader should view our estimates

in the light of several limitations. First,

although we used the best available epide-

miologic data to define needs-based treat-

ment levels, many LMICs do not report

population-based prevalence, particularly

for paediatric disorders. For this reason

we applied to these disorders conserva-

tive prevalence and treatment coverage

levels. Second, our target service deliv-

ery models rest on the assumption that

implementation, operational structure

and efficiency are identical across LMICs.

These limitations imply that the estimates

we provide represent approximate, rather

than definitive, benchmarks for human

resources. The reader, moreover, should

view the sensitivity analyses we performed

as indicative of the variability of our

estimates.

We focused on the eight disorders

prioritized by W H O s mhGAP to the ex-

clusion of other conditions (e.g. personal-

ity disorders) that comprise about 25% of

the burden of all mental, neurological and

substance abuse disorders in LMICs.'

In addition, our target treatment cover-

age levels for these priority disorders

may be viewed as suboptimal by some

policy-makers. It is therefore conceivable

that results underestimate mental health

workforce shortages.

To assess workforce shortages we

had to make several assumptions. For

example, we assumed that within a given

country, staff surpluses in one specialty

area did not offset shortages in another.

This in turn rests on the assumption that

different specialties have different training

requirements that preclude the transfer-

ability of staff across professional bound-

aries. However, some governments may

choose to employ specific management

mechanisms and incentives to facilitate

task-shifting across professions, while

others may incentivize team work at the

community level as part of the strategy

to scale up primary health care.^"•** Given

the challenges involved, we encourage

government officials to work with W H O

and other partners in tailoring our general

workforce model to the mental health sys-

tems of their particular countries. Other

circumstances unique to each country,

such as the high prevalence of a condition

Bull World Health Orffa« 2011;89;184-194 I doi;10,2471/BLT10.082784 191

Tim A Bruckner et al.

Research I

Mental health workforce gap in low- and middle-income countries |

épilepsie, démence, troubles liés à l'alcoolisme et aux substances illicites

ef troubles mentaux infantiles.

Résultats Tous les pays à revenu faible et 59% des pays à revenu moyen

de notre échantillon disposaient d'un nombre de professionnels largement

inférieur par rapport à leurs besoins en prestations de santé mentale

essentielles. Les 58 PRFI de l'échantillon devraient créer 239 000 emplois

supplémentaires à temps complet dans le secteur de la santé mentale

afin de parer au manque actuel.

Conclusion Des politiques inhérentes à chaque pays sont nécessaires

pour surmonter le vaste manque de personnel et de services de santé

mentale dans les PRFI.

PE3K)ME

HexBaTKa MeAMi^iiHCKMX Ka^poB B o6«acTM oxpaHbi ncMXMMecKoro 3AopoBbfl B CTpaHax c HM3KHM M

AOXO^OM: noflxofl Ha ocHOBe noTpeÔHOCTeii

OueHMTb fleejjMUMT cneqwanHCTOB B o6;iacTM oxpaHbi

nCMXMHeCKOrO 3flOpOBbH B CTpaHax C HM3KMM M CpeflHMM

AoxoflOM (CHCfl).

MeTOffbl MTOÓbl OqeHMTb, CKOnbKO nCMXMaTpOB, I

c e c T e p M nocTaBiuMKOB n c M x o c o q M a / i b H o i i

HeoÓXOflMMO ßjisi npeflocTaBneHMH MeAmíMHCKoíi noMomM B

oónacTM oxpaHbi ncMXMnecKoro 3flopoBbfl Bceiny HaceneHMK)

oócneflyeMbix CTpaH, MM Mcnonb3OBanM ^aHHbie, i

npM npMMeHeHMM p a 3 p a 6 o T a H H o r o B O 3

oiieHKM CMCTeM ncMXMMecKoro 3ÄopoBbH ( M O C n - B O 3 ) B 58

C H C / Í , CTpaHOByK) wH(})opMaiiMio o ópeMeHM pa3nMHHbix

ncMXMiecKMX paccTpoMCTB M TMnoTeTMHecKMM naKeT ycnyr. Mbi

({)OKycMpoBanMCb Ha cneflyioinMx BocbMM npoóneMax, Koxopbie

B O 3 CHMTaeT npiiopMTeTHbiMM: flenpeccMfl, uiM3O(})peHMii,

nCMX03bl, He OTHOCHmMeCK K UIM30<j)peHMM, C

paCCTpOMCTBa, CBfl3aHHbie C

M H e n e r a n b H i i x HapKOTMKOB M

paccTpoMCTBa fleTeM.

Pe3ynbTaTbi Bbi/io o6Hapy>KeHO, HTO BO Bcex CTpaHax c HM3KMM

floxoflOM M B 59% CI paH co cpeflHMM floxoflOM, BxofljimMx B Haiiiy

BbióopKy, cneiiManMCTOB 3HaHMTenbH0 MeHbuie, HeM TpeóyeTC«,

[ npeflocTaBAHTb KTiioHeBOM naKeT Mep BMemaTenbCTBa B

nCMXMHeCKOrO .3AOpOBbH. B 58 C H C f l , BK/IK)HeHHbIX

B BbióopKy, HeoÓXOflMMO yBeHMHMTb OÓlUyiO HMCneHHOCTb

MeflMijMHCKMX KaflpoB B oónacTM oxpaHbi ncMXMHecKoro

3flopoBbH, Ha 2 3 9 0 0 0 cneuManMCTOB B SKBWBaneHTe nonHOÜ

3aHHTOCTM, HTOÓbl yCTpaHMTb HaÓniOflaiOIUMMOI

Una npeofloneHMfl 3HaHMTenbHoro

MeflMUMHCKMX KaflpoB M ycnyr B oónacTM oxpaHbi ncMXMHecKoro

3flOpOBbil HeOÓXOflMMbl IlO/IMTMHeCKMe M6pbl, pa3paÓ0TaHHbie

c yneTOM ycnoBMM KOHKpeTHoii CTpaHbi.

Resumen

La diferencia en la saiud mental de los trabajadores en

basado en las necesidades

Objetivo Calcular la escasez de profesionales psiquiátricos en los paises

de ingresos medios y bajos (PIMB).

Métodos Para calcular el número de psiquiatras, personal de enfermería y

psicólogos que serían necesarios para proporcionar asistencia psiquiátrica

al total de la población de los países estudiados, utilizamos los datos

del Instrumento de Evaluación de los Sistemas de Salud Mental de la

Organización Mundial de la Salud (OMS-AIMS) de 58 PIMB, la información

específica de cada país sobre la carga de los distintos trastornos mentales

y la prestación hipotética de servicios básicos. Nos centramos en los

ocho problemas siguientes, a los que la OMS ha otorgado prioridad:

depresión, esquizofrenia y otras psicosis, suicidio, epilepsia, demencia,

los países de ingresos medios y bajos: un abordaje

trastornos asociados al abuso del alcohol y las drogas ilegales, así como

los trastornos mentales pediátricos.

Resultados Todos los paises de ingresos bajos y el 59% de los países

de ingresos medios de la muestra tenían muchos menos protesionales

sanitarios de los que necesitarían para proporcionar un conjunto básico

de intervenciones sanitarias en materia de salud mental. Los 58 PIMB

muestreados deberían aumentar su personal sanitario total del área de

psiquiatría a 239 000 protesionales sanitarios a tiempo completo (o

equivalente) para hacer frente a la escasez actual.

Conclusión Para poder superar la gran escasez de trabajadores y servicios

sanitarios en el área de salud mental en todos los PIMB, se necesitan

políticas específicas para cada país.

References

  1. Murray CJL, Lopez AD. Global mortality, disability, and the contribution ot

risk tactors: Giobai Burden ot Disease Study Lancet 1997:349:1436-42.

doi:10.1016/S0140-6736(96)07495-8 PMID:

  1. Hu TW. The economic burden of depression and reimbursement policy

in the Asia Pacitic region. Austraias Psycteííy 2004:12(Suppi):S11-5.

PMID:

  1. Kadri N, Manoudi F, Berrada S, iVioussaoui D. Stigma impact on Moroccan

tamilies ot patients witb schizophrenia. Can JPsyctefiy 2004:49:625-9.

PMiD:

  1. Tsang HWH, Tam PKC, Chan F, Cheung WM. Sources ot burdens on families

of individuáis with mentai iiiness. int J Rehabii Res 2003:26:123-30.

doi: 10.1097/00004356-200306000-00007 PMiD: 12799606

Chatterjee S, Patei V, Chatterjee A, Weiss HA. Fvaluation ot a community-

based rehabilitation model tor chronic schizophrenia in rural India. BrJ

Psychiatry 2003,182:57-62. doi:10.1192/bjp.182.1.57 PMiD:

Chishoim D, Lund C, Saxena S. Cost ot scaling up mental healthcare in iow- and middle-income countries. BrJ Psychiatry 2007:191:528-35.

doi: 10.1192/bjp.bp. 107.038463 PMiD: 18055957

Disease control priorities reiated to mentai, neuroiogicai, deveiopmentai and

substance abuse disorders. Geneva: Worid l-leaith Crganization: 2006.

Patei V, Araya R, Chatterjee S, Chishoim D, Cohen A, De Suva M et ai.

Treatment and prevention ot mentai disorders in iow-income and middie- income countries. Lancet 2007:370:991 -1005. doi:10.1016/S0140-

6736(07)6t 240-9 PMID:

Buii World Health Organ 2011:89:184-194 I doi:10.2471/BLT10.082784 193

I Research

I Mental health worktorce gap in low- and middle-income countries Tim A Bruckner et al.

  1. Wang PS, Aguiiar-Gaxioia S, Aionso J, Angermeyer MC, Borges G, Bromet

EJ et ai. Use of mental heaith services for anxiety, mood, and substance

disorders in 17 countries in the WHO worid mentai health surveys. Lancet

2007;370:841 -50. doi: 10.1016/S0140-6736(07)61414-7 PMiD: 17826169

  1. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental heaith

care. Bull World Health Organ 2004:82:858-66. PMiD:

  1. Demyttenaere K, Bruffaerts R, Posada-Viiia J, Gasquet i, Kovess V, Lepine JP

et ai. Prevaience, severity, and unmet need for treatment of mentai disorders

in the Worid Heaith Organization Worid Mentai Heaith Surveys. JAMA

2004;291:2581-90. doi:10.1001/jama.291.21.2581 PMiD:

  1. Chisholm D, Elisher AJ, Lund C, Patel V, Saxena S, Thornicroft G et ai. Scale

up services for mental disorders: a caii for action. í.aííceí2007;370:1241-

  1. doi:10.1016/S0140-6736(07)61242-2 PiVIID:
  2. mhGAP: mental Health Action Programme: scaling up care for mental,

neurological, and substance use disorders. Genem: Worid Heaith

Organization: 2008.

  1. The world health report 2001: mental health: new understanding, new hope.

Geneva: World Heaith Organization: 2001.

  1. Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje 0, Mahoney J

et ai. Barriers to improvement of mentai heaith services in iow-income and

middie-income countries. í.anceí2007:370:1164-74. doi:1O.1O16/SO14O-

6736(07)61263-X PMiD: 17804061

  1. Mental health atlas, 2005. Geneva: Worid Health Organization: 2005.
  2. The global burden ot disease: 2004 update. Geneva: World iHeaith

Organization: 2008.

  1. Saxena S, LoraA, van Ommeren M, Barrett T, Morris J, Saraceno B. WHO'S

Assessment Instrument for Mental Health Systems: collecting essential

information for policy and service deiivery. Psyc/?;afrSefv 2007:58:816-21.

doi:10.1176/appi.ps.58.6.816 PMID:

  1. WHO-AIMS 2.2: World Health Organization Assessment instrument tor Mental

Health Systems. Geneva: Worid Heaith Organization: 2005.

  1. mhGAP intervention guide tor mental, neurological and substance use

disorders in non-specialized health settings. Geneva: Worid Health

Organization: 2010.

  1. Degenhardt L, Haii H, Warner-Smith M, Lynskey M. iiiicit drug use. In: Ezzati

M, Lopez AD, Rodgers A, Murray CJL, editors. Comparative quantification of

heaith risks. Global and regional burden of diseases attributabie to seiected

major risk factors Geneva: Worid Health Organization: 2004.

  1. Patel V, Eiisher AJ, Hetrick S, McGorry P. Mentai heaith of young people: a

global pubiic-health chaiienge. íanceí2007:369:1302-13. doi:10.1016/

SOI 40-6736(07)60368-7 PMID: 17434406

  1. Beifer ML. Chiid and adolesoent mentai disorders: the magnitude of the

probiem across the globe. JCMcfPsyc/JO/Psycft/ai/y 2008:49:226-36.

doi:10.1111/j.i 469-7610.2007.01855.x PMiD:

  1. Schmidtke A, Biiie-Brahe U, DeLeo D, Kerkhof A, Bjerke T, Crepet P

et ai. Attempted suicide in Europe: rates, trends and sociodemographic

characteristics of suicide attempters during the period 1989-1992.

Results of the WHO/EURO Muiticentre Study on Parasuicide. Acta Psychiatr

Scand 1996:93:327-38. doi: 10.1111 /j. 1600-0447.1996.tb10656.x

PMiD:

  1. Kerkhof A. Attempted suicide: patterns and trends, in: Hawton K, van

Heeringen K, editors. The international handbook of suicide and attempted

suicide. London: Wiiey: 2000.

  1. Rodriguez JJ, Eerri CP, Acosta D. Guerra M, Huang Y. Jacob KS et al.

Prevalence of dementia in Latin America, india, and China: a popuiation-

based cross-sectional survey, /.anee/2008:372:464-74. doi:10.1016/

SOI 40-6736(08)61002-8 PMID:

  1. Durkin MS, Hasan ZM, Hasan KZ. Prevalence and correiates of mental

retardation among chiidren in Karachi, Pakistan. Am J Epidemiol

1998:147:281-8. PMiD:

  1. Tekle-Haimanot R, Abebe M, Gebre-Mariam A, Eorsgren L, Heijbel J,

Hoimgren G et al. Community-based study of neurological disorders

in rurai centrai Ethiopia. A/euroep/tíem/o/ogy 1990:9:263-77.

doi: 10.1159/000110783 PMiD:

  1. Xie ZH, Bo SY, Zhang XT. Liu M, Zhang ZX, Yang XL et ai. Sampiing survey

on inteiiectual disability in 0-6-year-oid children in China. J Inteiiect

Disabil Res 2008:52:1029-38. doi:10.1111/j.i 365-2788.2008.01048.x

PMiD:

  1. Gureje 0, Omigbodun 00, Gater R, Acha RA, ikuesan BA, Morris J. Psychiatric

disorders in a paediatric primary care clinic, ßr JPsycft/af/y 1994:165:527-

  1. doi:10.1192/bjp.165.4.527 PMiD:
    1. Adewuya AO, Oia BA, Aioba 00. Prevaience of major depressive disorders

and a validation of the Beck Depression inventory among Nigerian

adoiescents. Eur ChildAdolesc Psychiatry 2007:16:287-92. doi:10.1007/

S00787-006-0557-0 PMiD:

  1. ICD-10 classification of mental and behaviourai disorders: clinicai descriptions

and diagnostic guideiines. Geneva: Worid Heaith Organization: 1992.

  1. Kataoka SH. Zhang L, Weiis KB. Unmet need for mentai heaith care among

U.S. chiidren: variation by ethnicity and insurance status. Am J Psychiatry

2002:159:1548-55. dOÍ:10.1176/appi.ajp.159.9.1548PMiD:

  1. Eocusing on chiidren's mentai heaith. ¿ancei 2010:375:2052. doi:10.1016/

SOI40-6736(10)60943-9 PMiD:

  1. Hyman S, Chishoim D, Kessier R, Patel V, Whiteford HA. Mentai disorders in

disease controi priorities in developing countries. In: Jamison DT, Breman

JG, Measham AR, Alleyne G, Ciaeson M, Evans DB. editors. Disease controi

priorities in deveioping countries. Nevi/ York: The Worid Bank & Oxford

University Press: 2006. pp. 605-25.

  1. Chishoim D, Rehm J, Van Ommeren M, Monteiro M. Reducing the globai

burden of hazardous aicohoi use: a comparative cost-effectiveness analysis.

J Stud Alcohol 2004:65:782-93. PMID:

  1. Chishoim D, Sanderson K, Ayuso-Mateos JL, Saxena S. Reducing the

globai burden of depression: population-level analysis of intervention cost-

effectiveness in 14worid regions. SrJPsyctefo'2004:184:393-403.

doi:10.1192/bip.184.5.393PMID:

  1. Chisholm D, Gureje 0, Saldivia S, Viiialón Calderón M, Wickremasinghe

R, Mendis N et ai. Schizophrenia treatment in the developing worid: an

interregional and multinational cost-effectiveness analysis. Bull World Health

Organ 2008:86:542-51. doi:10.2471/BLT07.045377 PMID:

  1. Public mental health: guideiines for the elaboration and management of

national mental heaith programmes. Geneva: World Heaith Organization:

  2. Eerri C, Chisholm D, Van Ommeren M, Prince M. Resource utiiisation for

neuropsychiatrie disorders in developing countries: a muitinationai Deiphi

consensus study SocPsyc/í/aí/yPsyctefrEp/tíem/o/2004:39:218-27.

doi:10.1007/s00127-004-0729-5 PMiD:

  1. Lund C, Elisher AJ, Lee T, Porteus K, Robertson BA. A modei for estimating

mentai health service needs in South Africa. S/^fr Wed J2000:90:1019-24.

PMID:

  1. Lund C, Eiisher AJ. Norms for mental health services in South Africa. Soc

Psychiatry Psychiatr Epidemioi200eA^ :587-94. doi:10.1007/sOOI 27-006-

0057-zPMID:

  1. Eunk M, Saraceno B, Drev« H, Lund C, Grigg M. Mental heaith policy and

plans: promoting an optimal mix of services in deveioping countries. IntJ

Ment Health Syst 2004:33:4-16.

  1. Mental health policy and service guidance package: organization of services

for mentai health. Geneva: Worid Heaith Organization: 2003.

  1. Chaudhry MR. Staffing requirements, in: Baasher TA, Carstairs GM, Gier R,

Hassier ER, editors. Mental health services in developing countries. Geneva:

World Heaith Organization: 1975. Avaiiabie from: http:)'/whqlibdoc.who.int/

offset/WHO_OEFSET_22_(pt1-pt3).pdf [accessed 8 November 2010].

  1. Prince M, Patei V Saxena S, Maj M, Maseiko J, Phiilips MR et ai. No health

without mentai health. íanceí 2007:370:859-77. doi:10.1016/S0140-

6736(07)61238-0 PMiD:

  1. Brazii, Ministry of Health, Department of Healthcare & Department of

Strategic and Programmatic Actions. Proceedings of the Regionai Conference

on Reform of Mental Health Services: 15 years after the Caracas Declaration,

Brasiiia, 5-8 November 2005.

  1. Buchan J, Dai Poz MR. Skill mix in the heaith care workforce: reviewing the

evidence. Bull World Health Organ 2002:80:575-80. PMID:

  1. Planning and budgeting to deliver services for mental health. Geneva: World

Health Organization: 2003.

  1. Scheffler RM, Bruckner TA, Eulton BD, Yoon J, Shen G, Chishoim D et al.

Human resources for mental health: workforce shortages in iow and middle

income countries. Human Resources for Health Observera. Geneva: World

Health Organization (in press, Eebruary 2011).

  1. Patel V. The future of psychiatry in low- and middle-income countries.

Psychol /Wed 2009:39:1759-62. doi:10.1017/S

PMiD:2G

  1. Jacob KS, Sharan P, Mirza i, Garrido-Cumbrera M, Seedat S, Mari

JJ et ai. Mental health systems in countries: where are we now?

¿a/7Cei2007:370:1061-77. doi:10.1016/S0140-6736(07)61241 -

PMID:

194 Bull World Health Organ^ 2011:89:184-194 I doi:10.2471/BLI10.