Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme
Maya Semrau,
Atalay Alem,
Jose L. Ayuso-Mateos,
Dan Chisholm,
Oye Gureje,
Charlotte Hanlon,
Mark Jordans,
Fred Kigozi,
Crick Lund,
Inge Petersen,
Rahul Shidhaye,
Graham Thornicroft
Affiliations
Maya Semrau
Research Fellow in Implementation Research, Centre for Global Health Research, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Atalay Alem
Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
Jose L. Ayuso-Mateos
Chairman and Director, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid; and Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
Dan Chisholm
Programme Manager for Mental Health, Regional Office for Europe, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
Oye Gureje
Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
Charlotte Hanlon
Reader in Global Mental Health, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Adjunct Associate Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Inge Petersen
Research Professor and Director, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
Rahul Shidhaye
Clinical Psychiatrist, Public Health Foundation of India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
Graham Thornicroft
Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Psychiatry, King's College London, UK
BackgroundThere is a large treatment gap for mental, neurological or substance use (MNS) disorders. The ‘Emerging mental health systems in low- and middle-income countries (LMICs)’ (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems.AimsTo provide a set of proposed recommendations for mental health system strengthening in LMICs.MethodThe Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012–2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening.ResultsThe proposed recommendations align closely with the World Health Organization's key health system strengthening ‘building blocks’ of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald.ConclusionsThese recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders.Declaration of interestNone.
