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Overcoming barriers to improve mental-health services in low- and middle-income countries

Lancet

Despite the publication of high-profile reports and promising activities in several countries, progress in mental health service development has been slow in most low-income and middle income countries. In this fifth paper in The Lancet's Mental Health Series, Dr Benedetto Saraceno, Director, Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland and colleagues conclude: "Many of the barriers to progress in scaling-up of mental health services can be overcome by generation of political will for the organisation of accessible and humane mental-health care."

They add that advocates for mental health provision (which includes those with mental-health disorders and their families) need to come together to deliver clear, strong messages about what is required. Resistance to decentralisation of resources (eg. from mental health hospitals) must also be overcome, especially in many mental health professionals and hospital workers, who could feel their vested interests would be under threat by such move.

The authors say development of secondary care-level community mental health services should be prioritised, adding that mental health investments in primary care are also important but are unlikely to be sustained unless they are preceded or accompanied by the development of these community mental-health services, to allow for the training, supervision, and continuous support for primary care workers.

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