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Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

Abstract

Purpose of Review

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research.

Recent Findings

Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services.

Summary

Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013;382:1575.

  2. 2.

    Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2013;380(9859):2197–223.

  3. 3.

    Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82(11):858–66.

  4. 4.

    • Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu T, et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence. N Engl J Med. 2013;368(23):2182–91. A randomized controlled trial in a conflict-affected region of the Democratic Republic of Congo showed the effectiveness of an adapted group cognitive processing therapy intervention delivered by community-based paraprofessionals for reducing anxiety and depression symptoms in adults

  5. 5.

    Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372(9642):902–9.

  6. 6.

    Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376(9758):2086–95.

  7. 7.

    Mehta N, Clement S, Marcus E, Stona A-C, Bezborodovs N, Evans-Lacko S, et al. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry. 2015;207(5):377–84.

  8. 8.

    Fazel M, Hoagwood K, Stephan S, Ford T. Mental health interventions in schools in high-income countries. The Lancet Psychiatry. 2014;1(5):377–87.

  9. 9.

    Vieira MA, Gadelha AA, Moriyama TS, Bressan RA, Bordin IA. Evaluating the effectiveness of a training program that builds teachers’ capability to identify and appropriately refer middle and high school students with mental health problems in Brazil: an exploratory study. BMC Public Health. 2014;14(1):210.

  10. 10.

    Lund C, Tomlinson M, De Silva M, Fekadu A, Shidhaye R, Jordans M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low-and middle-income countries. PLoS Med. 2012;9(12):e1001359.

  11. 11.

    Hanlon C, Wondimagegn D, Alem A. Lessons learned in developing community mental health care in Africa. World Psychiatry. 2010;9(3):185–9.

  12. 12.

    Semrau M, Barley EA, Law A, Thornicroft G. Lessons learned in developing community mental health care in Europe. World Psychiatry. 2011;10(3):217–25.

  13. 13.

    Drake RE, Latimer E. Lessons learned in developing community mental health care in North America. World Psychiatry. 2012;11(1):47–51.

  14. 14.

    •• Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry. 2016;3(5):415–24. Return on investment analysis showed that returns to investment on scaling up effective treatment coverage for depression and anxiety disorders globally reults in benefit to cost ratios of up to 5.7 to 1 when the value of health returns is also included

  15. 15.

    Petersen I, Evans-Lacko S, Semrau M, Barry MM, Chisholm D, Gronholm P, et al. Promotion, prevention and protection: interventions at the population-and community-levels for mental, neurological and substance use disorders in low-and middle-income countries. Int J Ment Heal Syst. 2016;10(1):1.

  16. 16.

    WHO. mhGAP intervention guide for mental, neurological and substance use disorders in nonspecialized health settings version 2.0. Geneva: World Health Organization; 2016.

  17. 17.

    Thornicroft G. Evidence-based mental health care and implementation science in low-and middle-income countries. Epidemiol Psychiatr Sci. 2012;21(03):241–4.

  18. 18.

    Collins PY, Pringle BA. Building a global mental health research workforce: perspectives from the National Institute of Mental Health. Acad Psychiatry. 2015;40:1–4.

  19. 19.

    Saxena S, Saraceno B, Granstein J. Scaling up mental health care in resource-poor settings. Improving Mental Health Care: The Global Challenge. 2013;12–24.

  20. 20.

    Sweetland AC, Oquendo MA, Carlson C, Magidson JF, Wainberg ML. Mental health research in the global era: training the next generation. Acad Psychiatry. 2015;40:1–6.

  21. 21.

    Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R, et al. Scale up of services for mental health in low-income and middle-income countries. Lancet. 2011;378(9802):1592–603.

  22. 22.

    McGeorge P. Lessons learned in developing community mental health care in Australasia and the South Pacific. World Psychiatry. 2012;11(2):129–32.

  23. 23.

    Ito H, Setoya Y, Suzuki Y. Lessons learned in developing community mental health care in East and South East Asia. World Psychiatry. 2012;11(3):186–90.

  24. 24.

    Razzouk D, Gregório G, Antunes R. Mari JdJ. Lessons learned in developing community mental health care in Latin American and Caribbean countries. World Psychiatry. 2012;11(3):191–5.

  25. 25.

    Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries. PLoS One. 2014;9(2):e88437.

  26. 26.

    Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in global mental health. Nature. 2011;475(7354):27–30.

  27. 27.

    Petersen I, Lund C, Stein DJ. Optimizing mental health services in low-income and middle-income countries. Curr Opin Psychiatry. 2011;24(4):318–23.

  28. 28.

    Saxena S, Funk M, Chisholm D. World health assembly adopts comprehensive mental health action plan 2013–2020. Lancet. 2013;381(9882):1970–1.

  29. 29.

    • Lund C, Tomlinson M, Patel V. Integration of mental health into primary care in low-and middle-income countries: the PRIME mental healthcare plans. Br J Psychiatry. 2016;208(s56):s1–3. A blueprint is given for developing and testing district mental health plans in low and middle income countries

  30. 30.

    Patel V, Belkin GS, Chockalingam A, Cooper J, Saxena S, Unützer J. Grand challenges: integrating mental health services into priority health care platforms. PLoS Med. 2013;10(5):e1001448.

  31. 31.

    Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems. Cochrane Libr. 2012;10:CD006525.

  32. 32.

    Hay JW, Katon WJ, Ell K, Lee P-J, Guterman JJ. Cost-effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes. Value Health. 2012;15(2):249–54.

  33. 33.

    Mendenhall E, De Silva MJ, Hanlon C, Petersen I, Shidhaye R, Jordans M, et al. Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda. Soc Sci Med. 2014;118:33–42.

  34. 34.

    Ali G-C, Ryan G, De Silva MJ. Validated screening tools for common mental disorders in low and middle income countries: a systematic review. PLoS One. 2016;11(6):e0156939.

  35. 35.

    Ngo VK, Rubinstein A, Ganju V, Kanellis P, Loza N, Rabadan-Diehl C, et al. Grand challenges: integrating mental health care into the non-communicable disease agenda. PLoS Med. 2013;10(5):e1001443.

  36. 36.

    Kaaya S, Eustache E, Lapidos-Salaiz I, Musisi S, Psaros C, Wissow L. Grand challenges: improving HIV treatment outcomes by integrating interventions for co-morbid mental illness. PLoS Med. 2013;10(5):e1001447.

  37. 37.

    Fisher EB, Chan JC, Nan H, Sartorius N, Oldenburg B. Co-occurrence of diabetes and depression: conceptual considerations for an emerging global health challenge. J Affect Disord. 2012;142:S56–66.

  38. 38.

    Charlson FJ, Moran AE, Freedman G, Norman RE, Stapelberg NJ, Baxter AJ, et al. The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment. BMC Med. 2013;11(1):1.

  39. 39.

    Nakash O, Levav I, Aguilar-Gaxiola S, Alonso J, Andrade LH, Angermeyer MC, et al. Comorbidity of common mental disorders with cancer and their treatment gap: findings from the world mental health surveys. Psychooncology. 2014;23(1):40–51.

  40. 40.

    Parry CD, Patra J, Rehm J. Alcohol consumption and non-communicable diseases: epidemiology and policy implications. Addiction. 2011;106(10):1718–24.

  41. 41.

    Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.

  42. 42.

    Araya R, Alvarado R, Minoletti A. Chile: an ongoing mental health revolution. Lancet. 2009;374(9690):597–8.

  43. 43.

    Honikman S, van Heyningen T, Field S, Baron E, Tomlinson M. Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa. PLoS Med. 2012;9(5):e1001222.

  44. 44.

    Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE. Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):e1001442.

  45. 45.

    Lora A, Kohn R, Levav I, McBain R, Morris J, Saxena S. Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low-and middle-income countries. Bull World Health Organ. 2012;90(1):47–54B.

  46. 46.

    Caqueo-Urízar A, Urzúa A, Jamett PR, Irarrazaval M. Objective and subjective burden in relatives of patients with schizophrenia and its influence on care relationships in Chile. Psychiatry Res. 2016;237:361–5.

  47. 47.

    Sweetland AC, Oquendo MA, Carlson C, Magidson JF, Wainberg ML. Mental health research in the global era: training the next generation. Acad Psychiatry. 2016;40(4):715–20.

  48. 48.

    Patel V. Universal health coverage for schizophrenia: a global mental health priority. Schizophr Bull. 2016;42(4):885–90.

  49. 49.

    • Brooke-Sumner C, Petersen I, Asher L, Mall S, Egbe CO, Lund C. Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries. BMC Psychiatry. 2015;15:19. Preliminary evidence suggests acceptability of community-based psychosocial intervents for schizophrenia in LMICs, however well-designed interventions studies are need to provide evidence for overall feasibility

  50. 50.

    Asher L, De Silva M, Hanlon C, Weiss HA, Birhane R, Ejigu DA, et al. Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): study protocol for a cluster randomised controlled trial. Trials. 2016;17(1):299.

  51. 51.

    Da Silva TFC, Lovisi G, Conover S, Susser E. Critical time intervention–task shifting (CTI-TS): a psychosocial intervention for people with severe mental illness in Latin America. Global Advanced Research Journal of Medicine and Medical Sciences. 2014;3(5):087–9.

  52. 52.

    Farooq S. Early intervention for psychosis in low-and middle-income countries needs a public health approach. Br J Psychiatry. 2013;202(3):168–9.

  53. 53.

    Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013;103(5):777–80.

  54. 54.

    • Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet. 2016;387(10023):1123–32. Social contact was found to be the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term, but evidence for longer-term benefits is weak

  55. 55.

    de Girolamo G, Dagani J, Purcell R, Cocchi A, McGorry P. Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiol Psychiatr Sci. 2012;21(01):47–57.

  56. 56.

    Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–65.

  57. 57.

    Klasen H, Crombag AC. What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries. Soc Psychiatry Psychiatr Epidemiol. 2013;48(4):595–611.

  58. 58.

    • Barry MM, Clarke AM, Jenkins R, Patel V. A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health. 2013;13:835. Mental health promotion interventions for young people have been implemented effectively in LMIC school and community settings with moderate to strong evidence of their impact on positive and negative mental health outcomes, but evidence for interventions for younger children is lacking

  59. 59.

    Tomlinson M, Bornstein MH, Marlow M, Swartz L. Imbalances in the knowledge about infant mental health in rich and poor countries: too little progress in bridging the gap. Infant Ment Health J. 2014;35(6):624–9.

  60. 60.

    Kohrt BA, Yang M, Rai S, Bhardwaj A, Tol WA, Jordans MJ. Recruitment of child soldiers in Nepal: mental health status and risk factors for voluntary participation of youth in armed groups. Peace Confl. 2016;22(3):208–16.

  61. 61.

    O'Donnell K, Dorsey S, Gong W, Ostermann J, Whetten R, Cohen JA, et al. Treating maladaptive grief and posttraumatic stress symptoms in orphaned children in Tanzania: group-based trauma-focused cognitive-behavioral therapy. J Trauma Stress. 2014;27(6):664–71.

  62. 62.

    McMullen J, O'Callaghan P, Shannon C, Black A, Eakin J. Group trauma-focused cognitive-behavioural therapy with former child soldiers and other war-affected boys in the DR Congo: a randomised controlled trial. J Child Psychol Psychiatry. 2013;54(11):1231–41.

  63. 63.

    Betancourt TS, Chambers DA. Optimizing an era of global mental health implementation science. JAMA psychiatry. 2016;73(2):99–100.

  64. 64.

    Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala. Uganda BMC Med. 2014;12(1):122.

  65. 65.

    Veenema TG, Thornton CP, Corley A. The public health crisis of child sexual abuse in low and middle income countries: an integrative review of the literature. Int J Nurs Stud. 2015;52(4):864–81.

  66. 66.

    Sumner SAMA, Saul J, et al. Prevalence of sexual violence against children and use of social services- seven countries, 2007–13. 2015.

  67. 67.

    Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, et al. Childhood adversities and adult psychopathology in the WHO world mental health surveys. Br J Psychiatry. 2010;197(5):378–85.

  68. 68.

    Guedes A, Bott S, Garcia-Moreno C, Colombini M. Bridging the gaps: a global review of intersections of violence against women and violence against children. Global health action. 2016;9.

  69. 69.

    Whetten K, Shirey K, Pence BW, Yao J, Thielman N, Whetten R, et al. Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS One. 2013;8(10):e74771.

  70. 70.

    Patel V, Kieling C, Maulik PK, Divan G. Improving access to care for children with mental disorders: a global perspective. Arch Dis Child. 2013;98(5):323–7.

  71. 71.

    Weissman MM, Wickramaratne P, Gameroff MJ, Warner V, Pilowsky D, Kohad RG, et al. Offspring of depressed parents: 30 years later. Am J Psychiatr. 2016;173:1024.

  72. 72.

    • Herba CM, Glover V, Ramchandani PG, Rondon MB. Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries. The Lancet Psychiatry. 2016;3:983. A biopsychosocial model is used to show that the mechanisms underlying associations between maternal depression and child mental health outcomes are impacted by the problematic context in which maternal depression occurs in LMICs

  73. 73.

    McDonnell CG, Valentino K. Intergenerational effects of childhood trauma evaluating pathways among maternal ACEs, perinatal depressive symptoms, and infant outcomes. Child maltreatment. 2016;21(4):317–26.

  74. 74.

    Siegenthaler E, Munder T, Egger M. Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2012;51(1):8–17. e8.

  75. 75.

    Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. The Lancet Psychiatry. 2016;3(10):973–82.

  76. 76.

    • Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy T, et al. Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2013;91(8):593–601. The pooled effect size for maternal depression was moderately strong in interventions delivered by trained community health workers in LMICs

  77. 77.

    Organization WH. Thinking healthy: a manual for psychosocial management of perinatal depression, WHO generic field-trial version 1.0, 2015. Geneva: World Health Organization; 2015.

  78. 78.

    Austin A, Herrick H, Proescholdbell S. Adverse childhood experiences related to poor adult health among lesbian, gay, and bisexual individuals. Am J Public Health. 2016;106(2):314–20.

  79. 79.

    Katz-Wise SL, Hyde JS. Victimization experiences of lesbian, gay, and bisexual individuals: a meta-analysis. J Sex Res. 2012;49(2–3):142–67.

  80. 80.

    Sullivan CG. Lesbian, gay, bisexual, and transgender health disparities are a global concern. Nurs Outlook. 2016;64(3):279–80.

  81. 81.

    Hatzenbuehler ML, McLaughlin KA, Keyes KM, Hasin DS. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. Am J Public Health. 2010;100(3):452–9.

  82. 82.

    Logie C. The case for the World Health Organization’s commission on the social determinants of health to address sexual orientation. Am J Public Health. 2012;102(7):1243–6.

  83. 83.

    Blosnich JR, Farmer GW, Lee JG, Silenzio VM, Bowen DJ. Health inequalities among sexual minority adults: evidence from ten US states, 2010. Am J Prev Med. 2014;46(4):337–49.

  84. 84.

    Kates J, The U.S. Government and global LGBT health: opportunities and challenges in the current era. Henry J. Kaiser Family Foundation: Menlo Park; 2014.

  85. 85.

    Nguyen TQ, Bandeen-Roche K, German D, Nguyen NT, Bass JK, Knowlton AR. Negative treatment by family as a predictor of depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use in Vietnamese sexual minority women. LGBT health. 2016;3:357.

  86. 86.

    Hughes TL, Wilsnack SC, Kantor LW. The influence of gender and sexual orientation on alcohol use and alcohol-related problems: toward a global perspective. Alcohol Res. 2016;38(1):121.

  87. 87.

    Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–63.

  88. 88.

    Bruckner TA, Scheffler RM, Shen G, Yoon J, Chisholm D, Morris J, et al. The mental health workforce gap in low-and middle-income countries: a needs-based approach. Bull World Health Organ. 2011;89(3):184–94.

  89. 89.

    Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. Br J Psychiatry. 2011;199(6):459–66.

  90. 90.

    Kazdin AE, Rabbitt SM. Novel models for delivering mental health services and reducing the burdens of mental illness. Clin Psychol Sci. 2013; doi:10.1177/2167702612463566.

  91. 91.

    Petersen I, Lund C, Bhana A, Flisher AJ. A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings. Health Policy Plan. 2012;27(1):42–51.

  92. 92.

    Buttorff C, Hock RS, Weiss HA, Naik S, Araya R, Kirkwood BR, et al. Economic evaluation of a task-shifting intervention for common mental disorders in India. Bull World Health Organ. 2012;90(11):813–21.

  93. 93.

    Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty KF, et al. Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA. 2007 Aug 1;298(5):519–27.

  94. 94.

    •• Becker AE, Kleinman A. Mental health and the global agenda. N Engl J Med. 2013;369(1):66–73. An outline is given for how to reduce the mental health treatment gap by building clinical capacity, developing new models of treatment, creating a focused and relevant research agenda, and overcoming barriers to equitable care

  95. 95.

    • Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al. Task shifting for non-communicable disease management in low and middle income countries–a systematic review. PLoS One. 2014;9(8):e103754. A review shows preliminary evidence of the effectiveness and affordability of the use of non-physician health care workers for improving access to healthcare for non-communicable diseases, including mental health, however, such programs need to be accompanied by health system re-structuring, and additional high-quality studies are required to support preliminary evidence

  96. 96.

    Fricchione GL, Borba CP, Alem A, Shibre T, Carney JR, Henderson DC. Capacity building in global mental health: professional training. Harv Rev Psychiatry. 2012;20(1):47–57.

  97. 97.

    Thornicroft G, Cooper S, Bortel TV, Kakuma R, Lund C. Capacity building in global mental health research. Harv Rev Psychiatry. 2012;20(1):13–24.

  98. 98.

    •• Meffert SM, Neylan TC, Chambers DA, Verdeli H. Novel implementation research designs for scaling up global mental health care: overcoming translational challenges to address the world's leading cause of disability. Int J Ment Health Syst. 2016;10:19. A new type of implementation science study design, effectiveness-implementation hybrids, are proposed to speed the translation and scale up of mental health care in LMICs

  99. 99.

    Murray LK, Tol W, Jordans M, Sabir G, Amin AM, Bolton P, et al. Dissemination and implementation of evidence based, mental health interventions in post conflict, low resource settings. Intervention. 2014;12:94–112.

  100. 100.

    Stuart H. Reducing the stigma of mental illness. Global Mental Health. 2016;3:e17.

  101. 101.

    Shidhaye R, Kermode M. Stigma and discrimination as a barrier to mental health service utilization in India. International health. 2013;5(1):6–8.

  102. 102.

    Semrau M, Evans-Lacko S, Koschorke M, Ashenafi L, Thornicroft G. Stigma and discrimination related to mental illness in low-and middle-income countries. Epidemiol Psychiatr Sci. 2015;24(05):382–94.

  103. 103.

    Cuijpers P, Beekman AT, Reynolds CF. Preventing depression: a global priority. JAMA. 2012;307(10):1033–4.

  104. 104.

    Chisholm D, Saxena S. Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e609.

  105. 105.

    • Chisholm D, Burman-Roy S, Fekadu A, Kathree T, Kizza D, Luitel NP, et al. Estimating the cost of implementing district mental healthcare plans in five low-and middle-income countries: the PRIME study. Br J Psychiatry. 2016;208(s56):s71–s8. The cost of scaling up mental health services in four LMICs ranged from US$0.21 to 0.56 per person; in the higher income context of South Africa, it was US$1.86), and in all countries, the additional amount needed each year to reach target coverage goals after 10 years was below $0.10 per person

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Acknowledgements

The editors would like to thank Drs. Nakita Natala, Heidi Burns, and Daniel Wurzelmann for taking the time to review this manuscript.

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Correspondence to Milton L. Wainberg.

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Conflict of Interest

Milton L. Wainberg, Pamela Scorza, James M. Shultz, Liat Helpman, Jennifer J. Mootz, Karen A. Johnson, Yuval Neria, Jean-Marie E. Bradford, and Melissa R. Arbuckle declare that they have no conflict of interest.

Maria A. Oquendo’s family owns stock in Bristol Myers Squibb. Dr. Oquendo receives royalties for the commercial use of the Columbia Suicide Severity Rating Scale.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

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Wainberg, M.L., Scorza, P., Shultz, J.M. et al. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep 19, 28 (2017). https://doi.org/10.1007/s11920-017-0780-z

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Keywords

  • Global mental health
  • Implementation science
  • Task-sharing
  • Low- and middle-income countries
  • Primary care