Scarcity and inequity of mental health research resources in low-and-middle income countries: A global survey
Introduction
Mental health research is critical to guide rational policy development, program planning and the provision of mental health services. Evidence-based action can reduce the social impact and economic costs of mental disorders to tackle health inequity, to prevent disability and mortality, and ultimately to foster country development [1], [2], [3], [4], [5], [6], [7]. Recently, The Lancet Series on Global Mental Health identified a number of research priorities to inform the scaling-up of mental health service development in low-and-middle-income countries (LAMIC) [8]. However, low levels of investment and the scarcity of resources and capacity in mental health research constitute the main barriers to achieving the above goals [8], [9], [10].
On average, LAMIC invest less than 1% of their GDP in research and development, compared to 2.3% in high-income countries [11]. Moreover, developing countries account for only 29% of world researchers, with a ratio of fewer than 0.5 scientists per 1000 population, in contrast to 2 per 1000 in developed countries [11]. The low priority given to mental health research in these countries is one of the reasons for the lower ratio of qualified mental health researchers and lower research output in comparison to other non-communicable diseases [12], [13], [14], [15]. Compounding the situation is the “brain drain” (especially in India, Pakistan, the Philippines, and most African and Caribbean countries), whereby well-trained researchers leave their countries in search of better work conditions in high-income countries [11], [16], [17].
In 2004, the Global Forum for Health Research and the World Health Organization (WHO) launched an international study aimed at mapping mental health research capacity in 114 LAMIC during the period from 1993 to 2003 [18], [19], [20]. A central aim of this study was to build a case for action, including the identification of the main barriers to be addressed in the promotion of mental health research (e.g., scarcity, inequity and inefficiency) [21], based on an analysis of mental health publications in the indexed and grey literature as well as survey data on researchers’ background and available resources.
Section snippets
Method
In 2004, the Global Forum for Health Research and WHO, Department of Mental Health and Substance Abuse, Mental Health: Evidence and Research, initiated a project entitled: ‘Mental health: Mapping of research capacity in low- and middle-income countries’ [2]. Six proposals from Latin America and Caribbean (LAC), Africa and Asia (two from each region) were selected based on their scope and the capabilities of the teams to carry out this project [2], [18]. The 114 selected countries included 52
Results
Together, searches by the six teams identified 4208 mental health researchers in 83 LAMIC from 6340 mental health publications indexed in Medline and PsycInfo databases and from 3598 publications in grey literature/local databases sources (Table 1). No mental health researcher was identified through Medline and PsycInfo databases in 37 countries. These 37 countries comprised 5.7% of the population of the 114 LAMIC and included 21 countries from Africa, 8 from LAC and 8 from Asia. Low-income
Discussion
Our results reveal a severe scarcity of mental health research resources in LAMIC, their inequitable distribution and inefficient utilization—three challenges typical of other mental health resources as well [21]. The greatest shortage of mental health research capacity was among the poorest African and Asian countries, where the number of publications and researchers identified was much lower than other continents. The same pattern of shortage of mental health professionals has also been found
Role of the authors
D. Razzouk: Drafting the manuscript; acquisition, analysis, and interpretation of data.
P. Sharan: Study concept and design, analysis and interpretation of data, critical review of manuscript.
C. Gallo: Study concept and design; regional coordination/principal investigator; acquisition, analysis and interpretation of data; critical review of manuscript.
O. Gureje: Study concept and design; regional coordination/principal investigator; acquisition, analysis and interpretation of data, critical
Funding/support
This project was supported by the Global Forum for Health Research and the World Bank through its grant facility to the Global Forum for Health Research, and was implemented under the overall coordination and technical guidance of the Global Forum for Health Research and World Health Organization, Department of Mental Health and Substance Abuse, Evidence and Research.
Role of the sponsors
The Global Forum for Health Research was involved in the study design; data collection, analysis, and interpretation; and draft preparation. The World Bank was not involved in any stage of this study. No other sponsor played any role.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
Acknowledgements
The authors thank the following institutions for their contribution to the study:
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The Global Forum for Health Research for funding, overall coordination and technical guidance of the original research project.
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The World Health Organization for technical guidance.
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FAPESP for funding equipments for Brazilian's team.
References (41)
- et al.
Resources for mental health: scarcity, inequity, and inefficiency
The Lancet
(2007) Research capacity strengthening in the south
Social Science and Medicine
(2002)The World Health Report 2001. Mental Health: New Understanding, New Hope
(2001)- World Health Organization (WHO). Mental Health Global Action Programme: scalling up care for mental, neurological and...
- Global Forum for Health Research. Some networks in priority research areas: mental and neurological health. In: The...
- Global Forum for Health Research and Yvo Nuyens. No development without research: a challenge for research capacity...
- et al.
Bridging the mental health research gap in low- and middle-income countries
Acta Psychiatrica Scandinavica
(2004) - Patel V. Global mental health research. In: Global forum update on research for health 3: Combating infections and...
- et al.
The 10/90 divide in mental health research: trends over a 10-year period
British Journal of Psychiatry
(2006) Scale up services for mental disorders: a call for action
The Lancet
(2007)
The treatment gap in mental health care
Bulletin of World Health Organization
Reporting of non-communicable disease research in low-and-middle-income countries: a pilot bibliometric analysis
Journal of Medical Library Association
Assessing capacity for health policy and systems research in low and middle income countries
Health Research Policy Systems
Research for change: the role of scientific journals publishing mental health research
World Psychiatry
Mental health research on low-and-middle-income countries in indexed journals
Journal of Mental Health Policy and Economics
The metrics of the physician brain drain
New England Journal of Medicine
Recruiting doctors from poor countries: the brain drain robbery?
British Medical Journal
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2020, Journal of Psychiatric ResearchCitation Excerpt :In fact, Shinde et al. (2018) found that the lay counselors were able to deliver therapeutic interventions more effectively than teachers. With insufficient number of professionals in the areas of mental health, many professionals suggested that psychotherapeutic treatment interventions could be delivered through the lay counselors (Kakuma et al., 2011; Patel et al., 2011; Razzouk et al., 2010). Moreover, some studies found that clients preferred lay counselors over mental health clinicians as interventions delivery agents (Myers et al., 2018), lay consolers were also helpful to increase awareness and reduce stigma related mental illnesses (Paudel et al., 2014), increase accessibility (Mendenhall et al., 2014), and increase cultural consideration/sensitivity in mental health services (Mendenhall et al., 2014).
- 1
He was the principal investigator of the Peruvian team until his death on 1 August 2005. Carla Gallo subsequently assumed the role of PI.
- 2
See Appendix A.