MENTAL healthcare is too important to be left to psychiatrists or psychologists alone. In low-resource settings like ours, unaddressed mental health issues are growing at an alarmingly high rate and there are just not enough specialised mental health experts. Around 1,000 psychiatrists and 3,000 psychologists in a country of 240 million-plus people cannot possibly deal with this burden of disease. Specialist mental health care, by both psychiatrists and psychologists, is too expensive, inaccessible, and inefficient. Psychology practice is not even regulated. Sadly, a somewhat similar situation exists in most low- and middle-income countries (L&MICs).
For an acute depressive episode, for example, either antidepressant medicines are prescribed or psychological therapy is provided. There is growing evidence now that psychological treatments outperform medication on the important outcome of keeping people well in the longer term following an initial episode. But how many people can access psychotherapy? The majority are irrationally prescribed anti-depressants, which are also used irrationally.
Due to an extreme dearth of specialists, mental health researchers have developed a number of evidence-based psychological interventions for non-specialised settings employing a task-shifting approach. A former colleague at the World Health Organisation (WHO), Dr Shekhar Saxena, spent years studying, analysing and selecting such interventions with mental health researchers around the world. Then, with the help of a large and diverse group of experts, Dr Saxena managed to put together a mental health gap intervention guide (mhGAP) in 2010. The second version of the WHO mhGAP........