Collaborative Hubs for International Research in Mental Health
About the Collaborative Hubs for International Research in Mental Health
The proportion of people who need, but do not receive care—the mental health treatment gap—is exacerbated by the dearth of health care workers available to provide evidence-based mental health services that meet minimum standards. Although a growing evidence base for reducing the treatment gap exists for higher income countries like the United States, far less research has been conducted in countries identified by the World Bank as low- and middle-income (LMICs); yet approximately 85% of the world’s population resides in these settings, which face special human resource challenges. Evidence suggests that the majority of 58 LMICs have limitations in a number of mental health specialties: 67% showed a shortage of psychiatrists, 95% a shortage of nurses and 79% a shortage of psychological care providers.1 Global estimates from 183 countries (covering 99.3% of the world’s population) suggest an overwhelming shortage of mental health service providers of more than 1.18 million for all 144 LMICs.2
Although human resource inadequacies for mental health worldwide have been well established, researchers, policy-makers, and international agencies have called for scale-up of mental health services3. Task shifting—that is, delegating tasks to varied cadres of health professionals with specialized training—has shown promise with certain mental health interventions.4,5,6 These studies suggest that the delivery of mental health services in primary healthcare settings through community-based and task-shifting approaches, in combination with appropriate training and increased capacity, can be used as a strategy for reducing the burden on caregivers and coordinating care of individuals with mental disorders.2
NIMH established the Collaborative Hubs for International Research on Mental Health (CHIRMH) to increase the research base for mental health interventions in LMICs through integration of findings from translational, clinical, epidemiological and/or policy research. The program aims to expand research activities in LMICs with the goal of providing the necessary knowledge, tools, and sustainable research-based strategies for use by government agencies, non-governmental organizations, and health care institutions to reduce the mental health treatment gap. Lessons learned from these contexts can inform mental health service delivery in other low-resource settings.
As a group, awardees constitute a collaborative network of regional hubs for mental health research in Africa, Asia, and Latin America with capabilities for answering research questions (within and across regions) aimed at improving mental health outcomes for men, women, and children. Each hub supports research on task-shifting/task-sharing for the delivery of mental health services and provides research capacity-building opportunities. Hub teams are interdisciplinary, with strong interests in increasing the capacity of mental health services; enhancing collaborative learning and development; integrating local, state and national health interventions; and building relationships with governmental, non-governmental, and community-based stakeholders.
References
1Bruckner, T et al. The mental health workforce gap in low- and middle-income countries: a needs-based approach. Bull World Health Organ [online] 2011; 89(3).
2Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, et al. Human resources for mental health care: current situation and strategies for action. Lancet 2011; 378: 1654–1663.
3Prince M, Patel V, Saxena S, et al. No health without mental health. Lancet 2007; 370: 859-877.
4Bolton P, et al. Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA 2003; 289; 3117-3124.
5Rahman A, Patel V, Maselko J, Kirkwood B. The neglected ‘m’ in MCH programmes – why mental health of mothers is important for child nutrition. Trop Med Int Health 2008; 13(4): 579-583.
6Patel V, Prince M. Global Mental Health: A New Global Health Field Comes of Age. JAMA 2010;303(19):1976-1977.