Integrating Mental Health Care into Health Care Systems in Low- and Middle-Income Countries and Other Low-Resources Settings

Presenter:

Andrea Horvath Marques, M.D., MPH, Ph.D.
Center for Global Mental Health Research

Goal:

The goal of this concept is to encourage implementation research to develop, optimize, and test innovative theory-based strategies to integrate mental and physical health care within health care systems in low-and middle-income countries (LMICs) and other low-resource settings.

Rationale:

Globally, more than 75 percent of people do not receive treatment for mental, neurological, and substance use disorders. Further, people with mental illnesses often have other chronic health conditions. Individuals with comorbid conditions typically present lower treatment adherence, poorer clinical outcomes, and a higher risk of disability and mortality. Integrating mental health care into health care systems is a promising strategy to help expand access to mental health care and treat coexisting conditions. Integrated care may also enhance continuity of care and health care delivery efficiencies and increase treatment accessibility. Some integration models, such as the Collaborative Care and Stepped Care Model, have been used in the outpatient management of mental disorders and other chronic illnesses in high-income countries and have significantly improved mental health outcomes. However, while a variety of integrated care models have been tested in LMICs, considerably less is known about the optimal structure and implementation strategies necessary to scale up and sustain models of integration in LMICs. 

This scope of research may include, but is not limited to:

• Developing and testing implementation strategies and innovative health technologies to improve health system-, patient-, and family-level outcomes.
• Developing and testing models and strategies for training and supporting providers to deliver integrated care with fidelity and high quality.
• Developing and testing models and strategies for linking integrated care with other community-based services.
• Developing and testing behavioral economic strategies, financing models (payment mechanisms), and health policies that influence the success of scaling up and sustaining the provision of such services.
• Identifying the necessary core elements of integrated mental health care models to enable implementation, scalability, and sustainability of the model.

Findings may guide key stakeholders in implementing, scaling up, and sustaining effective integrated mental health care models across LMICs and low-resource settings.