Post-Acute Interventions to Optimize Long-Term Mental Health Outcomes in Low- and Middle-Income Countries

Presenter:

Leonardo Cubillos, M.D., MPH
Center for Global Mental Health Research

Goal:

The goal of this concept is to encourage research that improves post-acute mental health services in low- and middle-income countries (LMICs) and low-resource settings. Of specific interest is research that generates new information on the health system changes that could improve the scalability and sustainability of service provision.

Rationale:

Recovery-oriented management of mental health conditions requires outpatient post-acute care models best suited for chronic, relapsing, and even debilitating conditions. In LMICs, low public investments in mental health are associated with a shortage of mental health providers and facilities. Further, compared to high-income countries where most public investments are allocated to outpatient care models, low-income countries invest 99 percent of their mental health public expenditures on hospital-based models (WHO, 2017). These allocations impact the availability and accessibility of outpatient and post-acute mental health services, including pharmacological and psychosocial interventions. In LMICs, many patients and families resort to paying out-of-pocket for access to care, which can lead to further poverty and mask the need for public investment.

There is evidence of efficacy of post-acute psychosocial interventions in LMICs and humanitarian settings.  Adults with schizophrenia, depression, PTSD, and other common mental disorders have shown significant improvements in relevant clinical mental health outcomes following post-acute psychosocial interventions. Children with conduct disorders and PTSD have also benefited from post-acute psychosocial interventions.

Given the broad and growing evidence base for intervention efficacy, the next step is to test how well post-acute interventions work are implemented. Knowledge gained from this research may ultimately improve the implementation, scalability, sustainability, and accessibility of long-term care in LMICs and low resource settings.

The goal of this concept is to contribute to improving the accessibility and availability of post-acute mental health services in LMICs through the generation of an evidence base of effective interventions and a better understanding of the health system changes required to advance their implementation.