Abstract
To the Editors,
South Asia is densely populated and is home to a quarter of the world’s population. The treatment gap is wide for mental health, and the psychiatric services lag behind physical health facilities (Fernando, Suveendran, & de Silva, 2017). This article intends to highlight ways in which the Western world can contribute to better mental health for people living in resource-limited settings apart from providing direct financial aid.
The psychiatrist to population ratio is low in South Asia and the time that could be allocated to an individual patient is limited (World Health Organization (WHO), 2015). Therefore, there is a huge need for culturally validated screening tools. However, the number of validated psychometric instruments are limited and even they are not freely available to be used. For example, the Beck Depression Inventory has been validated to detect depressive symptoms among war-affected communities in Sri Lanka (Jayawickreme, Verkuilen, Jayawickreme, Acosta, & Foa, 2017). Even though the cost of using such a scale is minimal by Western standards, a community screening of 100 patients in a Sri Lankan setting would cost more than 1 month salary of a psychiatrist (Chandradasa & Champika, 2018a). Since the governments do not routinely fund screening instruments, making special provisions in the copyright laws would help to use these instruments free of charge in resource-limited settings. For example, the Achenbach System of Empirically Based Assessment (ASEBA) allows well-recognized tools such as the Child Behaviour Checklist (CBCL) to be used free of charge for authors in resource-limited settings after obtaining permission (ASEBA, 2018). Worldwide organizations such as the World Psychiatric Association (WPA) should inform and encourage their members to make provisions to allow better access to psychometric tools to researchers from resource-limited settings.
Many Western nations have established subspecialist services for unique populations. However, the subspecialisation in psychiatry is in its infancy in the developing world. This deprives appropriate mental health care for special groups such as children, adolescents, women, elderly and offenders (Chandradasa & Champika, 2018b). The affluent countries could provide opportunities for mental health specialists of resource-limited settings to obtain advanced training in specialized units. These arrangements need to be time limited and should ensure the trained professional’s return to their countries, preventing further brain drain, which has been a substantial drawback for the mental health development in Asia and Africa (Oladeji & Gureje, 2016). There is still a shortage of mental health professionals in regional areas of Western countries, and advanced trainees from the developing world could help to minimize this (Cook & Hoas, 2007). The United Kingdom through the Medical Training Initiative (MTI) scheme of the Royal College of Psychiatrists and Australia through the Specialist Specified Training (SST) Pathway of the Royal Australian and New Zealand College of Psychiatrists allows a small number of international medical graduates (IMG) to obtain supervised workplace-based training up to 2 years. It would be highly beneficial if these opportunities could be expanded to subspecialties as specialist IMGs from resource-limited settings would have regular opportunities to obtain specific skills and the affluent countries would have a stable flow of skilled advanced trainees. The European Psychiatric Association (EPA) should consider encouraging the member nations to open more time-limited training slots for specialist IMGs from Asia and Africa.
Most low and middle-income countries do not have country-specific data of mental disorders. This is counterproductive to policy planning and the West could support research through collaborative projects (Siriwardhana et al., 2011). Researchers would be easily able to study large samples as many health institutions cater for vast populations. Publications of such research would directly improve service provision in resource-limited settings and broaden the knowledge of mental disorders worldwide. The global contribution of mental health research from Asia and Africa is limited (Patel & Kim, 2007). High-quality studies are published in international indexed journals which require the authors to pay a subscription fee. This prevents professionals in poor countries from accessing valuable information. There should be lower subscription fees for the developing world, which would increase the readership and potential citations of the journals as well. Hinari programme set up by the WHO provides lower and middle-income countries to gain access to high-quality biomedical literature (WHO, 2018). WHO needs to invite more publishers to contribute and Universities in developing countries should be given wider access.
Many would consider measures to improve mental health care in the developing world as direct financial aid. However, support and assistance provided by the West could be done in ways mutually beneficial to both parties. As mentioned above specifically, world authorities in mental health such as the WHO, WPA, EPA and other organizations in the Western world should consider incorporating these measures into future policy statements and annual goals. This would help to generate more capable mental health professionals and culturally relevant knowledge leading to sustainable mental health development in resource-limited settings worldwide.
