Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review

Roxanne Keynejad¹, Maya Semrau², Mark Toynbee³, Sara Evans-Lacko^{4

5}, Crick Lund^{2

6}, Oye Gureje⁷, Sheila Ndyanabangi⁸, Emilie Courtin⁹, Jibril O Abdulmalik⁷, Atalay Alem¹⁰, Abebaw Fekadu^{11

12}, Graham Thornicroft¹³, Charlotte Hanlon¹⁴

Affiliations

¹ South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
² Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
³ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
⁴ Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
⁵ PSSRU, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
⁶ Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa.
⁷ Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁸ Ministry of Health, PO Box 7272, Kampala, Uganda.
⁹ London School of Economics and Political Science, Social Policy Department - LSE Health and Social Care, Houghton Street, London, WC2A 2AE, UK.
¹⁰ College of Health Sciences, School of Medicine, Department of Psychiatry, Sixth Floor, College of Health Sciences Building, Addis Ababa University, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia.
¹¹ College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, PO 9086, Addis Ababa, Ethiopia.
¹² Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Centre for Affective Disorders, London, UK.
¹³ Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
¹⁴ Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry & Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK. charlotte.hanlon@kcl.ac.uk.

PMID: 27769270
PMCID: PMC5073499
DOI: 10.1186/s12913-016-1853-0

Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review

Roxanne Keynejad et al. BMC Health Serv Res. 2016.

. 2016 Oct 21;16(1):601.

doi: 10.1186/s12913-016-1853-0.

Authors

Affiliations

¹ South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
² Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
³ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
⁴ Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
⁵ PSSRU, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
⁶ Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa.
⁷ Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁸ Ministry of Health, PO Box 7272, Kampala, Uganda.
⁹ London School of Economics and Political Science, Social Policy Department - LSE Health and Social Care, Houghton Street, London, WC2A 2AE, UK.
¹⁰ College of Health Sciences, School of Medicine, Department of Psychiatry, Sixth Floor, College of Health Sciences Building, Addis Ababa University, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia.
¹¹ College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, PO 9086, Addis Ababa, Ethiopia.
¹² Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Centre for Affective Disorders, London, UK.
¹³ Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
¹⁴ Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry & Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK. charlotte.hanlon@kcl.ac.uk.

PMID: 27769270
PMCID: PMC5073499
DOI: 10.1186/s12913-016-1853-0

Abstract

Background: Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs.

Methods: We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review.

Results: Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors.

Conclusions: This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches.

Keywords: Capacity-building; Global mental health; Health system strengthening; LMICs; Mental health; Policy-makers; Psychiatry; Systematic review.

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Figures

**Fig. 1**
PRISMA flow diagram for selection of peer-reviewed articles

See this image and copyright information in PMC

References

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Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review

Affiliations

Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review

Authors

Affiliations

Abstract

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References

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