Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project

Dan Chisholm¹, Sumaiyah Docrat², Jibril Abdulmalik³, Atalay Alem⁴, Oye Gureje⁵, Dristy Gurung⁶, Charlotte Hanlon⁷, Mark J D Jordans⁸, Sheila Kangere⁹, Fred Kigozi¹⁰, James Mugisha⁹, Shital Muke¹¹, Saheed Olayiwola¹², Rahul Shidhaye¹³, Graham Thornicroft¹⁴, Crick Lund¹⁵

Affiliations

¹ Health Systems Adviser, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland.
² Research Officer, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
³ Consultant Psychiatrist, Department of Psychiatry, University of Ibadan, Nigeria.
⁴ Professor of Psychiatry, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Ethiopia.
⁵ Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa.
⁶ Research Coordinator, Transcultural Psychosocial Organization (TPO) Nepal, Nepal.
⁷ Reader in Global Mental Health, Health Services and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Adjunct Associate Professor, Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia.
⁸ Reader, Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Senior Advisor, TPO Nepal, Nepal.
⁹ Research Officer, Butabika National Referral and Teaching Mental Hospital, Uganda.
¹⁰ Professor of Psychiatry, Butabika National Referral and Teaching Mental Hospital, Uganda.
¹¹ Research Fellow, Public Health Foundation of India, Bhopal, India.
¹² Lecturer II, Department of Economics, Federal University of Technology, Nigeria.
¹³ Research Coordinator, Public Health Foundation of India, Bhopal, India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands.
¹⁴ Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
¹⁵ Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Health Services and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.

PMID: 31530327
PMCID: PMC6688460
DOI: 10.1192/bjo.2019.24

Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project

Dan Chisholm et al. BJPsych Open. 2019.

. 2019 Aug 6;5(5):e68.

doi: 10.1192/bjo.2019.24.

Authors

Affiliations

¹ Health Systems Adviser, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland.
² Research Officer, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
³ Consultant Psychiatrist, Department of Psychiatry, University of Ibadan, Nigeria.
⁴ Professor of Psychiatry, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Ethiopia.
⁵ Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa.
⁶ Research Coordinator, Transcultural Psychosocial Organization (TPO) Nepal, Nepal.
⁷ Reader in Global Mental Health, Health Services and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Adjunct Associate Professor, Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia.
⁸ Reader, Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Senior Advisor, TPO Nepal, Nepal.
⁹ Research Officer, Butabika National Referral and Teaching Mental Hospital, Uganda.
¹⁰ Professor of Psychiatry, Butabika National Referral and Teaching Mental Hospital, Uganda.
¹¹ Research Fellow, Public Health Foundation of India, Bhopal, India.
¹² Lecturer II, Department of Economics, Federal University of Technology, Nigeria.
¹³ Research Coordinator, Public Health Foundation of India, Bhopal, India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands.
¹⁴ Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
¹⁵ Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Health Services and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.

PMID: 31530327
PMCID: PMC6688460
DOI: 10.1192/bjo.2019.24

Erratum in

Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project - CORRIGENDUM.
Chisholm D, Docrat S, Abdulmalik J, Alem A, Gureje O, Gurung D, Hanlon C, Jordans MJD, Kangere S, Kigozi F, Mugisha J, Muke S, Olayiwola S, Shidhaye R, Thornicroft G, Lund C. Chisholm D, et al. BJPsych Open. 2021 Jun 25;7(4):e117. doi: 10.1192/bjo.2021.948. BJPsych Open. 2021. PMID: 34180788 Free PMC article. No abstract available.

Abstract

Background: Current coverage of mental healthcare in low- and middle-income countries is very limited, not only in terms of access to services but also in terms of financial protection of individuals in need of care and treatment.

Aims: To identify the challenges, opportunities and strategies for more equitable and sustainable mental health financing in six sub-Saharan African and South Asian countries, namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.

Method: In the context of a mental health systems research project (Emerald), a multi-methods approach was implemented consisting of three steps: a quantitative and narrative assessment of each country's disease burden profile, health system and macro-fiscal situation; in-depth interviews with expert stakeholders; and a policy analysis of sustainable financing options.

Results: Key challenges identified for sustainable mental health financing include the low level of funding accorded to mental health services, widespread inequalities in access and poverty, although opportunities exist in the form of new political interest in mental health and ongoing reforms to national insurance schemes. Inclusion of mental health within planned or nascent national health insurance schemes was identified as a key strategy for moving towards more equitable and sustainable mental health financing in all six countries.

Conclusions: Including mental health in ongoing national health insurance reforms represent the most important strategic opportunity in the six participating countries to secure enhanced service provision and financial protection for individuals and households affected by mental disorders and psychosocial disabilities.

Declaration of interest: D.C. is a staff member of the World Health Organization.

Keywords: Low and middle income countries; financing; mental health; mental health systems.

PubMed Disclaimer

Figures

**Fig. 1**
Emerald project's conceptual framework for sustainable mental health financing.

**Fig. 2**
Emerald project's mental health financing algorithm.

See this image and copyright information in PMC

References

1. Lancet Global Mental Health Group. Scale up services for mental disorders: a call for action. Lancet 2007; 370: 1241–52. - PubMed
1. World Health Organization. mhGAP: Mental Health Gap Action Programme: Scaling up Care for Mental, Neurological and Substance Use Disorders. WHO Press, 2008. - PubMed
1. Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T, et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet 2015; 387: 1672–85. - PubMed
1. Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, et al. Scaling up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry 2016; 3: 415–24. - PubMed
1. Chisholm D, Saxena S. Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. Br Med J 2012; 344: e609. - PMC - PubMed

Grants and funding

LinkOut - more resources

Full Text Sources
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project

Affiliations

Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project

Authors

Affiliations

Erratum in

Abstract

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials