First line care facilities and support for providers have to be improved

EDITOR—Thornicroft and Maingay highlight the inadequacy of international responses to mental illness.1 In low income countries the burden of mental illness is amplified by financial insecurity, poverty, and partition of families, if not by violence and war. Prevention in mental health is intimately linked with overall human development. Individual care is also necessary. In some societies religious or traditional healers still provide culturally relevant and socially acceptable responses to problems labelled as mental illness. Nevertheless, mental suffering is manifest among users of modern medical services, where it goes largely unrecognised.

Besides poor availability of drugs, human resources are of utmost importance in understanding the apparent neglect of mental health problems. Doctors and nurses in low income countries are often described as rude to their patients,2 partly because they have low salaries and poor professional perspectives, which affects their morale, self confidence, and dedication.3 Some have problems similar to those of their patients—for example, domestic violence or living with …