Intended for healthcare professionals


Mental healthcare in low and middle income countries

BMJ 2014; 349 doi: (Published 25 November 2014) Cite this as: BMJ 2014;349:g7086
  1. Robert E Drake, professor of psychiatry and community and family medicine1,
  2. Agnes Binagwaho, minister of health2,
  3. H Castillo Martell, director general3,
  4. Albert G Mulley, director4
  1. 1Dartmouth College, Hanover, New Hampshire, USA
  2. 2Department of Health, Kigali, Rwanda
  3. 3National Institute of Mental Health, Lima, Peru
  4. 4Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, USA
  1. Correspondence to: R E Drake Robert.E.Drake{at}

Should not replicate the inefficient, inaccessible, and insensitive Western model

The global burden of disease is shifting rapidly from infectious disease to chronic non-infectious disease, with mental and substance use disorders the leading cause of years lost to disability in 2010 worldwide.1 Meanwhile, the movement for global mental health, largely based on evidence based treatments from wealthy countries, has been rapidly gaining momentum.2 Evidence for the effectiveness of these treatments is, however, often silent on culture, context, and preferences of patients. The failure to listen to people and to consider context has led to substantial waste and harm in wealthy countries.3 These concerns should be central in the global mental health movement and will be emphasised at the Salzburg Global Seminar session on mental health in December 2014, which will include teams from more than 12 countries.

Wealthy countries, whether they have market driven or state planned systems, have created expensive and inefficient mental healthcare. Government, industry, and experts make decisions at the top, while people who are …

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