Delivering Truly Evidence-Based Mental Health Care in Low-and Middle-Income Countries: The Dangers of Experimentation

Many low-and middle-income countries have poor mental health systems that suffer from chronic neglect and under-allocation of resources. This has led governments to operate on the assumption that it is not possible to provide their citizens with evidence-based high-quality mental health services. Consequently, they make plans based on this assumption, resulting in “solutions” that are suboptimal and even potentially harmful. These solutions include the creation of new cadres of mental health workers that are trained solely to address the gap in resource availability. This has resulted in harmful outcomes, including many avoidable deaths and increased morbidity that could have been prevented by investing in evidence-based solutions. We argue that it is possible to tackle this problem by empowering existing health workers with the knowledge and skills necessary to manage and appropriately refer people with common mental disorders, thus making it part of their routine scope of practice. This will enable them to work in an integrated health-care system with reduced stigma towards mental ill health and those that care for the mentally ill.