By Sara Gorman
In response to the realization that between 16% and 49% of people in the world have psychiatric and neurological disorders and that most of these individuals live in low- and middle-income countries, the World Health Organization (WHO) launched the Mental Health Gap Action Programme to provide services for priority mental health disorders in 2008. This focus on services is essential, but the WHO ran into a significant problem when confronting mental health disorders in the developing world: lack of research made it difficult to understand which mental health disorders should be prioritized and how best to reach individuals in need of care.
In 2011, The World Health Organization (WHO) embarked on a report entitled “No health without research.” The release of the report was recently postponed, but the problem identified by the report remains no less dire. In order to improve health systems in low- and middle-income countries, support for more research in epidemiology, healthcare policy, and healthcare delivery within these countries is essential.
Over the course of the past year and a half, PLoS Medicine has published a series of papers corresponding with this theme. In one paper, M. Taghi Yasamy and colleagues emphasize the importance of scaling up resources for mental health research in particular. This research, they explain, will help policymakers determine directions for improving policy and delivery of mental healthcare. Advancing this research will be challenging, though, because good governance for mental health research in developing countries is lacking.
Some of the most immediate problems with mental health research in developing countries are financial. Most developing countries lack institutions like the National Institute of Mental Health (NIMH) to help fund and structure research. Physicians and mental health professionals often have no incentive to conduct research because providing other health services is much more lucrative. In some cases, as in many countries in Latin America, researchers must fund their own research and experience no financial gain as a result of conducting research.
Yet financial reasons are not the only reasons for lack of mental health research in developing countries. Restructuring medical education could go a long way toward preparing physicians to participate in research. While research is valued as a key part of medical education and success in the United States, research is not a determining factor for getting into residency or achieving academic success in low-income countries. Many physicians-in-training thus encounter a lack of incentive to contribute to research initiatives. Making research a fundamental part of success in medical training could help make universities in low- and middle-income countries the research centers they are in high-income countries.
Even when clinicians and scientists in low- and middle-income countries are able to conduct mental health research, they often find it difficult to publish their findings in prestigious, widely circulating international medical journals. Researchers from developing countries often struggle to meet the requirements of indexed journals because of lack of access to information, lack of guidance in research design and statistical analysis, and difficulty communicating in foreign languages. Researchers in developing countries often work in research centers or universities that are not considered “prestigious” on an international scale and may not garner the attention of international journals. Editors may be more likely to give serious consideration to submissions from authors at big-name universities. Another serious problem with publication of research from developing countries in prestigious medical and scientific journals is the language barrier, with most top journals being English-language. Procuring better translation services for scientists in developing countries could be key in overcoming the dearth of publications from these areas of the world.
Policymakers and providers in developing countries may also struggle to learn about findings published in expensive journals for which their institutions cannot afford subscriptions. Open access policies represent one way to alleviate some of the problems mental health researchers in developing countries confront. Free access to a wider body of research published in highly-regarded journals could vastly improve mental health research in developing countries and help researchers attract the attention of these high-level journals.
Mental health interventions that truly help communities in low- and middle-income countries cannot succeed if data on epidemiology of mental disorders, current problems in the delivery of healthcare services, and evidence-based solutions are not available. A survey of mental health research priorities in low- and middle-income countries in 2009 found that stakeholders and researchers ranked three types of research as most important: epidemiological studies of burden and risk factors, health systems research, and social sciences research. Researchers and stakeholders agreed that attending to the growing problems of depression, anxiety, and substance abuse disorders, among other frequently occurring mental disorders, was dependent on procuring better resources for research.
Improving service gaps in mental healthcare is vital, especially in light of a growing epidemic of mental illness globally. But this work cannot be done without more research to identify the problems and evidence-based solutions that will help bring mental healthcare to all those in need.
Sara Gorman, PhD is an MPH student at Columbia University’s Mailman School of Public Health. She has written extensively about HIV, TB, and women’s and children’s health for a variety of public health organizations, including Save a Mother and Boston Center for Refugee Health and Human Rights. She most recently worked in the policy division at the HIV Law Project.