Organization of Mental Health Services in Rural Areas

Abstract

A large proportion of people live in rural areas of the world especially in the low- to middle-income countries. The services for mental disorders of rural population remain poor even in high-income countries. The treatment gap for mental illness is about 80% in low-income countries and perhaps even worse for rural people. The reasons of treatment gap are complex. Mental health is often given low priority despite constituting nearly one fifth of the overall health morbidity. Low investment in mental health leads to limited mental health resources available to the country’s health service. In low- to middle-income countries, these are concentrated in the cities, depriving rural communities of any specialist mental health services. Stigma, discrimination, poor literacy, and specific cultural belief toward mental illness restrict rural people to accept and access appropriate help.

Integration of mental health at primary care level is the only way forward to address this unmet need. Primary care health workers, however, lack in knowledge and skills to detect and manage mental disorders. The World Health Organization has come up with an ambitious mhGAP initiative to train primary care workers using its intervention guidelines. Recent mental health programs (PRIME) involving primary care workers and local organizations have shown some benefits as well as highlighted challenges in organizing services especially in low-income countries to serve predominant rural communities.

Organizing services for people in the rural areas needs to involve local people by understanding their views and perception of mental disorders, an extensive public health education program addressing the issues of stigma and discrimination existing toward mental illness, investing in adequate mental health resources, but more importantly integrating mental health with general health. This can be achieved by training frontline health workers in diagnosing and managing mental disorders supported by specialists. Modern technology and tools using mobile- and computer-assisted methods could greatly assist frontline workers if well supported by telemedicine approaches by mental health specialists.