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.
References
Behere PB, Behere AP (2008) A Farmers’ suicide in Vidarbha region of Maharashtra state: a myth or reality? Indian J Psychiatry 50(2):124–127. https://doi.org/10.4103/0019-5545.42401
Behere P, Sharma V, Kumar V, Shah V (eds) (2017) Mental health training for health professional: global mental health assessment tool (GMHAT). Indian Psychiatric Society Publication, India. ISBN: 978-1-68419-385-1
Carpenter-Song E, Snell-Rood C (2016) The changing context of rural America: a call to examine the impact of social change on mental health and mental health care. Psychiatr Serv 68(5):503–6
Department of Health (2011) No Health without mental health: a cross-government mental health outcomes strategy for people of all ages. HM Government, London
Donaghy J (2012) Consulting rural mental health, stigma, services and support within the AWARD region. Research report
Epstein J (2017) Mental Healthcare in Rural Latin America. Práctica Familiar Rural 1(4). (Ver En Linea). https://doi.org/10.23936/pfr.v0i4.172.g227
Fekadu A, Hanlon C, Medhin G et al (2016) Development of a scalable mental healthcare plan for a rural district in Ethiopia. Br J Psychiatry 208(Suppl 56):s4–s12. https://doi.org/10.1192/bjp.bp.114.153676
Gamm L, Stone S, Pittman S (2010) Mental health and mental disorders – a rural challenge: a literature review. Rural Healthy People (1):97–114
Jack-Ide IO, Uys L (2013) Barriers to mental health services utilization in the Niger Delta region of Nigeria: service users’ perspectives. Pan Afr Med J 14:159. https://doi.org/10.11604/pamj.2013.14.159.1970
Jacobson N, Greenley D (2001) What is recovery? A conceptual model and explication. Psychiatr Serv 52(4):482–485. https://doi.org/10.1176/appi.ps.52.4.482
Jenkins R, Kiima D, Njenga F, Okonji M, Kingora J, Kathuku D, Lock S (2010) Integration of mental health into primary care in Kenya. World Psychiatry 9:118–120
Jordans MJD, Luitel NP, Pokhrel P, Patel V (2016) Development and pilot testing of a mental healthcare plan in Nepal. Br J Psychiatry 208(Suppl 56):s21–s28. https://doi.org/10.1192/bjp.bp.114.153718
Kigozi FN, Kizza D, Nakku J et al (2016) Development of a district mental healthcare plan in Uganda. Br J Psychiatry 208(Suppl 56):s40–s46. https://doi.org/10.1192/bjp.bp.114.153742
Krishna M, Lepping P, Sharma VK, Copeland JRM, Lockwood L, Williams M (2009) Epidemiological and clinical use of GMHAT-PC (Global Mental Health Assessment Tool – primary care) in cardiac patients. Clin Pract Epidemiol Ment Health 13:5–7
Kumar A (2011) Mental health services in rural India: challenges and prospects. Health 3:757–761. https://doi.org/10.4236/health.2011.312126
Lund C, Tomlinson M, De Silva M et al (2012) PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 9:e1001359
Lund C, Tomlinson M, Patel V (2016) Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans. Br J Psychiatry 208(Suppl 56):s1–s3. https://doi.org/10.1192/bjp.bp.114.153668
Ma Z, Huang H, Chen Q, Chen F, Abdullah AS, Nie G, Feng Q, Wei B (2015) Mental health services in rural China: a qualitative study of primary health care providers. Biomed Res Int 2015:151053. https://doi.org/10.1155/2015/151053
Mental Health in Rural and remote Australia (2017) National Rural Health Alliance. http://ruralhealth.org.au/sites/default/files/publications/nrha-mental-health-factsheet-2017.pdf
Mohit A (2001) Mental health and psychiatry in the Middle East: historical development. East Mediterr Health J 7:336–347
Monteiro NM, Ndiaye Y, Blanas D, Ba I (2014) Policy perspectives and attitudes towards mental health treatment in rural Senegal. Int J Ment Heal Syst 8:9. https://doi.org/10.1186/1752-4458-8-9
Ngui EM, Khasakhala L, Ndetei D, Roberts LW (2010) Mental disorders, health inequalities and ethics: a global perspective. Int Rev Psychiatry (Abingdon, England) 22(3):235–244. https://doi.org/10.3109/09540261.2010.485273
Pan American Health Organization (2016) Regional mental health atlas december 2015. PAHO Publication, Washington, DC
Patel V, Garrison P, de Jesus Mari J, Minas H, Prince M, Saxena S (2008) Advisory group of the Movement for Global Mental Health. The Lancet’s series on global mental health: 1 year on. Lancet 372(9646):1354–1357. https://doi.org/10.1016/S0140-6736(08)61556-1. PMC2570037
Patel V, Boyce N, Collins PY, Saxena S, Horton R (2011) A renewed agenda for global mental health. Lancet 378(9801):1441–1442. https://doi.org/10.1016/S0140-6736(11)61385-8
Patel V, Saxena S, Frankish H, Boyce N (2016) Sustainable development and global mental health – a Lancet Commission. Lancet 387(10024):1143–1145. https://doi.org/10.1016/S0140-6736(16)00208-7
Petersen I, Fairall L, Bhana A, Kathree T, Selohilwe O, Brooke-Sumner C, Faris G, Breuer E, Sibanyoni N, Lund C, Patel V (2016) Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry 208(Suppl 56):s29–s39. https://doi.org/10.1192/bjp.bp.114.153726
Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, Naeem F (2017) Mental health service provision in low- and middle-income countries. Health Serv Insights 10:1178632917694350. https://doi.org/10.1177/1178632917694350
Riva M, Bambra C, Curtis C, Gauvin L (2011) Collective resources or local social inequalities? Examining the social determinants of mental health in rural areas. Eur J Pub Health 21(2):197–203. https://doi.org/10.1093/eurpub/ckq064
Sharma VK (2015) Psychiatry in primary care- Indian perspectives. In: Malhotra S, Chakrabarti S (eds) Developments in psychiatry in India. Springer. ISBN: 978-81-322-1674-2
Sharma VK, Copeland JRM (2009) Detecting mental disorders in primary care. Ment Health Fam Med 6(1):11–13
Sharma VK, Lepping P, Cummins AG, Copeland JRM, Parhee R, Mottram P (2004) The Global Mental Health Assessment Tool: Primary Care Version (GMHAT/PC): development, reliability and validity. World Psychiatry 3(2):115–119
Sharma VK, Lepping P, Krishna M, Durrani S, Copeland JR, Mottram P et al (2008) Mental health diagnosis by nurses using the Global Mental Health Assessment Tool: a validity and feasibility study. Br J Gen Pract 58(551):411–416
Sharma VK, Jagawat S, Midha A, Jain A, Tambi A, Mangwani LK, Sharma B, Dubey P, Satija V, Copeland JRM, Lepping P, Lane S, Krishna M, Pangaria A (2010) The global mental health assessment tool-validation of GMHAT/PC in Hindi: a validity and feasibility study. Indian J Psychiatry 52(4):316–319
Sharma BB, Singh S, Sharma VK, Choudhary M, Singh V, Lane S, Lepping P, Krishna M, Copeland J (2013a) Psychiatric morbidity in chronic respiratory disorders in an Indian service using GMHAT/PC. Gen Hosp Psychiatry 35(1):39–44
Sharma VK, Durrani S, Sawa M, Copeland JR, Abou-Saleh MT, Lane S, Lepping P (2013b) Arabic version of the Global Mental Health Assessment Tool-Primary Care version (GMHAT/PC): a validity and feasibility study. East Mediterr Health J 19(11):905–908
Shidhaye R, Shrivastava S, Murhar V, Samudre S, Ahuja S, Ramaswamy R, Patel V (2016) Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. Br J Psychiatry 208(Suppl 56):s13–s20. https://doi.org/10.1192/bjp.bp.114.153700
Simpson EL, House AO (2002) Involving users in the delivery and evaluation of mental health services: systematic review. BMJ 325:1265
Tejada P, Jaramillob LE, Garcíab J, Sharma V (2016) The global mental health assessment tool primary care and general health setting version (GMHAT/PC) – Spanish version: a validity and feasibility study. Eur J Psychiatry 30(3):195–204
Thornicroft G, Deb T, Henderson C (2016) Community mental health care worldwide: current status and further developments. World Psychiatry 15(3):276–286. https://doi.org/10.1002/wps.20349
Walker JF (2012) Mental health in the rural sector – a review, Farmsafe, New Zealand
Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Twelve-month use of mental health services in the United States. Results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):629–640
WHO (2016) mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP): version 2.0. World Health Organization, Geneva
World Bank Population Data (2015) World Bank Group, Washington
World Health Organisation (2001) The world health report 2001- mental health: new understanding, New Hope. World Health Organization, Albany
World Health Organisation (2013) Mental health action plan 2013–2020. World Health Organization, Geneva
World Health Organisation (2015) Mental health atlas 2014. World Health Organization, Geneva
World Health Organization (2010) mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP) [Internet]. WHO Publication
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this entry
Cite this entry
Sharma, V.K. (2019). Organization of Mental Health Services in Rural Areas. In: Chaturvedi, S. (eds) Mental Health and Illness in Rural World. Mental Health and Illness Worldwide. Springer, Singapore. https://doi.org/10.1007/978-981-10-0751-4_14-1
Download citation
DOI: https://doi.org/10.1007/978-981-10-0751-4_14-1
Received:
Accepted:
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-0751-4
Online ISBN: 978-981-10-0751-4
eBook Packages: Springer Reference Behavioral Science and PsychologyReference Module Humanities and Social SciencesReference Module Business, Economics and Social Sciences