Mental health disorders are a huge burden for health systems, particularly in low and middle income countries. A new research hub based in Sao Paulo and Lima is exploring the opportunity to use technology to tackle these disorders.
In 2010, mental and substance use disorders were responsible for the greatest number of years of life lost to ill health worldwide.(1) In 2012, the World Health Assembly officially recognised the major contribution of mental disorders to the global non-communicable disease burden.(2) It urged member states to develop a coordinated and comprehensive response towards mental health treatment through their health and social sectors. Worldwide a large treatment gap exists for mental health disorders, particularly in low and middle income countries (LMICs). Insufficient financial resources in LMICs results in inadequate numbers of trained personnel, and a high proportion of patients who do not receive care; 76-85% of people with severe mental health conditions do not receive treatment.(3)
The Latin American Treatment and Innovation Network in Mental Health (LATIN-MH) is a regional hub for research and training in mental health, based in Lima (CRONICAS), Sao Paulo, Chicago and London. Its aim is to find innovative solutions to address the treatment gaps that exist in mental health care. Although undoubtedly a difficult challenge, at CRONICAS we believe that to develop sustainable mental health interventions, health systems must adapt to scarce resources and health inequities, effectively building upon the existing context. We see LATIN-MH as a “disruptive innovation”: a new product that transforms and adds to traditional ones. This innovation is driven by three pillars: (i) building capacity to achieve sustainability, (ii) developing strategic interdisciplinary partnerships, and (iii) integrating effective mental health treatment into primary care and community health systems.
LATIN-MH combines the innovative use of task shifting and technology to address the mental health treatment gap. Task shifting at the level of healthcare providers and patients’ self-management has been successfully shown to increase child survival rates and maternal health.(4) Furthermore, the growing implementation of e-health and m-health interventions has played an important role in changing unhealthy habits or lifestyles.(5)
Our research component is centred on assessing the feasibility of using a technologically driven nurse assisted intervention (CONEMO) for people with co-morbid depression and diabetes/hypertension to reduce symptoms of depression. The intervention is a 6-week programme based on behavioural activation, an approach which works by engaging patients in activities that improve their mood. Implementing this smartphone application shifts tasks to nurses and smartphones by taking advantage of the huge mobile phone penetration in the region.(6) This is hugely important in settings where staff shortages exist. At the same time, the project builds research capacity within Peru and Brazil by providing a framework for hands-on mentoring and training for junior investigators who will form part of the new cohort of public health researchers. The success of the intervention is currently being evaluated.
We hope that this model will be sustainable and will help improve the management of mental health in the long-term in order to overcome the barriers preventing us from achieving universal access to mental health care and improved population mental wellbeing.
CRONICAS Center of Excellence in Chronic Diseases, supported by the National Heart, Lung, and Blood Institute’s Global Health Initiative under the contract ‘Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases’.
1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet (London, England). 2013;382(9904):1575-86.
2. WHO (World Health Organisation). The global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. Geneva: WHO, 2012.
3. WHO (World Health Organisation). 10 facts on mental health 2014 [cited 2015]. Available from: http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/.
4. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. The Cochrane database of systematic reviews. 2010(3):Cd004015.
5. WHO (World Health Organisation). mHealth: New horizons for health through mobile technologies: second global survey on eHealth. Geneva: WHO, 2011.
6. GSMA Intelligence. The Mobile Economy; Latin America 2014. London: 2014.