How to fix mental health in poor countries

In developing countries, depression and anxiety are widespread, but the requisite healthcare to treat them rarely is. There are several reasons why mental health is woefully neglected in poor countries.

Often, such illnesses are harder to identify. Doctors and nurses are not always trained enough to spot these disorders in patients they see, nor is the population always educated enough to seek treatment themselves. Not only that, there is an extreme shortage of skilled mental health professionals even in relatively wealthy developing nations.

As a study published by The Lancet today shows, in these situations, lay health counsellors could provide vital support for mental health programmes in poor countries.

The use of lay health workers is highly controversial, and there are ferocious debates over how much responsibility they should be given, and what tasks can be delegated to them. These arguments are entirely valid - doctors are trained not just in medical knowledge but also in ethics. How much can a training course, however rigorous, compensate for years of experience? Still, while countries are trying hard to recruit health professionals, and trying even harder to stop them flying off to more prosperous countries, the shortage of staff is impossible to ignore.

Vikram Patel, a mental health expert at the London School of Hygiene and Tropical Medicine, UK, also runs a clinic in Goa, India. Patel has for some years argued that for countries like India, people with mental illness will continue to be neglected unless less formally trained healthcare workers are incorporated into the health system.

Now, Patel and his colleagues have found that adding a lay health counsellor to a team of a primary care physician and visiting psychiatrist meant that after 6 months, patients were much more likely to recover from mental illnesses such as depression.

The lay health workers effectively oversaw the patients' care from educating them about mental health issues, and advising them on ways to communicate their illness to family members, to coordinating non-drug treatments with the physician or psychiatrist.

Essentially, these health workers are the driving force behind ensuring that patients turn up to appointments, and that their care is well-coordinated - which can be difficult in remote areas. In patients treated privately, lay workers made no difference, which is perhaps understandable since private care is likely to be more personalised and have a better ratio of doctors to patients.

If properly trained and supervised, there doesn't seem to be any reason why health workers shouldn't have some role in delivering healthcare. After all, without them, some patients have no healthcare at all.