The Centre for International Mental Health Approach to Mental Health System Development

Figures & data

Table

Mental Health System Issues and Challenges
Context	System elements	Outcomes
• Little understanding of mental health as an important public health and social and economic development issue • Little understanding that effective and affordable interventions and service models are available • Mental health is a low political and social priority • Weak investment • Weak drive for mental health system reform and development • Low levels of skill in policy development and implementation • Weak governance and management arrangements • Low population “mental health literacy”	• Inadequate infrastructure, facilities, equipment, drug distribution systems • Shortage of skilled mental health workers • Geographic maldistribution of available workforce • Disciplinary imbalance: dominated by physicians and nurses • Hospital centered • Undeveloped information systems, with lack of high-quality local information to support planning • Poorly developed mental health systems research capacity • No culture of evaluation or continuous quality improvement • Poorly organized and marginalized consumers, carers, civil society	• Narrow population coverage: wide “treatment gap” • Very wide gap between best (usually in major urban centers) and worst (usually in poor rural areas) mental health services • Low and inequitable access (geographic, economic, linguistic, cultural) to mental health services • Stigma, discrimination, social and economic exclusion • Mental health training is unattractive for most disciplines • Inadequate protection of rights, with widespread human rights abuses • Lack of locally relevant evidence for policy and practice • Poorly developed advocacy by civil society and groups

Figure 1: Structure of the CIMH mental health system development program.

Table

Strengthening Mental Health Systems Research Capacity
Strategy	Notes
Communication infrastructure and active networking	The International Observatory on Mental Health Systems (IOMHS) Secretariat facilitates communication within the IOMHS network, and between IOMHS and other organizations. The networks should be across different institutions and teams, across different parts of the research system (e.g., research producer and user groups), and across different disciplines.
Strategic leadership, training, and skills development	Within countries the IOMHS collaborating groups will contribute to strategic leadership and to shaping the national mental health systems research agenda. Observatory partners are linked into training opportunities offered by CIMH and other organizations, such as the International Master in Mental Health Policy and Services^13 and the International Diploma in Mental Health Law and Human Rights.^14
Resource concentration	A central element of the observatory strategy is resource concentration through the establishment of mental health systems research, education, and development groups—which strengthens capacity to secure research funds from national and international sources.
User-researcher interaction	It is essential that the users of the research results are engaged as early as possible in the research process. IOMHS collaborating groups have established links with key research users, particularly ministries of health and civil society and consumer and carer organizations.
Research career development	The establishment of mental health systems research, education, and development groups in key academic departments will open up career pathways that currently do not exist for mental health systems researchers, and will improve ability to compete for scarce research funds. Training will contribute to building careers in mental health systems research.
Ensuring political independence	The establishment of IOMHS collaborating groups in influential academic institutions—which everywhere jealously guard their independence—will contribute to ensuring political independence. However, political independence does not mean political isolation.
Cultural change	A key component of necessary cultural change is the creation of a culture in which the production, dissemination, and use of high-quality research is valued as an integral part of the health system. Knowledge should be publicly owned, widely disseminated, and shared, and should be used for public benefit. Building an open research culture is an essential and long-term objective.

Figure 2.  Structure of the CIMH mental health system development program and outcomes of the Health for the South project. CIMH, Centre for International Mental Health; CSO, community service officer; iMHLP, International Mental Health Leadership Program; MoH, Ministry of Healthcare and Nutrition; MOMH, medical officers of mental health; NIMH, National Institute of Mental Health; SL, Sri Lanka; WHO, World Health Organization; WVA, World Vision Australia.

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