Mental health care is a fundamental human right that significantly impacts our ability to work, connect with others and lead fulfilling lives. Despite its importance, mental health care in developing countries often remains a marginalized aspect of the global health agenda. Nearly 1 billion people globally endure a mental disorder. This global statistic, however, reveals an unequal distribution of mental health care. Seven out of every 10 individuals with psychosis receive treatment in high-income countries, while only 12% receive care in low-income countries.

While one might attribute this disparity to the shortage of mental health professionals, such as psychiatrists, according to a 2017 OECD report, low-income countries (with only two per 100,000 people), compared to the United States, where there are 45,000 psychiatrists for 340 million people, addressing this issue necessitates looking beyond the numbers. The solution may not solely lie in increasing the number of psychiatrists but in transitioning from Westernized institutional mental health treatments to robust community-based systems that offer culturally relevant care in regions where mental health remains stigmatized.

The Global Mental Health Crises

Low-income countries bear a disproportionate burden of the global mental health crises, accounting for 80% of the mental disease burden. However, the prevalence of stigma within low-and middle-income countries often acts as a significant barrier to seeking help. While the reasons for stigmatization may vary across communities, the universal presence of stigma remains evident. The World Mental Health Survey Initiative conducted in 16 countries spanning the Americas, Europe, the Middle East, Africa, Asia and the South Pacific reported 22.1% of participants from developing countries experienced shame and embarrassment due to a mental illness. Moreover, 63% of Africans viewed depression as a “personal weakness.” These statistics underscore the importance of addressing mental health through a culturally specific lens. 

What is Community-Based Care? 

Community-based mental health care represents a holistic approach to providing services and support rooted in the communities where individuals live. This approach recognizes developing countries’ unique challenges and needs, including limited resources, infrastructure, trained mental health professionals and cultural differences. Mental health care in developing countries has challenges as it is often perceived as a sign of weakness, danger, or having supernatural origins. Westernized approaches to mental health can unintentionally be harmful. 

To bridge this gap, presenting mental health care services in a culturally sensitive way is crucial. Community-based mental health care is a system that delivers mental health services through community health care workers (CHWs), individuals within the community with limited training but specific expertise in particular treatment areas. The World Health Organization (WHO) has played a prominent role in advocating for developing community-led mental health services globally.

The Role of Community-Based Care in Low-Income Countries 

CHWs play an essential role within the framework of community-based care. These individuals, typically members of the community they serve, are familiar with the local cultural stigmas and norms – bridging the gap between institutional health care and underserved populations. CHWs provide essential services to patients with less severe mental health needs, such as basic therapy and house-to-house medication distribution. At the same time, medically trained professionals can focus on patients with more acute symptoms. 

Examples of Community-Based Mental Health Care: StrongMinds Success Stories

Founded in 2013, StrongMinds is a social enterprise dedicated to treating depression among low-income women and children through group interpersonal therapy facilitated by CHWs. StrongMinds originated in Kampala, Uganda, and currently operates in four districts of Uganda. The organization is one of the few organizations addressing depression in Africa – a leading cause of disability among women in Africa. StrongMinds leverage unity over individualism. Over eight weeks, women come together to share their experiences of mental health issues, ultimately empowering each other and building a supportive community.

Through peer-to-peer therapy, public education, CHWs and global partnerships, Strongminds has provided group talk therapy to 260,000 women and children in Uganda and Zambia. About 80% of clients remain depression-free six months post-treatment. Recovery from depression not only benefits individual women but has a ripple effect on their communities and families. Women who received treatment reported a 16% increase in economic activity and a 30% increase in regularly sending their children to school.

Call to Action

Organizations such as StrongMinds show the potential of community-based programs in creating locally-led initiatives equipped to address their community’s unique mental health needs. Mental health is subjective, and there is no silver bullet to address these complex issues. The essential starting points are initiating community dialogue, nurturing relationships and providing support and resources. Community-based care can effectively facilitate mental health care in developing countries.

– Bella Oliver-Steinberg
Photo: Flickr