Grand Challenges in Global Mental Health: Integrating Mental Health into Chronic Care Provision in Low- and Middle-Income Countries
Sarah S. Joestl, MPH
Social Science Analyst
Office for Research on Disparities and Global Mental Health
To promote the establishment of an evidence base on contextually relevant, cost-effective integrated care interventions for the treatment of co-morbid mental and chronic illnesses in resource-poor low- and middle-income countries (LMICs).
According to the World Health Organization1, mental illness accounts for 30 percent of the global burden of non-communicable disease. However, given the contribution of mental illness to morbidity from other chronic diseases, this figure is likely a conservative estimate of the overall impact of mental illness on disease burden worldwide. With the global population steadily increasing and chronic illnesses replacing infectious diseases as the primary cause of death and disability worldwide, the disease burden from mental illness is likely to increase. Recognizing this trend, the global health community is increasingly attentive to the importance of integrating mental health care into treatment delivery systems for chronic non-communicable diseases.
The relationship between mental illness and chronic diseases is one of mutual and complex causality. On the one hand, mental illness increases the risk for both communicable and non-communicable diseases (e.g., HIV/AIDS, cardiovascular disease, diabetes), and contributes to unintentional injuries and self-harm behaviors. In this same vein, side effects of psychotropic medications, as well as unhealthy lifestyles and potential genetic susceptibilities, increase the likelihood of developing co-morbid physical conditions. On the other hand, many chronic diseases increase an individual’s risk for mental illness, thereby complicating help-seeking, diagnosis, treatment, and prognosis.
While the effectiveness of integrated care approaches for reducing morbidity from co-occurring mental and chronic illnesses has been demonstrated in high-income countries, little parallel evidence exists supporting this approach in LMICs. Existing global health research centers in LMICs offer a unique opportunity to investigate models for integrating mental health into chronic disease care in those resource-poor settings.
Scientific areas of interest include, but are not limited to:
- Identification of systemic facilitators of and barriers to integrating mental health services into chronic care settings in LMICs, including resource sharing, communication, effective service planning, and case referral;
- Examination of the efficacy of models for screening and treating mental illness in the context of HIV, cardiovascular disease, diabetes, or other prevalent chronic disease care and treatment programs; and,
- Examination of the cost-effectiveness of integrating mental health services into chronic disease care in LMICs.
1World Health Organization. (2008). The Global Burden of Disease: 2004 Update. Geneva, Switzerland.