In the early 1970s, comprehensive and authoritative reviews of psychiatric disorders in low- and middle-income (LAMI) countries in Latin America, sub-Saharan Africa and South-East Asia showed that all types of mental disorders were widely prevalent. The reviews highlighted the gross neglect of mental disorders in these countries for a variety of reasons, which included pervasive stigma, widespread misconceptions, grossly inadequate budgets and acute shortages of trained personnel. It was pointed out that, in these countries, basic mental healthcare should be decentralised and integrated with the existing system of general health services (German, 1972; Leon, 1972; Carstairs, 1973; Neki, 1973). The strategy of integrating mental health into primary care services was endorsed by a Mental Health Expert Committee of the World Health Organization (WHO) in 1974 (WHO, 1975). More than 25 years later, in 2001, the WHO devoted its World Health Report to mental health, focusing on the importance of integrating mental health into primary care (WHO, 2001a). Several other influential international reports have recommended the strengthening of existing systems of primary care services in LAMI countries to provide services for persons with mental disorders (Institute of Medicine, 2001; Hyman et al, 2006). More recently, the Lancet series ‘Global Mental Health’ unequivocally recommended that mental health be recognised as an integral component of primary and secondary general healthcare, particularly in LAMI countries (Chisholm et al, 2007a; Gureje et al, 2007).
Better recognition of the societal burden of mental disorders, availability of effective interventions and high-profile recommendations often do not result in improved provision of mental healthcare in LAMI countries. This chapter reviews the widely varying nature of LAMI countries, their health policies, health systems, health personnel and barriers to better healthcare delivery in the context of the integration of mental health into primary healthcare.
More than 80% of the world's population of over 6 billion live in countries that are referred to as ‘developing’, a euphemism for poor countries. These countries are situated mostly in Africa, Latin America, Asia and some parts of eastern Europe. The typology of countries has changed over time. Terms such as ‘Third World’ have given way to newer operational ones, such as ‘developing countries’, ‘less economically developed countries’ (LEDC), ‘emerging economies’ and ‘non-industrialised nations’. The World Bank (2006) classifies economies according to their gross national income per capita (Table. 6.1).