Elsevier

The Lancet

Volume 378, Issue 9803, 5–11 November 2011, Pages 1654-1663
The Lancet

Series
Human resources for mental health care: current situation and strategies for action

https://doi.org/10.1016/S0140-6736(11)61093-3Get rights and content

Summary

A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.

Introduction

“At the heart of each and every health system, the workforce is central to advancing health”1

The World Health Report 20061 focused global attention on the shortage of health workers. Many countries of low and middle income face a health workforce crisis, and the scarcity of human resources and training is similarly overwhelming for mental health.2, 3, 4, 5 Practical guidelines to assist policy makers, health planners, and educators to address shortfalls in human resources for mental health are available;6, 7, 8 efforts are increasing to focus on this issue; and evidence from countries of low and middle income is emerging that will have many implications for policy on human resources for mental health.

The mental health workforce described in this report includes three groups of individuals. The first is composed of specialist workers, such as psychiatrists, neurologists, psychiatric nurses, psychologists, mental health social workers, and occupational therapists. The second group is formed of non-specialist health workers, such as doctors, nurses and lay health workers, affected individuals, and caregivers. In the third group, other professionals are included, such as teachers and community-level workers.

Here, we discuss the current status and needs of human resources for mental health. We also review available evidence about actions and strategies to strengthen human resources for mental health in low-income and middle-income countries, with the objective to inform development of policies in this area.

Section snippets

Identification of data sources

Evidence of the current status of human resources for mental health was obtained from WHO's 2011 Mental Health Atlas.9 WHO has been gathering data on mental health resources approximately every 5 years since 2000 from almost all countries of the world.3, 9, 10 The latest data were published in 2011 and were obtained with a questionnaire containing standard definitions for all variables, from 183 countries covering 99·3% of the world's population. Median change scores were calculated to assess

Current state of human resources for mental health

Figure 1 shows the median number of human resources for mental health reported in Atlas 2011,9 separated by income groups of countries. Globally, nurses were the largest workforce category in the mental health system, with a median of 4·95 nurses per 100 000 population, followed by psychiatrists (1·27 per 100 000 population). Although numbers of psychologists and social workers were much smaller, occupational therapists were especially rare, with not one occupational therapist working in the

Task shifting

Task shifting (also known as task sharing), defined as “delegating tasks to existing or new cadres with either less training or narrowly tailored training”,16 is an essential response to shortages in human resources for mental health. This process can entail: employment of mental health care providers in different sectors; intersectoral collaborations with other professionals, such as teachers and prison staff, to strengthen mental health awareness, detection of mental disorders, referrals, and

Concluding remarks

Human resources for mental health continue to be grossly inadequate in most countries of low and middle income. The shortage is likely to worsen unless substantial investments are made to train a wider range of mental health workers in much higher numbers. Task shifting seems to be an effective and feasible approach but it too will entail substantial investment, innovative thinking, and effective leadership.

Here, we have shown examples of innovative and effective strategies to expand mental

Future directions

Global efforts to address widespread shortages in the health workforce have entailed development of a technical framework to assist governments and health managers to work on and implement a comprehensive strategy to achieve an effective and sustainable health workforce.1 The Human Resources for Health Action Framework,76 which consists of six interconnected components necessary in human resource development (policy, health workforce management, finance, education, partnerships, and

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