SeriesHuman resources for mental health care: current situation and strategies for action
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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Contributed equally to this report