A Critique on the Factors that Influence Mental Health Workforce Training in Developing Countries

Background

This chapter will focus on some of the issues important to the development of the mental health workforce globally, but particularly to developing countries. The controversial issues addressed in the chapter are ones that the author frequently faced in his international work in the World Health Organization (WHO). The relevancy and suitability to developing countries of the practices and approaches of rich countries to manage mental health workforce issues will be examined. The cost of mental health care in developed countries is substantial. But the reality is that low and mid-income countries cannot afford many of the expensive and sophisticated approaches found in these financially richer countries. And even if they could afford them, the approaches may not be suitable. The proposition being made in this chapter is that developing countries need to develop their own approaches to health care in general and mental health care more. In particular approaches that are culturally sound and that can be sustained from national and local resources without relying on wealthy country support. While there is a need for medicines to treat mental illness, which is usually beyond national production capabilities, many developing countries have a socio-cultural infrastructure to care for their mentally ill within their families and communities. Essential to this infrastructure is the production and deployment of trained primary health care workers to help support and guide families in caring for their kin in their communities.

Fortunately the capability of countries to independently develop their own health care systems is increasingly being realized and being pursued in the more stable nation states. Mental illness and the need for mental health care are now becoming more visible. Systems and innovations are being put into place to fit identified needs. A major purpose to this chapter is to examine some of the major historical influences on the structure of mental health services in developed countries and the influence this has had on the training curricula and composition of mental health care services in the developing world. Some of the effects are positive but some not so useful. Epidemiological data will be used to compare the rich and poor countries and show where gaps and inconsistencies exist.