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Int. J. Environ. Res. Public Health 2018, 15(6), 1279;

The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies

Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC 20037, USA
Division of Epidemiology and Public Health, University of Nottingham, NG7 2RD, UK
Department of Psychiatry, University of Oxford, Warneford Lane, OX1 2JD, UK
Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
War Child, Research and Development, 1098 LE, Amsterdam, The Netherlands
Butabika National Mental Hospital, 2 Kirombe-Butabika Road, P.O. Box 7017 Kampala, Uganda
YouBelong, P.O. Box 36510 Kampala, Uganda
Sangath, Socorro, Porvorim, Goa 403501, India
Department of Psychiatry, Sinai Health System & University of Toronto, Toronto, ON M5G 1X5, Canada
Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA 02115, USA
Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
Author to whom correspondence should be addressed.
All authors contributed equally and are presented in alphabetical order.
Received: 9 May 2018 / Revised: 13 June 2018 / Accepted: 14 June 2018 / Published: 16 June 2018
(This article belongs to the Special Issue Mental Health and Social Care and Social Interventions)
PDF [1404 KB, uploaded 16 June 2018]


Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community components included greater accessibility and acceptability compared to healthcare facilities, greater clinical effectiveness through ongoing contact and use of trusted local providers, family involvement, and economic benefits. Locations included homes, schools, and refugee camps, as well as technology-aided delivery. Activities included awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments. There was substantial variation in the degree to which community components were integrated with primary care services. Addressing gaps in current practice will require assuring collaboration with service users, utilizing implementation science methods, creating tools to facilitate community services and evaluate competencies of providers, and developing standardized reporting for community-based programs. View Full-Text
Keywords: community; global health; low- and middle-income countries; mental disorders; meta-review; paraprofessionals; psychological treatments community; global health; low- and middle-income countries; mental disorders; meta-review; paraprofessionals; psychological treatments

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Kohrt, B.A.; Asher, L.; Bhardwaj, A.; Fazel, M.; Jordans, M.J.D.; Mutamba, B.B.; Nadkarni, A.; Pedersen, G.A.; Singla, D.R.; Patel, V. The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies. Int. J. Environ. Res. Public Health 2018, 15, 1279.

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