title: Optimizing mental health services in low-income and middle-income countries.
abstract: OBJECTIVE
  Against the backdrop of a large burden and treatment gap for mental disorders in low-income and middle-income countries (LMICs), recently published articles were reviewed to assess strategies and actions for optimizing mental health services in LMICs.
  
  
  RESULTS
  Key strategies and actions are as follows: (i) the adoption of a decentralized stepped care approach embracing task shifting to nonspecialists for those disorders for which it has been shown to be effective; (ii) ensuring adequate numbers of mental health specialists to provide a supportive supervisory framework and referral pathways; (iii) ensuring adequate infrastructure to support decentralized care; (iv) promoting mental health literacy; (v) adoption of a social inclusion and developmental model of disability in caring for people with chronic mental illness; and (vi) embracing a multisectoral community collaborative approach.
  
  
  CONCLUSIONS
  Optimizing mental health services in LMICs requires legislation, policies and plans that are enabling of the above strategies and actions. Studies demonstrating the cost-effectiveness of integrated stepped packages of care embracing a task-shifting approach, and best practices for strengthening mental health literacy and collaborative arrangements with community caregivers and other sectors, can assist this process. Specialist mental health training programmes in LMICs also need to be responsive to the changing demands on service providers, incorporating a public health approach and equipping specialists for diversification of their roles within the task shifting model.
authors.affiliation: School of Psychology, University of KwaZulu-Natal, South Africa. peterseni@ukzn.ac.za
authors.forename: Inge
authors.initials: I
authors.lastname: Petersen
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D008605:Mental Health Services / Q000191:economics*