title: Improving access to psychological treatments: lessons from developing countries.
abstract: Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed.
authors.affiliation: Department of Nutrition and Public Health Intervention Research, London School of Hygiene and Tropical Medicine, UK. vikram.patel@lshtm.ac.uk
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.forename: Neerja
authors.initials: N
authors.lastname: Chowdhary
authors.forename: Atif
authors.initials: A
authors.lastname: Rahman
authors.forename: Helen
authors.initials: H
authors.lastname: Verdeli
mesh_terms: D003150:Community Health Workers / Q000600:supply & distribution; D003431:Cross-Cultural Comparison; D019049:Developed Countries / Q000191:economics*; D006295:Health Resources / Q000191:economics* / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008605:Mental Health Services; D011203:Poverty; D012424:Rural Population; D000078329:Workforce