title: Rethinking the service delivery system of psychological interventions in low and middle income countries.
abstract: Global mental health is a growing field intricately connected to broader health, violence and economic issues. Despite the high prevalence and cost of mental health disorders, an estimated 75 % of those with need in lower resource settings do not receive intervention. Most studies to date have examined the effectiveness of single-disorder mental health treatments - an approach that may be a significant challenge to scale-up and sustainability in lower resource settings.
  
  
  
  This paper presents a brief overview of the scientific progress in global mental health, and suggests consideration of an internal stepped care delivery approach. An internal stepped care model is one idea of a delivery system, utilizing a common elements approach, where the same provider could navigate between different elements based on severity and type of problems of the client. It is distinct from traditional stepped care models in that clients remain with the same provider, rather than relying on referral systems.
  
  
  
  An internal stepped care delivery system based on a simplified common elements approach could be more efficient, scalable, sustainable, and reduce the loss of clients to referrals in lower resource settings.
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Baltimore, MD, 21205, USA. lmurra15@jhu.edu.
authors.forename: L K
authors.initials: LK
authors.lastname: Murray
authors.affiliation: Center for Global Mental Health; Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, London, UK.|Research and Development Department, War Child Holland, 61G, 1098 Amsterdam, Amsterdam, Netherlands.
authors.forename: M J D
authors.initials: MJ
authors.lastname: Jordans
mesh_terms: D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods / Q000639:trends; D014943:Global Health; D006801:Humans; D007182:Income / Q000639:trends; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008603:Mental Health / Q000191:economics* / Q000639:trends; D008605:Mental Health Services / Q000191:economics* / Q000639:trends; D011203:Poverty / Q000191:economics* / Q000639:trends
keywords: Common elements approach; Global mental health; Health systems; Implementation science; Low resource settings