title: Mapping actions to improve access to medicines for mental disorders in low and middle income countries.
abstract: In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013-2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use.
  
  
  
  Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines.
  
  
  
  A 4 × 4 framework mapping actions as a function of the four components of access - selection, availability, affordability and appropriate use - and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines.
  
  
  
  Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.
authors.affiliation: Department of Neuroscience,Biomedicine and Movement Sciences,Section of Psychiatry,WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation,University of Verona,Italy.
authors.forename: C
authors.initials: C
authors.lastname: Barbui
authors.affiliation: Department of Mental Health and Substance Abuse,World health Organization,Geneva,Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Dua
authors.affiliation: Massachusetts General Hospital,McLean Psychiatry Residency,Harvard Medical School,Boston,USA.
authors.forename: K
authors.initials: K
authors.lastname: Kolappa
authors.affiliation: Lisbon Institute of Global Mental Health,Nova University of Lisbon,Portugal.
authors.forename: B
authors.initials: B
authors.lastname: Saraceno
authors.affiliation: Department of Mental Health and Substance Abuse,World health Organization,Geneva,Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Saxena
mesh_terms: D003906:Developing Countries / Q000191:economics; D018954:Drugs, Essential / Q000600:supply & distribution*; D017408:Guidelines as Topic; D006297:Health Services Accessibility / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy; D008605:Mental Health Services; D011619:Psychotropic Drugs / Q000600:supply & distribution* / Q000627:therapeutic use*; D014944:World Health Organization
chemical_list: D018954:Drugs, Essential; D011619:Psychotropic Drugs
keywords: access; guidelines; low and middle income countries; medicines; mental disorders