Learning from low income countries: mental health.

Thirty one per cent of all years lived with disability are due to mental illness. Mental health problems are important in every country, even those with high burdens of illness due to infectious diseases. Wealthy countries generally have more services to combat mental health problems than low income countries. In many low income countries there is typically one psychiatrist per population of 1 000 000, with little or no multidisciplinary team and few regular drugs. Given this mismatch, it is easy to conclude that there is little that psychiatry in developed countries can learn from poorer countries, but this is not the case. Services in low income countries are often greatly under-resourced, under strain, and leave most people with mental health problems with no care. But there are examples of different ways to treat or prevent mental illness from which high income countries can learn. Some are born from the ingenuity of necessity, others from cultural knowledge. We do not aim to idealise low income countries, to demonise high technology and psychiatric care, or to offer the stereotype of cohesive traditional communities as a panacea, which could undermine the development of appropriate services. We simply present examples that challenge the orthodox, make us pause to think, and offer rational models for provision of care that high income countries may consider useful.