Responsible Governance for Mental Health Research in Low Resource Countries

Between 13% and 49% of the world’s population develop neuropsychiatric disorders at some point in their life [1]. More and more evidence indicates that mental disorders and problems are common in all countries studied [2–4], and supports earlier projections that the burden of mental health problems is increasing in lowand middle-income countries (LMICs) as well [5]. Most people with these disabling conditions now live in LMICs, but at most one in five receives treatment and care [6–8]. In order to narrow this gap, the World Health Organization (WHO) launched the Mental Health GAP Action Programme (mhGAP) [9] with the objective of scaling up services for priority mental disorders using evidence-based interventions. In 2009, evidence profiles were compiled based on a systematic review of the literature for interventions that were to form part of the mhGAP Intervention Guide (mhGAPIG) [10,11]. These recent initiatives have once again shown that mental health research resources are sparse and unevenly distributed within LMICs, and that most research and publications originate from just 10% of this group of countries [12,13]. Lack of good mental health research governance seems to be an important reason for the lack of mental health research from LMICs. In this article, we identify the challenges facing sound research governance in LMICs and provide suggestions regarding how research should be governed in this context, including suggestions for a way forward. Challenges Facing Good Governance Lack of an Organizational Structure for National Mental Health Research Governance As is true for health research in general, the availability and strength of organizational structures that can lead and coordinate mental health research are limited and varied across LMICs. Most of the mental health research in LMICs is restricted to few larger countries (e.g., Argentina, Brazil, China, India, the Republic of Korea, and South Africa), and in three-quarters of mental health research, policy makers were not involved in planning or conducting the research [14]. The presence of mental health professionals in LMICs does not automatically translate to an effective ‘‘system’’ that governs mental health research. Universities in most LMICs do not have a strong link with the health system and psychiatrists do not receive much public health training [15]. Mental health research frequently does not follow health system needs [12].