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Health Policy and Planning Advance Access originally published online on March 7, 2006
Health Policy and Planning 2006 21(3):157-170; doi:10.1093/heapol/czl003
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© The Author 2006. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.

Economic barriers to better mental health practice and policy

Martin Knapp1,2, Michelle Funk3, Claire Curran1, Martin Prince4, Margaret Grigg5 and David McDaid1,6

1Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, UK, 2Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London, UK, 3Mental Health Policy and Service Development, World Health Organization, Geneva, Switzerland, 4International Mental Health, Division of Psychological Medicine, Institute of Psychiatry, King's College London, UK, 5Mental Health Department of Human Services, Victoria, Australia (formerly Mental Health Policy and Service Development, World Health Organization, Geneva) and 6European Observatory on Health Systems and Policies, London School of Economics and Political Science, UK

Correspondence: Martin Knapp, LSE Health & Social Care, London School of Economics, Houghton Street, London, WC2A 2AE, UK. Tel: +44 (0)20–7955–6225. E-mail: M.Knapp{at}lse.ac.uk.

Mental health systems in many countries are seriously under-developed, yet mental health problems not only have huge consequences for quality of life, but – particularly in low- and middle-income countries – contribute to continued economic burden and reinforce poverty. This paper discusses economic barriers to improving the availability, accessibility, efficiency and equity of mental health care in low- and middle-income countries. Six sets of barriers are identified: an information barrier, resource insufficiency, resource distribution, resource inappropriateness, resource inflexibility and resource timing. Overcoming these barriers will be a major task, although there is no shortage of suggestions for action. The paper discusses broadening the evidence base, improving mental health literacy, tackling stigma, improving financing mechanisms, prioritizing and protecting mental health care budgets, emphasizing mental health promotion through the development of resilience, exploring routes to improved equity, experimenting with new arrangements for purchasing and delivering services, improving coordination between agencies and professionals at both macro- and micro-levels, building alliances between public and private sectors, and training and mobilizing primary care services to improve identification and treatment of mental health problems.

Key Words: mental health, low-income countries, barriers to effectiveness, economics


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