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Where it really counts – Mental health implementation in LMICs

Thu. 02. May 2019 14:30

There is a big difference between the mental healthcare systems in Low- and Middle-Income Countries (LMICs) compared to high-income countries. Therefore the IMA consortium finds it highly interesting to have two LMICs in our consortium and part of the trial. For this blog post, we wanted to find out if and how IMA has made an impact in these countries, so we asked our partners in Albania and Kosovo.

In LMICs, the mental healthcare system often poses a bigger challenge than a help for those in need of its services. However, in Albania and Kosovo, reformations are put in motion and change is happening. In Albania, the mental healthcare system is moving from being highly centralised and providing symptom-focused, biological treatment to decentralisation and deinstitutionalisation, where the patients receive psychotherapy as well as support. In Kosovo, the mental healthcare system is also in the process of decentralisation and now counts one psychiatric clinic, four hospital wards, and seven community-based mental health centres across the country. However, none of these are located outside the larger cities. Despite the budget (based on GDP) in these countries being nearly half the size of that in other EU countries, the mental healthcare system receives great support from the policy makers.

Our two partners from Albania and Kosovo were introduced to us by the London School of Hygiene and Tropical Medicine, who “joined IMA with the hope of introducing and implementing a new way of providing therapy for depression on the newly established mental health community teams in Albania and Kosova. We stepped in, knowing that we would be facing many challenges in terms of institutional resistance and mental health stigma, but also being prepared to encounter unknown difficulties, since information and evidence-based data from these countries is quite limited. We ultimately aimed to narrow the treatment gap for people suffering from depression in Albania and Kosova. If we could increase awareness about the condition, tackle stigma and treat just one more patient that would otherwise go untreated, we would have made a great achievement,” says Arlinda from the London School of Hygiene and Tropical Medicine. 

Especially the notion of challenges in terms of mental health stigma is mentioned by the two partners, when asked why they decided to join our team in IMA. Gentiana from Tirana Community Centre for Health and Wellbeing says, “Mental health in Albania continues to be an important, but overlooked health issue. Albania joined the IMA project in order to contribute to the improvement of depression treatment, increased access, and lowering of stigma through the use of innovative methods,” and in Kosovo, Naim from the Mental Health Centre MCHPriz in Kosovo reasons that “The major problem with the stigma and other difficulties in providing mental health in Kosovo, such as staff shortages, especially psychologists and psychotherapists, makes it necessary to explore other options to increase people's access to depression in getting the most needed services for them.” 

Even though it is still quite early to detect any influence IMA might have had on the national mental healthcare systems in the two countries, several factors are repeated when asking our partners this question. They include an attitude shift; awareness of the importance of psychologists; sparked curiosity within the field from clinicians, policy makers, and researchers; and an increase in the number of people who seek help within the mental healthcare system. 

The project still has almost two years left before its conclusion, thus the impact of IMA in these two LMICs has potential to grow. In the future, Gentiana from Albania hopes “that the IMA project will have an impact on raising the issue of mental health at the attention of the public and policy makers. Demonstrating the use of innovative, effective, and evidence-based methods for treating depression will impose the necessity for scaling up these models throughout Albania,” and in Kosovo, Naim explains his hopes for the future, “IMA can manage to get into the list of services offered by the Mental Health Centres in Kosovo even after the completion of the project. Also, experience from implementation and its application can serve as a basis for the further development of eHealth approaches.” We in IMA hope that all of these hopes and predictions will come true and continue even after the project has run its course, but only time will tell. To find out more about the mental healthcare systems in Albania and Kosovo, check out their Prezi from our midterm workshop last year. 

How do you think a project like IMA could affect the mental healthcare system in your country? Please write a comment below to let us know!