Global mental health perspectives on rural and remote mental health provision

Low- and middle-income countries (LMICs) are home to the vast majority of the world’s population. These countries tend to lack adequate resources to meet the mental health needs of their populations. The limited infrastructure for supporting mental health in LMIC tends to be concentrated in urban areas, with remote and rural areas fairing much worse. Particular challenges relate to a lack of highly skilled practitioners to deliver support. Drawing on insights from Global Mental Health, the chapter reflects on innovative and pragmatic strategies that can help to bolster mental health provision in remote and rural parts of LMICs. These include “task-sharing” initiatives which aim to train nonspecialist workers to assume responsibilities which have historically been undertaken by highly skilled practitioners. Issues relating to the training and supervision of nonspecialists are flagged as being central to the success of these initiatives. The chapter highlights the importance of attending to the social and cultural context in which people live their lives. Incorporating local language terms and local explanatory models for distress into interventions is presented as key to maximizing engagement with local communities. Case studies from Uganda and Bangladesh are used to illustrate key points. International collaborations are highlighted as an important vehicle for building capacity for remote and rural mental health provision in LMICs. However, such collaborations will necessitate attention to be allocated to how dynamics of power operate at the meeting space between different epistemologies and the risk that local ways of understanding could be subjugated in such collaborations. While acknowledging the importance of directly addressing distress experienced by people living in remote and rural areas of LMIC, the chapter also recognizes that resilience factors can serve to mitigate against the impact of adversity on these communities. Consideration is given to the importance of harnessing collective strengths, so that “community” can serve as a resource to promote mental health and well-being.