Vol 378 November 5, 2011
2011; 378: 1654–63
October 17, 2011DOI:10.1016/S0140-6736(11)61093-3See
1441 and 1534See
DOI:10.1016/S0140-6736(11)61270-1This is the ﬁfth in a
of six papers about globalmental health*Contributed equally to thisreport
Centre for International MentalHealth, Melbourne School of Population Health, Universityof Melbourne, Melbourne, VIC,Australia
(R Kakuma PhD,H Minas FRANCZP)
; Centre forAddiction and Mental Health,and University of Toronto,Toronto, ON, Canada
; London School of Hygiene and Tropical Medicine,London, UK
(N van Ginneken MRCGP)
;Department of HumanResources for Health
(Prof M R Dal Poz PhD)
Department of Mental Healthand Substance Abuse
(J E Morris PhD, S Saxena MD)
,World Health Organization,Geneva, Switzerland; Ministryof Health and Family Welfare,Government of India, NirmanBhawan, New Delhi, India
(K Desiraju MA)
; and Universityof California at Berkeley, Schoolof Public Health, Berkeley, CA,USA
(Prof R M Scheﬄ er PhD)Correspondence to:Dr Ritsuko Kakuma, Level 5,207 Bouverie St, Carlton,VIC 3053, Australia
Global Mental Health 5Human resources for mental health care: current situationand strategies for action
Ritsuko Kakuma, Harry Minas, Nadja van Ginneken, Mario R Dal Poz, Keshav Desiraju, Jodi E Morris, Shekhar Saxena*, Richard M Scheﬄ er*
A challenge faced by many countries is to provide adequate human resources for delivery of essential mental healthinterventions. The overwhelming worldwide shortage of human resources for mental health, particularly inlow-income and middle-income countries, is well established. Here, we review the current state of human resourcesfor mental health, needs, and strategies for action. At present, human resources for mental health in countries of lowand middle income show a serious shortfall that is likely to grow unless eﬀective steps are taken. Evidence suggeststhat mental health care can be delivered eﬀectively in primary health-care settings, through community-basedprogrammes and task-shifting approaches. Non-specialist health professionals, lay workers, aﬀected individuals, andcaregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose,treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs,human resources management, and leadership for mental health, particularly within the context of low-income andmiddle-income countries.
“At the heart of each and every health system, theworkforce is central to advancing health”
World Health Report 2006
focused global attentionon the shortage of health workers. Many countries of low and middle income face a health workforce crisis,and the scarcity of human resources and training issimilarly overwhelming for mental health.
Practicalguidelines to assist policy makers, health planners, andeducators to address shortfalls in human resources formental health are available;
eﬀorts are increasing tofocus on this issue; and evidence from countries of low and middle income is emerging that will havemany implications for policy on human resources formental health.The mental health workforce described in this reportincludes three groups of individuals. The ﬁrst is composedof specialist workers, such as psychiatrists, neurologists,psychiatric nurses, psychologists, mental health socialworkers, and occupational therapists. The second group isformed of non-specialist health workers, such as doctors,nurses and lay health workers, aﬀected individuals, andcaregivers. In the third group, other professionals areincluded, such as teachers and community-level workers.Here, we discuss the current status and needs of human resources for mental health. We also reviewavailable evidence about actions and strategies tostrengthen human resources for mental health in low-income and middle-income countries, with the objectiveto inform development of policies in this area.
Identiﬁcation of data sources
Evidence of the current status of human resourcesfor mental health was obtained from WHO’s 2011
Mental Health Atlas
WHO has been gathering data onmental health resources approximately every 5 yearssince 2000 from almost all countries of the world.
The latest data were published in 2011 and wereobtained with a questionnaire containing standarddeﬁnitions for all variables, from 183 countries covering99·3% of the world’s population.
Median change scoreswere calculated to assess the alteration in the numberof psychiatrists per 100 000 population from
Information on estimated need andshortages of psychiatrists, psychosocial care providers,
• Human resources for mental health are inadequate inmost countries of low and middle income and are likely toworsen unless substantial investments are made andeﬀective strategies are implemented• Mental health care can be delivered eﬀectively in primarycare settings, through community-based programmesand task shifting approaches that engage and supportskilled non-specialist health professionals, lay workers,aﬀected individuals, and caregivers in mental healthservice delivery• Mental health specialists should, and will, continue tohave essential roles in delivery of services and in training,supervision, and mentoring of non-specialist workers• The speciﬁc composition of the mental health workforceshould be expected to vary across countries, according todiﬀering population needs, mental health service deliverysystems, and resources• Eﬀective leadership and management of human resourcesfor mental health will be essential to address keychallenges such as mobilisation of ﬁnancial resources,recruitment, and retention, and equitable distribution of the workforce