Mental care difficulties on the agenda

"In many countries such as India, they have community health workers who can expand the manpower of physicians," he says. "In some areas, the NGOs act to provide effective social support to serious mentally ill patients," referring to non-governmental organizations.

Doctors in rural areas already have their hands full, he says, with little time or necessary training to focus on mental health.

"We need to rethink the model and see if we can get some services (in rural locations) provided by non-medical professionals."

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Phillips says the recruiting of social workers could range from high school graduates to early-retired people, either working voluntarily or being paid nominal salaries.

Shekhar Saxena, director of the Department of Mental Health and Substance Abuse at WHO, echoed this idea.

"Mental healthcare doesn't require a lot of money. It doesn't require high-cost machines. It requires innovative thinking, good policies and people who can be trained to deliver mental healthcare," said Saxena at the World Innovation Summit for Health (WISH) in Doha last December.

He added that WHO's new action plan signed in May of last year by 194 ministers of health, which recognizes mental health as a public health priority, is the milestone for global mental healthcare work.

WHO's Comprehensive Mental Health Action Plan 2013-2020 calls for comprehensive, integrated and responsive mental health and social care services in community-based settings.

According to a report published by WISH, there is a universal problem existing in many countries where mental healthcare resources are largely being used by big institutions that distance the patients from their communities.

In China's case, the Ministry of Health has intended to bring mental healthcare to community clinics for decades, but there are many practical obstacles, Phillips says.

First, psychiatry hospitals certainly will not take lightly a cut in their spending for the money to go to communities. In addition, adding psychiatric wards onto general hospitals has proved very difficult to be accepted by both the public and doctors working there.

Second, under China's current healthcare system, urban people seldom go to community clinics. In rural areas, people are willing to go, but it is tough to get proper diagnosis or treatment in the local clinics.

"The government wants to put three targets into the community clinics: hypertension, diabetes, and mental illness. So mental illness is on the agenda," says Phillips. "But changing peoples' care-seeking patterns is a very complicated issue."

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