Many of the social determinants of mental health cut across a range of sectors, such as labour and employment, commerce and economics, education, housing, other social welfare services, and the criminal justice system. Mental health inputs are thus necessary in many departments to ensure that policies improve the mental health of the population and do not have the opposite effect.
For example, mental health input in the criminal justice system can prevent the inappropriate imprisonment of people with mental disorders, make treatment for mental disorders available in prisons, and reduce the mental health sequel of imprisonment for prisoners and their families (WHO, 2001b), (e. g. the AUDIT questionnaire) disorders are a more accurate way of monitoring community mental health because o low recognition rates for these disorders among health workers.
The WHO is trying to bridge this information gap, at least in part, through the development of a set of indicators to monitor mental health systems and services at the country level (S. Saxena, personal communication). The implementation of these indicators could lead to substantial gains in the current status of mental health information.
Countries could be able to monitor progress in the implementation of their reform policies, provision of community services and activities, and the involvement of the communities, consumers’ and families’ associations, and other governmental sectors in mental health promotion, prevention, care, and rehabilitation. Countries would that reach a clearer and more comprehensive picture of the main mental health issues and be able to asses improvement over time.
Furthermore, at the country level, indicators may prompt governments and health systems managers to build a data infrastructure, implement information systems, and foster the use of surveys of mental disorders. Research is necessary to generate the necessary evidence for guiding an appropriate response by policy makers and practitioners to the large unmet needs of care for mental illnesses, particularly in developing countries.
The need for psychiatric research to reflect the diverse realities of health systems and cultural factors is crucial if research is to inform local health policy and practice. As with most areas of health, the contribution of developing countries to mental health research is very low. Surveys of high-impact journals typically show that less show that less than 10% of published research originates from developing countries, and the vast majority of journals published in developing countries are non-indexed, limiting their impact (cited Patel & Sumathipala, 2001).
A major factor that is impending the use of more appropriate interventions or a greater prominence to mental illness in policy is the lack of evidence about treatments and the tendency for research to be focused on psychiatrics and psychiatric contexts. Arguably, if there was evidence that treatments were efficacious and cost-effective and that they were clearly linked to other community health problems, then they would be more widely adopted by health workers and health policy makers. It is clearly the time, then, to move from surveys demonstrating prevalence to research.
Future psychiatric research in developing countries needs to be more action oriented, in the form of actual intervention trials or studies with the explicit goal of influencing the integration of mental health care in existing community health services and public health priorities. The research must be sensitive to local needs and involve active participation from potential users of the findings. In selecting settings for intervention research, a variety of health systems should be considered to ensure that findings can be generalized to many regions of the world (Merson, Black & Mills, 2006).