News FocusMental Health Care

Who Needs Psychiatrists?

Science  16 Mar 2012:
Vol. 335, Issue 6074, pp. 1294-1298
DOI: 10.1126/science.335.6074.1294

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Summary

Fewer than a quarter of the people with severe mental illness in low- and middle-income countries receive any treatment, according to the World Health Organization. Psychiatrists are scarce and often concentrated in overcrowded urban hospitals, where human-rights abuses are all too common. Now, thanks to efforts started in the wake of the devastating 2004 earthquake and tsunami, provincial health authorities in Indonesia, aided by foreign advisers, are creating a community mental health program that shifts much of the work traditionally done by psychiatrists to general practitioners, nurses, and even village volunteers. The results of the few studies of whether nonpsychiatrists can provide adequate psychiatric care are encouraging, but scaling up to the real world is no small challenge. If these projects succeed, they could be a model for other developing countries, where mental illness is an enormous, if largely underappreciated, cause of disability and financial hardship.