Evidence-Based Mental Health Assessment and Care in Low- and Middle-Income Countries: A Promising Campaign.

Dissemination of evidence-based mental health care is a significant problem in the United States and other developed countries. Despite costly endeavors to develop and empirically validate psychosocial interventions, access to quality, data-supported treatment remains limited. Many patients fail to access evidence-based psychological care because of barriers including distance, cost, and a limited number of trained providers. Notably, non-evidence-based care continues to dominate mental health arenas and many providers continue to rely on non- empirically based techniques. Unfortunately, the onus of obtaining evidence-based treatment often falls upon the consumer who must investigate and seek out the best course of care. Notably, the current limited state of access is in spite of hundreds of millions of dollars in government- and private foundation-funded efforts to close the gap between research and practice. A sizable literature documents challenges and efforts to overcome the research-practice gap-which remains a significant problem in countries with advanced infrastructure, such as the United States. This gap will not be the focus of the present issue. Rather, the present issue addresses the seemingly insurmountable challenge of characterizing mental health problems and introducing and testing evidence-based psychosocial treatments in low- and middle-income countries. Remarkably in regions around the globe, where civil unrest is rampant while clean water, roads, and health care are lacking, encouraging efforts directed at evidence-based evaluation and intervention are materializing. The present issue focuses on groundbreaking international endeavors in these emerging areas.According to the World Health Organization (2008), mental illness contributes to at least 14% of the world's global disease burden. Not surprisingly, both mental health research and evidence-based services are lacking in developing countries. Research emphasis is not commensurate with the staggering extent and impact of this pandemic. Patel and Sumathipala (2001) reported on international representation in psychiatric journals: Only 6% of mental health literature was published on regions accounting for more than 90% of the world's population (with less than 1% describing interventions in developing countries). Evidence-based services and practice guidelines are similarly lacking. The treatment gap in developing countries exceeds 75%, that is, the large majority of the population receives no care at all (Dua et al., 2011). Political and economic unsteadiness, limited human resources, and generally low fiscal investment contribute to disparaging availability of mental health services within low- and middle-income countries (Breuer et al., 2014; Kakuma et al., 2011; Lund, Petersen, Kleintjes, & Bhana, 2012; Saraceno et al., 2007). Furthermore, mental health services and research must compete with other public health priorities (e.g., HIV/AIDS, diabetes; Lund et al., 2012).Although there are trends suggesting that the disparity in mental health services and research among low- and middle-income regions is gradually improving, only a small minority of individuals with mental illness receive services (Thornicroft, 2012). Unfortunately, even when treatment is available, interventions are often of substandard quality and without evidence basis (Dua et al., 2011). Notably, despite these considerable obstacles, prodigious efforts are emerging. For example, a strong line of research suggests the feasibility and efficacy of implementing mental health treatments in nontraditional settings/formats (e.g., primary care; Patel et al., 2003), training and supervising nonspecialized workers to maximize the scant availability of experts in mental health care (Kakuma et al., 2011; van Ginneken et al., 2013).This special issue presents seven review and empirical articles addressing the aspirational goals of improving research and dissemination of evidence-based mental health care to low- and middle-income countries. …