Improving access to psychological treatments: Lessons from developing countries

Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed. ⺠Three trials in developing countries addressed barriers to improving access to psychological treatments for depression. ⺠The barrier of human resources was addressed by using lay health workers. ⺠A systematic process of adaptation was followed to ensure contextual appropriateness. ⺠Other barriers such as low recognition, low adherence and stigma were also addressed. ⺠The resulting interventions showed significant benefits when compared with usual care.