Ten Low-Cost Interventions to Provide Mental Health Care in Low- and Middle-Income Countries

 

Mental health challenges are a growing concern in low- and middle-income countries (LMICs), with over 75% of those needing mental health treatment receiving no treatment at all. Limited resources, stigma, and a lack of trained professionals make addressing these issues difficult.

Many LMICs face multiple, overlapping crises, such as war, economic decline, and pandemics – which can exacerbate the mental health of a population. Access to health, including mental health, is a human right. Although more attention is being paid to normalizing mental health care — and promoting quality health services. In 2020, global governments spent on average about 2% of their health budgets on mental health care. However, low-cost psychosocial interventions can offer effective solutions, particularly when tailored to the unique needs and contexts of these regions. Here are 10 strategies that can be implemented, even with a limited budget:

  1. Community-Based Support Groups

Community-based support groups offer a space where individuals can share experiences, learn from each other, and receive emotional support. These groups are often led by trained community members or volunteers who understand the local cultural context, which not only reduces costs and increases accessibility, but promotes locally-led solutions. Support groups can be tailored to specific issues like depression, anxiety, or substance abuse, and they empower communities to take an active role in mental health care.

  1. Task-Shifting to Non-Specialists

Task-shifting involves training non-specialists, such as community health workers, teachers, or lay counselors, to provide basic mental health support. This approach addresses the shortage of mental health professionals in LMICs by expanding the workforce at a low cost. The Friendship Bench is a perfect intervention example developed in Zimbabwe that trains community volunteers, without any prior medical experience to counsel patients for six structured 45-minute sessions. With the proper training and support, non-specialists can deliver psychoeducation and basic counseling, provide Psychological First Aid (PFA), identify signs of gender-based violence, and refer patients to specialized care when necessary.

  1. Psychoeducation Programs

Psychoeducation involves teaching individuals and communities about mental health, symptoms of mental illness, and coping strategies. By raising awareness and reducing stigma, psychoeducation can encourage individuals to seek help earlier, reducing the potential for developing chronic mental health conditions that may require more intensive treatment later. These programs can be delivered through community workshops, radio broadcasts, or text/SMS messaging, making them accessible and affordable as demonstrated by the Tele-MANAS project in India, availing timely mental health resources to rural residents.

  1. Peer Counseling and School-Based Programs

Leveraging the power of shared experience, peer counselors can provide empathetic listening, guidance, and encouragement, making mental health care more relatable and less stigmatized. School-based programs that include mental health education, stress management techniques, and peer support systems offer opportunities for early intervention and can help build resilience in young people. This approach can be implemented with minimal resources by training teachers or using existing educational infrastructure.

  1. Integration of Mental Health into Primary Care

Integrating mental health services into primary care settings is a cost-effective way to reach more people. Primary care providers, including general practitioners, can be trained to recognize and manage common mental health issues, ensuring that mental health care is a part of routine health services. This approach reduces the need for specialized mental health facilities and makes services more accessible. As countries integrate mental health care, they can conduct mapping of services and referral of complex cases for therapeutic support, including medications.

  1. Use Innovative and Not-So-Innovative Technologies

Innovative mobile health (mHealth) technologies, such as apps and SMS-based interventions, can provide mental health support at a low cost. These tools can deliver psychoeducation, mood tracking, and reminders for medication or appointments. In regions with high mobile phone penetration, mHealth offers a scalable solution to bridge gaps in mental health services. Other interventions like having an active suicide hotline in place and conducting national awareness campaigns with relevant stakeholders can also be a crucial part of a national mental health program.

  1. Culturally Adapted Psychotherapy Techniques

A range of non-medical psychotherapy techniques can be adapted for low-resource settings and cultural contexts, including Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Interpersonal Psychotherapy (IPT). Simplified versions of CBT, which is a widely recognized treatment focusing on problem-solving and behavioral activation, can be delivered by non-specialist health workers who have received comprehensive training and supervision or through group sessions. EMDR has been utilized in low-income countries that have experienced conflict, natural disasters, or other traumatic events, such as in Rwanda, Cambodia, and parts of the Middle East to help individuals process trauma from war, genocide, and displacement. IPT is a time-limited, focused, and evidence-based approach to treat mood disorders, which seeks to improve the quality of a client’s interpersonal relationships and social functioning, reducing overall distress.

  1. Psychological First Aid

Psychological First Aid (PFA) is a basic intervention that provides human, supportive, practical, and culturally adapted support after a crisis. With training, PFA can be provided by anyone and consists of helping people to feel safe, heard, and supported.

  1. Art and Music Therapy

Art and music therapy provide alternative ways to express emotions and process trauma, especially in contexts where mental health is stigmatized. These therapies can be conducted in group settings with minimal resources, making them accessible to a wide range of people. Art and music therapy can be particularly beneficial for children and adolescents and has been shown to be effective in post-conflict settings.

  1. Faith-Based and Spiritual Support

In many LMICs, religious and spiritual practices are deeply embedded in daily life and can be leveraged to support mental health. Faith-based counseling, meditation groups, and spiritual retreats can offer solace and guidance to individuals struggling with mental health issues. Collaborating with religious leaders to promote mental health can help reduce stigma and reach a broader audience.

Prioritizing mental health interventions in complex contexts is essential for communities to thrive, and systemic change is possible when policymakers, advocates, and experts work together. By leveraging community resources, integrating mental health into existing structures, training health workers, and utilizing innovative approaches, it is possible to make a meaningful impact on mental health outcomes with very limited resources.

 

Authors: Rawan Hamadeh, MSc is a Program Officer and Mental Health Specialist at Project HOPE, advocating for health equity, health care reform, and community-based mental health initiatives. With a master’s in quality and healthcare management and extensive experience in the humanitarian sector, she is dedicated to empowering vulnerable communities.

Kavitha Nallathambi, MPH MBA, is a public health professional with expertise in policy, partnerships, and communications. She is a participant of WomenLift Health’s 2024 North America Leadership Journey. Previously, she served as Senior Advisor for Policy and Advocacy at Project HOPE, a nongovernmental global health and humanitarian organization.

Competing interest: None

Handling Editor: Neha Faruqui

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