Author reply to: Evaluation of the WHO Assessment Instrument for Mental Health Systems

We appreciate the letter by Saxena et al.¹ as well as the extensive contribution they have made to global mental health. With regard to the methodology of our evaluation, we briefly described each domain and, for the purpose of cross-cultural comparison, demonstrated how the WHO-AIMS (Assessment Instrument for Mental Health Systems) may be applied to very different societies: Iraq, Japan, the Philippines, and The former Yugoslav Republic of Macedonia.² Each item of WHO-AIMS has been well described.³ While the WHO-AIMS is both comprehensive and user-friendly, mental health policy-makers and researchers should be aware that there is no item to assess the social histories, cultural nuances and political processes that often shape mental health policy.

We agree that WHO-AIMS achieves its goals of providing a framework for assessing mental health systems. However, as with any assessment instrument, it has its limitations. Social and cultural variables are very difficult to measure and are perhaps beyond the scope of the WHO-AIMS. Nevertheless, mental health policy-makers should be aware of the ways these variables inform health policy, as we, and others, have demonstrated. ■