• Little understanding of mental health as an important public health and social and economic development issue |
• Inadequate infrastructure, facilities, equipment, drug distribution systems |
• Narrow population coverage: wide “treatment gap” |
• Little understanding that effective and affordable interventions and service models are available |
• Shortage of skilled mental health workers |
• Very wide gap between best (usually in major urban centers) and worst (usually in poor rural areas) mental health services |
• Mental health is a low political and social priority |
• Geographic maldistribution of available workforce |
• Low and inequitable access (geographic, economic, linguistic, cultural) to mental health services |
• Weak investment |
• Disciplinary imbalance: dominated by physicians and nurses |
• Stigma, discrimination, social and economic exclusion |
• Weak drive for mental health system reform and development |
• Hospital centered |
• Mental health training is unattractive for most disciplines |
• Low levels of skill in policy development and implementation |
• Undeveloped information systems, with lack of high-quality local information to support planning |
• Inadequate protection of rights, with widespread human rights abuses |
• Weak governance and management arrangements |
• Poorly developed mental health systems research capacity |
• Lack of locally relevant evidence for policy and practice |
• Low population “mental health literacy” |
• No culture of evaluation or continuous quality improvement |
• Poorly developed advocacy by civil society and groups |
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• Poorly organized and marginalized consumers, carers, civil society |
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