Mental Health System Issues and Challenges
Context	System elements	Outcomes
• 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
	• Poorly organized and marginalized consumers, carers, civil society