SUMMARY | FULL STORY
SOCIAL MEDICINE
Considering What Works: Book Documents
Mental Health Care Successes in Poor Nations
There is a growing awareness that mental health has been given short shrift in health budgets and priorities internationally and that mental disorders put an undue burden on individuals and families when untreated. But in developing countries with few resources to devote to specialized mental health services, it is unclear what kinds of programs would be most effective in delivering care. A new book from the Department of Social Medicine at HMS begins to answer this question by documenting a series of case studies of mental and social health programs that have succeeded in relatively resource-poor areas.
Alex Cohen and colleagues are moving beyond the identification of mental illness to finding models for care and prevention that work in low-income countries. (Photo by Pam Murray)
"We decided that really what was needed was a book that looked at why programs work," said Arthur Kleinman, the Maude and Lillian Presley professor of medical anthropology and professor of psychiatry at HMS. Kleinman and co-editors Alex Cohen, HMS instructor in social medicine, and Benedetto Saraceno, director of the Department of Mental Health and Substance Dependence at the World Health Organization, developed the
World Mental Health Casebook to begin the process of documenting and evaluating programs that seem to have succeeded in making improvements in mental health in the context of few resources.
Kleinman, for example, was part of a team that evaluated the Shanghai model of rehabilitation for schizophrenic patients in China. This widely regarded system for delivering treatment and ongoing support to patients includes a guardianship network of volunteers who act as case managers for patients. Cohen examined several literacy programs for poor women in Northern India. Although a case study on a literacy program may seem out of place in a book on mental health, Cohen said: "We should also look at social interventions as integral components of mental health programs."
In another program, Partners in Health was able to enhance the adherence and well-being of patients with multidrug-resistant tuberculosis in Peru through group psychotherapy sessions. Ideally, these cases can be used as models for similar programs around the world.
--Courtney Humphries
Copyright 2002 by the President and Fellows of Harvard College
