The British Journal of Psychiatry (2007) 191: 528-535. doi: 10.1192/bjp.bp.107.038463
© 2007 The Royal College of Psychiatrists
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Cost of scaling up mental healthcare in low- and middle-income countries

Dan Chisholm, PhD

Department of Health Systems Financing, World Health Organization, Geneva, Switzerland

Crick Lund, PhD

Department of Psychiatry and Mental Health, University of Cape Town, South Africa

Shekhar Saxena, MD

Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

Correspondence: Dr Dan Chisholm, Department of Health Systems Financing (HSF), World Health Organization, 1211 Geneva, Switzerland. Email: ChisholmD{at}who.int

Declaration of interest None.

Background No systematic attempt has been made to calculate the costs of scaling up mental health services in low- and middle-income countries.

Aims To estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006-2015).

Method A core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low- and middle-income countries were established using the WHO-AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.

Results The cost per capita of providing the core package at target coverage levels (in US dollars) ranged from $1.85 to $2.60 $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18-0.55 per capita.

Conclusions Although significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.


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A response to Cost of scaling up mental health care in low- and middle - income countries
Prof K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), et al.
BJP Online, 25 Apr 2008 [Full text]