Presented at ACBS World Conference 13, Berlin, Germany, 2015
Empirically-supported psychological treatments (EPT) are amongst the most effective of mental healthcare interventions but are not accessible in most countries and populations, especially to low income populations and in low-and middle income countries. This is, in part, due to the very nature of the process of development of EPT which typically begins in highly specialized academic centres, are trialled on patients who are attending mental health clinics (and thus already have a ‘psychological’ explanatory model) mostly drawn from a narrow socio-cultural group, and relies on specialized, but scarce and expensive, mental health professionals for delivery. Not surprisingly, disseminating these treatments in the ‘real-world’ of communities and non-specialized healthcare settings, with their diverse populations, many of whom use explanatory models distinct from those of mental health practitioners, and F R I D A Y 59 *=Peer Reviewed ACT Trainer relying on non-specialist health workers for delivery, poses formidable challenges. This presentation will draw on the experiences of studies carried out by innovators in low resource settings in developing countries, including PREMIUM, a ‘Program for Effective Mental Health Interventions in Under-resourced Health Systems’ led by the author in India. The goal of these innovators is to design a methodology for the development of PTs which are defined by their property of scalability, viz., that they are sensitive to the context of the population in which the PT will be used, and are feasible for delivery by non-specialist health workers, i.e. health workers who do not have any prior training in mental health. Based on these experiences, this presentation will seek to address the following key themes: the barriers to dissemination of EPT; how these barriers have been addressed by global mental health practitioners; the methodology the PREMIUM program which has led to the design of new treatments for severe depression and harmful drinking; and the lessons which inform the key conceptual and methodological principles to engineer psychological treatments for scaling up.
Keywords: Rural, large scale, group, developing nations