Barriers and Institutional Dynamics in Public Mental Health Across Income Groups
Keywords:
public mental health, income disparities, LMICs, institutional engagement, training quality, implementation barriersAbstract
Public Mental Health (PMH) has increasingly attracted global attention, yet substantial disparities in its implementation persist between high-income countries (HICs) and low- and middle-income countries (LMICs). As the global burden of mental disorders continues to rise, many countries-particularly LMICs-face challenges including limited institutional capacity, workforce shortages, and fragmented policies. This study examines institutional dynamics, barriers, and engagement practices in PMH across income groups, aiming to identify structural strengths and weaknesses that shape organizational contributions. A cross-sectional survey was conducted with 242 respondents from 52 countries, classified according to World Bank income groups. Participants evaluated key PMH components, opportunities, barriers, engagement frequency, and training quality. Statistical analyses included descriptive comparisons, ANOVA, correlation, and linear regression models stratified by income level. While strategic PMH priorities show broad convergence, significant disparities remain in institutional capacity and implementation readiness. Effective PMH reform must therefore be context-sensitive, emphasizing strengthened knowledge systems and networks in LMICs, alongside continued investment in high-quality training infrastructure in HICs. The advancement of global PMH will depend on scalable strategies that address these structural asymmetries.
References
1. K. Wahlbeck, "Public mental health: the time is ripe for translation of evidence into practice," World Psychiatry, vol. 14, no. 1, pp. 36-42, 2015. doi: 10.1002/wps.20178.
2. G. D. Fee, "1 & 2 Timothy, Titus (Understanding the Bible Commentary Series)," Baker Books, 2011.
3. F. Mullan, "The metrics of the physician brain drain," New England journal of medicine, vol. 353, no. 17, pp. 1810-1818, 2005. doi: 10.1056/nejmsa050004.
4. J. Campion, "Public mental health: Evidence, practice and commissioning," Royal Society for Public Health, 2019.
5. W. M. Cohen, and S. Klepper, "A reprise of size and R & D," The Economic Journal, vol. 106, no. 437, pp. 925-951, 1996.
6. W. O. R. L. D. Health Organization, "World mental health report: Transforming mental health for all," World Health Organization, 2022.
7. S. Rathod, N. Pinninti, M. Irfan, P. Gorczynski, P. Rathod, L. Gega, and F. Naeem, "Mental health service provision in low-and middle-income countries," Health services insights, vol. 10, p. 1178632917694350, 2017.
8. R. Veugelers, "Internal R & D expenditures and external technology sourcing," Research policy, vol. 26, no. 3, pp. 303-315, 1997.
9. I. Petersen, C. Lund, and D. J. Stein, "Optimizing mental health services in low-income and middle-income countries," Current opinion in psychiatry, vol. 24, no. 4, pp. 318-323, 2011. doi: 10.1097/yco.0b013e3283477afb.
10. L. Belkhir, and A. Elmeligi, "Assessing ICT global emissions footprint: Trends to 2040 & recommendations," Journal of cleaner production, vol. 177, pp. 448-463, 2018.
11. K. S. Jacob, "Repackaging mental health programs in low-and middle-income countries," Indian Journal of Psychiatry, vol. 53, no. 3, pp. 195-198, 2011.
12. J. I. Mechanick, C. Apovian, S. Brethauer, W. T. Garvey, A. M. Joffe, J. Kim, and C. D. Still, "Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures-2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists," Surgery for Obesity and Related Diseases, vol. 16, no. 2, pp. 175-247, 2020.
13. J. Campion, A. Javed, M. Vaishnav, and M. Marmot, "Public mental health and associated opportunities," Indian journal of psychiatry, vol. 62, no. 1, pp. 3-6, 2020.
