and has put mental health on the policy agenda (WHO, 2008b). Many countries have developed or revised their policies, programs, and legislation related to these disorders. Despite this, as will be discussed in further detail, the treatment gap is tremendous and the resources provided to tackle the huge combined burden of MNS disorders, not just mental health, are insufficient. The “rich” countries such as the United States and England have roughly 200 times more psychiatrists than most countries in Africa. This ratio is even worse when looking at the enrollment of the medical professionals such as psychiatric nurses and clinical psychologists. To add to these challenges, within each country mental health professionals are concentrated in urban areas, where a minority of the population lives. In addition, health professionals are increasingly working in the private sector, resulting in decreased access for a significant proportion of the populations.

Many neurological disorders remain undiagnosed because of the limited diagnostic facilities at health centers, which is even worse in the rural places where the majority of the patients reside. Often much-needed drugs are in short supply or are too expensive to purchase. In the end, the patients and their families prefer to stay at home or revert to readily available and accessible remedies within their communities. For many in sub-Saharan Africa, this means relying on traditional healers for health care. These providers are more accessible than mental, neurological, or substance use disorder specialists, and they frequently provide continuity of care and social support for patients. An estimated 60–80 percent of individuals with mental disorders in developing countries first seek care through traditional healers (Abbo et al., 2008). Despite the widespread use of traditional healers in sub-Saharan Africa, there is no standard of care and there is little evidence from which to assess its effectiveness. As a result, there is an ongoing debate about whether traditional healers should be recognized as part of the healthcare delivery system, and, if so, how they could be more formally integrated into the healthcare delivery system.

Other solutions to the human resource shortfalls are also being addressed. One suggestion is to use “task shifting,” which transfers a range of medical tasks, where appropriate, from more expensive and specialized medical workers to people with shorter training and therefore a much lower cost in the health system. Many workshop participants believe this approach makes more efficient use of the human resources that are available in the health system and is one way of closing the mental health treatment gap. However, without the political will of governments and the support of international donor communities, adequate resources



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