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Year : 2014  |  Volume : 12  |  Issue : 4  |  Page : 15-20

Rethinking mental health care: bridging the credibility gap

Professor of International Mental Health and Wellcome Trust Senior Research Fellow in Clinical Science, the London School of Hygiene & Tropical Medicine, London, UK, and the Public Health Foundation of India and Sangath, India., India

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Innovations in global mental health have focused on addressing the ‘supply side’ barriers to reduce the treatment gap and, in doing so, have redefined three core assumptions regarding mental health care, namely, what comprises a mental health care intervention, who is a mental health care provider and what is a mental health care setting. However, such innovations alone will not reduce the treatment gap because of the gap between the understanding of mental disorder that mental health specialists use, best illustrated through the diagnostic systems and the epidemiological instruments arising from them, and how the rest of the world conceptualises psychological suffering. It is this ‘credibility’ gap that needs to be bridged in three key ways: first, to distinguish mental disorders that could benefit from biomedical interventions from milder distress states; to offer interventions for distress states mainly through low intensity psychosocial interventions delivered outside the formal health care system; and to base the descriptions of diagnostic categories on the patterns of phenomena observed in general populations, rather than those observed in specialist settings.

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