Global Priorities and Possibilities

The high prevalence of poor mental health at later ages is a central challenge for all countries; however, it is a greater challenge for low- and middle-income countries (LMICs). Recognizing this challenge, WHO and other organizations have launched several global initiatives to address disparities in access to mental health clinical specialists in LMICs. Greater educational efforts are needed to ensure proper identification of late-life depression and reduce stigma and discrimination associated with mental illness. Efforts should be invested in developing more accurate and brief diagnostic tools. The shortage of mental health specialists requires task sharing using non-clinicians to triage symptoms and therapies and support adherence to pharmacotherapy. Diagnosis and treatment of depressive disorders in primary care settings in LMICs is feasible, cost-effective, and likely to reduce ‘spillover’ morbidity (i.e, effect of mental illness on family members). Research on the experience of mental illness and treatment among LMIC populations is required to guide these efforts.