Key challenges in the dissemination and implementation of guidelines for mental health and psychosocial support interventions in low- and middle-income countries

© 2016 Nova Science Publishers, Inc.The burden of mental health and psychosocial problems is especially acute amongst populations in low- and middle-income countries (LMIC) and those affected by humanitarian emergencies. Over the past ten years, the field of global mental health has shifted from a primary focus on psychiatric epidemiology and intervention impact evaluation to one concentrated on identifying and disseminating effective mechanisms for implementing mental health programs in LMIC. This movement has included a substantial effort by international organizations to develop guidelines for the treatment and management of mental health and psychosocial problems. These guidelines have been established with current best practices based on evidence (in the case of guidelines for LMIC generally) and expert consensus (in the case of guidelines for humanitarian settings, for which evidence is less available). The implementation of these guidelines has not been without challenge, and additional barriers are anticipated as the dissemination of guidelines continues throughout LMIC. This chapter presents a review of the literature on barriers and challenges to implementation of the World Health Organization’s Mental Health Gap Action Programme (mhGAP) guidelines and the Inter-Agency Standing Committee’s guidelines for Mental Health and Psychosocial Support in Emergency Settings. We discuss the development of the guidelines, the challenges that have emerged with regard to their utility and feasibility, and potential strategies for overcoming experienced and anticipated barriers. Challenges, barriers, and strategies are presented at the individual (e.g., intervention participant), provider (e.g., counselor), organization, and policy levels. The chapter concludes with recommendations for next steps in mental health guideline implementation research in LMIC.