Briefing Paper: Improving Access to Evidence-Based Interventions for Trauma-Exposed Adults in LMICs
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Briefing Paper Working Group Members
Debra Kaminer, PhD
University of Cape Town, South Africa
Duane D. Booysen, PhD
Rhodes University, South Africa
Kate Ellis, PhD
American University in Cairo, Egypt
Christian H. Kristensen, PhD
Pontifical Catholic University of Rio Grande do Sul, Brazil
Anushka R. Patel, PhD
Harvard University, United States
Katy Robjant, PhD
University of Konstanz, Germany
Srishti Sardana, PhD
Johns Hopkins University, United States
The authors gratefully acknowledge valuable input from Drs. Rachel Hiller, Debra Kaysen, Judith Bass, Christine Bourey, Jaimie Gradus, Angela Nickerson, Elana Newman, and Kathryn Magruder, of the ISTSS Public Health and Policy Committee, and Diane Elmore Borbon of the ISTSS Executive Office.
Suggested citation: Kaminer, D., Booysen, D. D., Kristensen, C. H., Ellis, K., Patel, A. R., Robjant, K., & Sardana, S. (2023). Improving Access to Evidence-Based Interventions for Trauma-Exposed Adults in Low- And Middle-Income Countries: An International Society for Traumatic Stress Studies Briefing Paper. Retrieved from: https://istss.org/public-resources/istss-briefing-papers/briefing-paper-improving-access-lmics
In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to recognize obstacles to receiving treatment and identify strategies to improve access to evidence-supported interventions.
Multiple treatment barriers prevent help-seeking for individuals living with trauma-related mental health difficulties in LMICs. These include attitudinal barriers (such as a low perceived need for treatment, stigma, and a lack of confidence in the effectiveness of treatment) and resource-related barriers (such as a scarcity of mental health specialists, prohibitive treatment costs, and an absence of nearby services). There is an urgent need for effective strategies to reduce these barriers. This briefing paper highlights several innovative, evidence-based approaches that can be harnessed to better meet the treatment needs of trauma-exposed adults in lower-resource settings. These include training a cadre of non-specialist mental health providers from local communities, developing culturally informed and co-developed access and intervention strategies, the use of digital technology to deliver scalable public health messaging and mental health intervention, and the delivery of programs that address a range of trauma-related mental and behavioral health difficulties.
Based on existing evidence regarding treatment barriers and strategies to address these, key recommendations for improving access to evidence-based mental health interventions for adult survivors of trauma in LMICs are as follows. More detailed recommendations spanning public health and policy, research, and practice, are located at the end of the document.