A Model for Sustainable Development of Child Mental Health Infrastructure in the LMIC World: Vietnam as a Case Example

Children and adolescents (hereafter collectively referred to as children) are one of the most important populations in regards to mental health support. This is true not only because of the prevalence and significance of their problems, but also because first onset of adult mental health disorders often is in childhood or adolescence (Kessler et al., 2005). Child and adolescent mental health (CAMH) is especially important in lower and middle income countries (LMIC), as they face particularly high levels of mental health-related challenges whereas at the same time treatment and prevention resources for CAMH are generally low, even compared to adults (WPA, WHO, & IACAPAP, 2005). A number of factors underlie this scarcity of resources but ultimately a – if not the – pivotal factor is a lack of mental health professionals appropriately trained to develop and implement CAMH interventions (Belfer, 2008). One approach to compensating for this scarcity is mental health task-shifting, the use of non-mental health professionals (e.g., nurses, general practitioners, teachers) who receive relatively circumscribed training focused on specific mental health programs (World Health Organization, 2008). Mental health task-shifting is recognized within global mental health as a central strategy for provision of mental health support in low resources settings. However, although there are a number of CAMH programs recognized as evidence-based treatments (EBT) in the high income countries within which they have been developed (Chorpita et al, 2011), few are well validated for the LMIC context, or when implemented by non-specialists or paraprofessionals (i.e., task-shifting personnel), and research remains critical (Patel, Flisher, Nikapota, & Malhotra, 2008). Yet at the same time that there is a lack of CAMH treatment infrastructure in LMIC, there often also is a concomitant lack of CAMH research infrastructure. This high level of need has been recognized but as Graeff-Martins et al. (2008) noted, there are few published reports of initiatives to develop CAMH infrastructure in LMIC. The present article presents a conceptual framework for development of CAMH infrastructure in LMIC, linking the model to our CAMH development initiative in Vietnam, as an illustration of this model's application.