Wildlife: Exploring the Potential of an Innovative Digital Narrative Approach to Improve Mental Health Interventions for Adolescents in Indigenous Rural Populations of Low- to Middle-Income Countries


In Chapter 6, Ikonomopoulos, Liang, Furgerson, and Garza argued that the lack of mental health resources and referral opportunities in rural areas necessitates more in-depth counselling and therapy. They illustrated how mental health professionals working with rural communities and populations must become aware of the best treatments available. These can be costly to deliver and new approaches to mental health interventions for rural areas are needed. Online therapies are available increasingly and evidence is emerging about the potential of mixed reality (MR) as a clinical and therapeutic tool for mental health treatment. In this chapter, we consider Wildlife: South Africa — a case study in the deployment of an innovative digital narrative approach (DNA) to online and blended behaviour change interventions and therapies. Comparative work took place under the auspices of the same project at related sites Wildlife: Myanmar and Wildlife: India.

This chapter first considers rural mental health from an international comparative perspective by contrasting South Africa’s (SA) mental health workforce to the other low- and middle-income countries (LMICs) included in the study and then to the high-income countries (HICs) discussed in this book. This illuminates how rurality and mental health interact to create risk but also opportunity for innovative mental health care in rural LMICs. We argue that there is a need for more innovative approaches and cite the use of DNA as one such approach to address the global implications of rural mental health.


The global burden of mental illness

As discussed elsewhere in this volume, neuropsychiatric conditions, including mental illness, constitute approximately 13% of the global burden of disease,

Innovative digital narrative approach 117 making them the official third largest cause of disability in the world (World Health Organization, 2013a). With life expectancy rising, populations aging, and mortality rates waning, it is argued that non-lethal outcomes of diseases are becoming a larger component of the global burden of disease and that current appraisals vastly underestimate the burden of mental illness (Vigo, Thornicroft, & Atun, 2016, Whiteford et al., 2013).

Mental illness is responsible for 30% of disability-adjusted life-years (DALYs), the disability component of the burden of disease calculation (World Health Organization, 2012a). New estimates place mental illness first in burden of disease when considered in terms of years lived with disabilities (YLDs), and on a par with circulatory and cardiovascular diseases in terms of DALYs (Vigo et al., 2016). The global need for the treatment of mental illness and associated YLDs and DALYs outweighs the current capacity to provide appropriate services dramatically. According to the World Health Organization (WHO), the global shortage of mental health care professionals is dire (Shah & Beinecke, 2009, World Health Organization, 2012b). Worldwide, the treatment gap for mental illness is undisputable, with 85% of people in LMICs and between 35% and 50% of people in HICs living with severe mental disorders receiving no medical intervention (WHO, 2012a). While these figures suggest that mental illness is affecting a vast proportion of the global population, it is clear that LMICs carry the heaviest burden of mental illness (Bruckner et al., 2011; World Health Organization, 2013c, 2017b).

Mental illness in LMICs and HICs: a comparative perspective

The most recent WHO’s ATLAS report for mental health (WHO, 2017b) indicates immense disparities between LMICs and HICs in mental health system governance and financial and human resources for health and mental health service availability (Bruckner et al., 2011): By 2014, over 75% of HICs had stand-alone laws for treating and preventing mental illness, contrasted to the less than 10% of LMICs in Africa who had these laws in place (World Health Organization, 2015). Government mental health expenditure per capita in the European region and other HICs are more than 20 times higher than that in the LMICs in the African and South East Asian Regions. This translates to people with less disposable income having to pay more for mental health services (WHO, 2017b). While the global median of mental health workers per 100,000 population remained at 9 between 2014 to 2017, the discrepancy between LMICs and HICs is widening. HICs have 71.7 mental health workers per 100,000 population compared to 1.6 in low-income countries. The same trend is observed in regional classifications where the median number of mental health workers per 100,000 population in Europe is 50 compared to that of countries in Africa and South East Asia at 0.9 and 2.5 per 100,000 population respectively (WHO, 2017b). This brief examination of comparative access to mental health services exposes the mental health resource crisis faced by LMICs, especially those in the WHO Africa and South East Asia

AFR= Africa; AMR=Americas; EMR=Eastern Mediterranean; EUR=European Union; SEAR=South-East Asia; WPR=Western Pacific

■ Mental Healthcare Workers per 100 000 population

■ Government mental health expenditure per capita (US$)

Figure 7.1 Comparison of mental health care workers per 100,000 population and government mental health expenditure per capita by region.

regions. The three LMICs included in our study — Myanmar, India, and SA -fall within these sparsely resourced regions. Figure 7.1 provides an overview of the mental health workforce per population, and government expenditure per capita by WHO region.

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