Social Science & Medicine 118 (2014) 181
Contents lists available at ScienceDirect
Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed
Commentary
Rejoinder to Lund: Plan and action in mental health research and policy in low and middle-income countries Gindo Tampubolon, Wulung Hanandita Institute for Social Change, School of Social Science, Manchester, United Kingdom
a r t i c l e i n f o Article history: Received 25 June 2014 Accepted 2 July 2014 Available online 2 July 2014 Keywords: Mental health Low and middle-income countries Poverty Indonesia Social inequality
We thank Dr Lund (Lund, 2014) for thoughtful reflection and commentary on our paper (Tampubolon and Hanandita, 2014) and most importantly for clearly laying out what research is needed and what international and national support is required to remove the burden of mental health diseases in low and middle-income countries. The paper and the commentary together provide a new impetus to build evidence-based knowledge about how various dimensions of social deprivations, expenditure is but one of them, affect mental health as manifested in different ways from common disorders to suicides. Future research and practice in this field can certainly benefit from more and stronger evidence originating in these countries, one that is sensitive to their social, economic and cultural contexts. One more recent work (Hanandita and Tampubolon, 2014) can be seen in this vein. Using a larger sample of more than half a million, a more robust estimator of causal effect that is instrumental variable estimator, the authors find that poverty reduces mental health by a magnitude larger than mere association suggests, a difference that has also been observed in developed country. Instead of an association elasticity of 0.11%, a 1% reduction in expenditure per person reduces mental health by 0.62%. With findings such as these, we hope strong and compelling
DOI of original article: http://dx.doi.org/10.1016/j.socscimed.2014.04.010. E-mail address: [email protected] (G. Tampubolon). http://dx.doi.org/10.1016/j.socscimed.2014.07.002 0277-9536/© 2014 Elsevier Ltd. All rights reserved.
evidence feeds into enlightened public policy on mental health that is sorely needed in low and middle-income countries. Our ongoing work highlights an example of the need in practice. In 2013 surveying all public hospitals (54 with 1 refusal) in East Java, Indonesia, a province with population of more than 38 million, we found only one specialist mental health hospital, or one bed for nearly 43 thousand people, forcing some patients and family carers to travel up to 8 h to access these services when needed. As Dr Lund concludes in his commentary, ‘we have sufficient evidence to include mental health in the post-2015 Sustainable Development Goals…and [we need to monitor] government commitments to mental health budgets and human resources’ [:136]. The plan of research and policy is clearly laid out in these documents; this amounts to a call for action on the part of the research and policy communities.
References Hanandita, W., Tampubolon, G., 2014. Does poverty reduce mental health? Instrum. Var. Anal. 113, 59e67. http://dx.doi.org/10.1016/ j.socscimed.2014.05.005. Lund, C., 2014. Poverty and mental health: towards a research agenda for low and middle-income countries. Commentary on Tampubolon and Hanandita (2014). Soc. Sci. Med. 111, 134e136. http://dx.doi.org/10.1016/ j.socscimed.2014.04.010. Tampubolon, G., Hanandita, W., 2014. Poverty and mental health in Indonesia. Soc. Sci. Med. 106, 20e27. http://dx.doi.org/10.1016/j.socscimed.2014.01.012.
Contents lists available at ScienceDirect
Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed
Commentary
Rejoinder to Lund: Plan and action in mental health research and policy in low and middle-income countries Gindo Tampubolon, Wulung Hanandita Institute for Social Change, School of Social Science, Manchester, United Kingdom
a r t i c l e i n f o Article history: Received 25 June 2014 Accepted 2 July 2014 Available online 2 July 2014 Keywords: Mental health Low and middle-income countries Poverty Indonesia Social inequality
We thank Dr Lund (Lund, 2014) for thoughtful reflection and commentary on our paper (Tampubolon and Hanandita, 2014) and most importantly for clearly laying out what research is needed and what international and national support is required to remove the burden of mental health diseases in low and middle-income countries. The paper and the commentary together provide a new impetus to build evidence-based knowledge about how various dimensions of social deprivations, expenditure is but one of them, affect mental health as manifested in different ways from common disorders to suicides. Future research and practice in this field can certainly benefit from more and stronger evidence originating in these countries, one that is sensitive to their social, economic and cultural contexts. One more recent work (Hanandita and Tampubolon, 2014) can be seen in this vein. Using a larger sample of more than half a million, a more robust estimator of causal effect that is instrumental variable estimator, the authors find that poverty reduces mental health by a magnitude larger than mere association suggests, a difference that has also been observed in developed country. Instead of an association elasticity of 0.11%, a 1% reduction in expenditure per person reduces mental health by 0.62%. With findings such as these, we hope strong and compelling
DOI of original article: http://dx.doi.org/10.1016/j.socscimed.2014.04.010. E-mail address: [email protected] (G. Tampubolon). http://dx.doi.org/10.1016/j.socscimed.2014.07.002 0277-9536/© 2014 Elsevier Ltd. All rights reserved.
evidence feeds into enlightened public policy on mental health that is sorely needed in low and middle-income countries. Our ongoing work highlights an example of the need in practice. In 2013 surveying all public hospitals (54 with 1 refusal) in East Java, Indonesia, a province with population of more than 38 million, we found only one specialist mental health hospital, or one bed for nearly 43 thousand people, forcing some patients and family carers to travel up to 8 h to access these services when needed. As Dr Lund concludes in his commentary, ‘we have sufficient evidence to include mental health in the post-2015 Sustainable Development Goals…and [we need to monitor] government commitments to mental health budgets and human resources’ [:136]. The plan of research and policy is clearly laid out in these documents; this amounts to a call for action on the part of the research and policy communities.
References Hanandita, W., Tampubolon, G., 2014. Does poverty reduce mental health? Instrum. Var. Anal. 113, 59e67. http://dx.doi.org/10.1016/ j.socscimed.2014.05.005. Lund, C., 2014. Poverty and mental health: towards a research agenda for low and middle-income countries. Commentary on Tampubolon and Hanandita (2014). Soc. Sci. Med. 111, 134e136. http://dx.doi.org/10.1016/ j.socscimed.2014.04.010. Tampubolon, G., Hanandita, W., 2014. Poverty and mental health in Indonesia. Soc. Sci. Med. 106, 20e27. http://dx.doi.org/10.1016/j.socscimed.2014.01.012.
