Resource utilisation for neuropsychiatric disorders in developing countries: A multinational Delphi consensus study

Background Substantial information is now available at a global and regional level relating to the burden of mental disorders, yet hardly any international data are available on the resources that are needed to respond to this global burden. Aims The aim of this study was to develop consensus-driven estimates of resource utilisation, coverage and adherence for key mental health care interventions capable of reducing leading neuropsychiatric causes of disease burden. Methods A resource utilisation questionnaire was developed for a series of mental health care interventions for schizophrenia, affective and anxiety disorders, alcohol misuse, epilepsy and Alzheimer's disease. Expert opinion surveys using a Delphi approach were conducted in seven countries (Brazil, China, Egypt, Ghana, India, Mexico and Thailand). Initial results were fed back to participants in order to elicit a second, final set of consensus estimates. Mean and median values were calculated, together with measures of dispersion and agreement. Results Sixty-seven psychiatrists took part in the first Delphi round and 60 completed the seven consensus panels in the second Delphi round. Expected resource use was highest for acute psychosis, mania, severe depression and severe dementia (at least monthly outpatient visits, and over 25% of cases admitted to hospital with an average length of stay one month). Aggregated estimates for current treatment coverage ranged from below 20% for Alzheimer's disease to 60% for epilepsy. Coverage and adherence levels for affective disorders were both below 50%. Conclusion The Delphi technique proved to be a feasible and efficient method for data collection and consensus generation concerning mental health care resource utilisation. Results provide a set of range estimates for mental health resource planning and evaluation in a variety of developing regions.