Addressing Sexual and Reproductive Health Needs of People with Mental Illness
Evidence-Based Approaches from High-Income Countries for Low- and Middle-Income Settings
Keywords:
Mental illness, Sexual, Reproductive, Health, Services, Program, Intervention, Inclusion, Stigma, Mental illnessAbstract
Objective: This study reviews inclusive SRH intervention programs from high-income countries (HICs) to guide the development of similar programs for people with mental illness in low- and middle-income countries (LMICs), with a focus on LIMCs.
Methods: A literature review was performed using databases such as PubMed and Google Scholar, focusing on articles from 2010 to 2024. The review examined peer-reviewed articles and credible reports on SRH services for people with mental illness.
Results: Findings indicate that integrating SRH services with mental health support is effective in HICs. LMICs face challenges like stigma and limited-service integration. Successful strategies from HICs, including legal protections and specialized services, offer valuable lessons.
Conclusion: Adapting successful SRH intervention models from HICs to LMICs, incorporating multisectoral approaches and legal reforms, is essential to improving SRH service access for people with mental illness.
References
World Health Organization. (2016). Framework on integrated, people-centred health services
(IPCHS). Geneva: World Health Organization.
United Nations. (2011). Annual report of the United Nations high commissioner for human rights
and reports of the Office of the High Commissioner and the Secretary-General: Thematic study
by the Office of the United Nations High Commissioner for Human Rights on participation in
political and public life by persons with disabilities. New York: United Nations General
Assembly.
United Nations General Assembly. (2017). Report of the Special Rapporteur on the right of
everyone to the enjoyment of the highest attainable standard of physical and mental health. The
Hague: United Nations.
WHO Social Exclusion Knowledge Network. (2014). Understanding and tackling social
exclusion: Final report to the WHO Commission on Social Determinants of Health. Lancaster:
WHO Commission on Social Determinants of Health.
United Nations Development Programme. (2015). Human development report: Briefing notes for
countries - Timor-Leste. New York: UNDP.
Drew, N., Funk, M., Tang, S., Lamichhane, J., Chávez, E., Katontoka, S., et al. (2011). Human
rights violations of people with mental and psychosocial disabilities: An unresolved global crisis.
The Lancet, 378(9803), 1664–1675.
Curran, C., Burchardt, T., Knapp, M., McDaid, D., & Li, B. (2007). Challenges in
multidisciplinary systematic reviewing: A study on social exclusion and mental health policy.
Social Policy and Administration, 41(3), 289–312.
Subramaniam, M., Abdin, E., Picco, L., Pang, S., Shafie, S., Vaingankar, J. A., et al. (2017).
Stigma towards people with mental disorders and its components - A perspective from
multi-ethnic Singapore. Epidemiology and Psychiatric Sciences, 26(4), 371–382.
Baumgartner, J. N., & Burns, J. K. (2014). Measuring social inclusion—A key outcome in global
mental health. International Journal of Epidemiology, 43(2), 354–364.
Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: Ignorance, prejudice or
discrimination? British Journal of Psychiatry, 190(3), 192–193.
Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma.
Schizophrenia Bulletin, 30(3), 511–541.
Fox, A. B., Earnshaw, V. A., Taverna, E. C., & Vogt, D. (2018). Conceptualizing and measuring
mental illness stigma: The mental illness stigma framework and critical review of measures.
Stigma and Health, 3(4), 348–376.
Corrigan, P. W., Markowitz, F. E., & Watson, A. C. (2004). Structural levels of mental illness
stigma and discrimination. Schizophrenia Bulletin, 30(3), 481–491.
Lauber, C., & Rossler, W. (2007). Stigma towards people with mental illness in developing
countries in Asia. International Review of Psychiatry, 19(2), 157–178.
Phelan, J. C., Bromet, E. J., & Link, B. G. (1998). Psychiatric illness and family stigma.
Schizophrenia Bulletin, 24(1), 115–126.
National Academies of Sciences, Engineering, and Medicine. (2016). Ending discrimination
against people with mental and substance use disorders: The evidence for stigma change.
Washington, DC: The National Academies Press. https://doi.org/10.17226/23442
Stuart, H. (2006). Mental illness and employment discrimination. Current Opinion in Psychiatry,
(5), 522–526.
Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2001). Stigma as a
barrier to recovery: The consequences of stigma for the self-esteem of people with mental
illnesses. Psychiatric Services, 52(12), 1621–1626.
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., et al.
(2015). What is the impact of mental health-related stigma on help-seeking? A systematic review
of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27.
World Health Organization. (2019). Social determinants of health: Civil society. Retrieved from
https://www.who.int/social_determinants/themes/civilsociety/en/
The Intersection of Disability and Gender in the Global South: Narratives, Gaps and
Opportunities - CBM UK. (2018).
Cohen, A., Padmavati, R., Hibben, M., Oyewusi, S., John, S., Esan, O., et al. (2016). Concepts of
madness in diverse settings: A qualitative study from the INTREPID project. BMC Psychiatry,
(1), 388.
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and
social isolation as risk factors for mortality: A meta-analytic review. Perspectives on
Psychological Science, 10(2), 227–237.
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., et al.
(2013). Global burden of disease attributable to mental and substance use disorders: Findings
from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1575–1586.
Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., et al. (2018). The Lancet
Commission on global mental health and sustainable development. The Lancet, 392(10157),
–1598.
Cobigo, V., & Stuart, H. (2010). Social inclusion and mental health. Current Opinion in
Psychiatry, 23(5), 453–457.
Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., et al. (2016).
Evidence for effective interventions to reduce mental-health-related stigma and discrimination.
The Lancet, 387(10023), 1123–1132.
Marshall, T., Goldberg, R. W., Braude, L., Dougherty, R. H., Daniels, A. S., Ghose, S. S., et al.
(2014). Supported employment: Assessing the evidence. Psychiatric Services, 65(1), 16–23.
Yang, L. H., Kleinman, A., Link, B. G., Phelan, J. C., Lee, S., & Good, B. (2007). Culture and
stigma: Adding moral experience to stigma theory. Social Science & Medicine, 64(7),
–1535.
Palmer, L., Barnes, S., & Kakuma, R. (2017). Opening the paths to healing: Developing an
integrated approach to health in Timor Leste. Third World Thematics: A TWQ Journal, 2(2–3),
–262.
Fernandes, H. L., Cantrill, S., Shrestha, R., Raj, B. B., Allchin, B., Kamal, R., et al. (2018). Lived
experience of psychosocial disability and social inclusion: A participatory Photovoice study in
rural India and Nepal. Disability, CBR & Inclusive Development, 29(2), 5–23.
Handlin, O., & Handlin, O. (2018). Worlds Apart: The Distortion of America (pp. 205–216).
Miller, H. L., Pavlik, K. M., Kim, M. A., & Rogers, K. C. (2017). An exploratory study of the
knowledge of personal safety skills among adults with disabilities. Journal of Applied Research
in Intellectual and Mental Disabilities, 30(2), 290–300.
Van der Stege, H. A., Hilberink, S. R., Visser, A. P., & Van Staa, A. L. (2014). Motivational
factors in discussing sexual health with young people with chronic conditions or disabilities. Sex
Education, 14(6), 635–651.
McCarthy, M. (2011). Prescribing contraception to women with intellectual and psychosocial
disabilities: General practitioners' attitudes and practices. Sexuality & Disability, 29(4), 339–349.
Dgardh, K. (2002). Adolescent health in Sweden. Sexually Transmitted Infections, 78, 352–356.
Tyden, T., & Norden, L. (2009). Swedish adolescent knowledge of sexually transmitted diseases
and their attitude to condom use. Midwifery, 725–730.
Centre for Developmental Disability Health. (2010). Victoria. Retrieved from
www.cddh.monash.org/2010
Cook, J. (2011). Sexuality and people with psychiatric disabilities. Journal of Sexuality and
Disability, 18(3), 195–206.
American Association on Intellectual and Developmental Disabilities (AAIDD). (2011).
Sexuality & Intellectual Disability. Retrieved from www.aamr.org/content_198.cfm
Mathias, K., Kermode, M., San Sebastian, M., Koschorke, M., & Goicolea, I. (2015). Under the
banyan tree--exclusion and inclusion of people with mental disorders in rural North India. BMC
Public Health, 15, 446.
Tanaka, C., Tuliao, M. T. R., Tanaka, E., Yamashita, T., Matsuo, H. (2018). A qualitative study
on the stigma experienced by people with mental health problems and epilepsy in the Philippines.
BMC Psychiatry, 18(1), 325.
Allan, E. B., Najm, A. F., Fernandes, H., & Allchin, B. (2018). Participatory lived experience
research: Barriers and enablers for social inclusion for people with psychosocial disability in
Afghanistan? Intervention, 16(3), 222–230.
Fernandes, H., Cantrill, S., Kamal, R., & Shrestha, R. (2017). Inclusion of people with
psychosocial disability in low and middle-income contexts: A practice review. Christian Journal
of Global Health, 4(3), 72–81.
Hawkins, Z., & Tilman, T. (2011). “The family is the clinic, the community is the hospital”:
Community mental health in Timor-Leste. Australasian Psychiatry, 19(Suppl 1), S95–S97.
Institute for Health Metrics and Evaluation (IHME). (2016). Share of population with any mental
health or substance use disorders. Retrieved from
https://ourworldindata.org/grapher/share-with-mental-and-substance-disorders?tab=chart&time=
.2017&country=TLS
Mathias, K., Kermode, M., Goicolea, I., Seefeldt, L., Shidhaye, R., & San Sebastian, M. (2018).
Social distance and community attitudes towards people with psychosocial disabilities in
Uttarakhand, India. Community Mental Health Journal, 54(3), 343–353.
Minas, H., & Diatri, H. (2008). Pasung: Physical restraint and confinement of the mentally ill in
the community. International Journal of Mental Health Systems, 2(1), 8.
Ofori-Atta, A., Attafuah, J., Jack, H., Baning, F., & Rosenheck, R. (2018). Joining psychiatric
care and faith healing in a prayer camp in Ghana: Randomised trial. British Journal of
Psychiatry, 212(1), 34–41.
Social Exclusion Unit. (2005). Transitions: Young adults with complex needs; A social exclusion
unit final report. Great Britain: Office of the Deputy Prime Minister.
Thornicroft, G., Brohan, E., Rose, D., Sartorius, N., & Leese, M. (2009). Global pattern of
experienced and anticipated discrimination against people with schizophrenia: A cross-sectional
survey. The Lancet, 373(9661), 408–415.
Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rusch, N. (2012). Challenging the
public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10),
–973.
Na, L., & Hample, D. (2016). Psychological pathways from social integration to health: An
examination of different demographic groups in Canada. Social Science & Medicine, 151,
–205.
Carroll, A., Davar, B., Eaton, J., Catherine, R., Cambri, J., Devine, A., et al. (2016). Promoting
the rights of people with psychosocial disability in development research and programming.
Development Bulletin, 77, 25–30.
Han, C. S., & Oliffe, J. L. (2016). Photovoice in mental illness research: A review and
recommendations. Health, 20(2), 110–126.
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