Evaluation of the WHO Assessment Instrument for Mental Health Systems



Shekhar Saxena1; Antonio Lora; Mark van Ommeren; Thomas Barrett; Jodi Morris; Benedetto Saraceno

Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland



We read with interest the recent paper by Hamid et al. on the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS),1 an instrument that we are pleased to have developed and that flls a major gap in this feld.2,3 We thank the authors for their interest and their mostly positive appraisal of WHO-AIMS.

We would like to note that the primary objective of the WHO-AIMS project is to enable countries to generate information on the strengths and weaknesses of their mental health system to facilitate improvement of services. Trough a WHO-AIMS assessment, countries are enabled to develop information-based mental health plans with clear baseline information and targets, and to monitor progress in implementing reform policies.

Given the objective of the project, the WHO-AIMS instrument has been designed to be used by a local team for comprehensive assessment of the country's mental health system (or an assessment of a region within the country). A complete assessment using WHO-AIMS usually takes 3 to 6 months and involves an iterative process of checking and triangulating data between the local team and the ministry of health (which is the source of many critical elements of the assessment). Tis work is carried out with continuous and substantial technical support from WHO headquarters, regional and country ofces. Te fnal report is jointly published by the WHO country ofce and the ministry of health. WHO has now published WHO-AIMS assessments on 36 countries (available at: http://www.who.int/mental_health/who_aims_ country_reports/en/index.html).

Tough the Hamid et al. paper does not provide details of the methodology followed in collection of WHO-AIMS data, it appears that the authors were not able to use the recommended WHO-AIMS method.4 Also, the paper gives data for just a few indicators out of 155 included in the instrument. In view of these limitations, we believe that this paper provides a less than adequate basis for evaluation of this instrument.

WHO will soon publish a report on available WHO-AIMS data from a large number of countries. Tis report is likely to provide a more adequate basis to evaluate this instrument.



1. Hamid H, Abanilla K, Bauta B, Huang KY. Evaluating the WHO Assessment Instrument for Mental Health Systems by comparing mental health policies in four countries. Bull World Health Organ 2008;86:467-73. PMID:18568276 doi:10.2471/BLT.07.042788        

2. Saxena S, Lora A, van Ommeren M, Barrett T, Morris J, Saraceno B. WHO's Assessment Instrument for Mental Health Systems: collecting essential information for policy and service delivery. Psychiatr Serv 2007;58:816-21. PMID:17535942 doi:10.1176/appi.ps.58.6.816        

3. Saxena S, van Ommeren M, Lora A, Saraceno B. Monitoring of mental health systems and services - comparison of four existing indicator schemes. Soc Psychiatry Psychiatr Epidemiol 2006;41:488-97. PMID:16565914 doi:10.1007/ s00127-006-0053-3        

4. World Health Organization Assessment Instrument for Mental Health Systems, version 2.2. Geneva: WHO; 2005.         



1 Correspondence to Shekhar Saxena (e-mail: saxenas@who.int).
World Health Organization Genebra - Genebra - Switzerland
E-mail: bulletin@who.int