Community models of mental care warrant more governmental support.

rehabilitation model are relatively new initiatives. It could be argued that all these models use the least possible healthcare resources. With fewer resources the community may be empowered to take on more responsibilities for ill people. Some may see this as a positive development, but others may see such initiatives as a way of transferring state responsibilities to the population. If there were to be such a diversification in provision of care in the developed world then it would be hoped that resources would follow responsibility. The development of sufficient open access psycho-therapeutic groups for depression as part of a stepped care approach, or the changes in tax and benefits required for increased support to new mothers, may only be cost neutral if they are balanced against the costs of poorly or untreated depression. If these initiatives represented a decrease in service quality or outcome, it would be difficult for developed countries to consider them. In the developing world the poorest have no choice but to take what is offered. This is sometimes true of inner city areas in developed countries where novel cheaper healthcare initiatives are sometimes introduced. We understand the tension between value for money, innovation, and quality. We do not advocate the development of two tier healthcare systems in developed countries. Of interest for developed countries is that when these simple models have been tested in the developing world they have been shown to be at least equally effective as more sophisticated and expensive ones. Moreover, whether through decreasing the cultural gulf between services and their recipients, increasing community involvement in health care, reinforcing preventive strategies, or developing more rational models of service delivery the examples that we have cited may offer added value. et al. Redesigning postnatal care: a randomized controlled trial of protocol based midwifery-led care focused on individual women's physical and psychological health needs. depression in primary care in low income women in Santiago, Chile: a randomized controlled trial. Although developed countries are relatively well resourced there is an unmet demand for mental health services, particularly for anxiety disorders and depression. A similar and escalating demand exists for services for other forms of chronic illness too, such as diabetes secondary to obesity. In both, the potential of community care is increasingly recognised. The core elements that emerge from the models McKenzie et al describe are community involvement in the planning and delivery of services, …