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Global survey reveals significant gap in meeting world's mental health care needs

September 07, 2007

Mental disorders rank among the top ten illnesses causing disability-more than 37 percent worldwide-with depression being the leading cause of disability among people ages 15 and older, according to the Global Burden of Disease and Risk Factors published in 2006. Yet, the world's mental health care needs are largely going unmet, especially in less developed nations but also in high-income countries, according to results from a new survey of 17 countries conducted as part of the World Health Organization's (WHO) World Mental Health Survey Initiative. The results of the initiative, partially funded by the National Institutes of Health's National Institute of Mental Health (NIMH), were published in The Lancet in September 2007.

"Good treatments are available for many mental disorders. Yet, the world continues to struggle with the very real challenge of providing these services to the people who most need them," said NIMH Director Thomas R. Insel. "The WHO survey unmistakably reinforces the urgency that we must do better."

Philip S. Wang, M.D., Dr.P.H., currently director of the NIMH Division of Services and Intervention Research, and colleagues analyzed data from face-to-face interviews on mental health service use with 84,848 adults across all economic spectrums in countries around the world. Respondents were asked about anxiety, post-traumatic stress, mood, and substance abuse disorders. They were also asked if they received any services in the past year for mental disorders; and if so, what types of services they had used, such as general medical professional, mental health professional, religious counselors or traditional healers.

The survey found that mental health service use varied significantly among the 17 countries. Overall, fewer people in less developed countries with mental disorders sought services compared with people in developed countries. In addition, the survey found that people in countries spending more of their gross national product (GDP) on health care used services more often. The U.S. population used services more than any other country, at 18 percent. By comparison, 11 percent of France's population used services. The lowest rate of services use was 1.6 percent in Nigeria.

In all countries surveyed, women were more likely than men to seek mental health services. Additional results of countries surveyed found that,

* middle-aged people were more likely to receive services than those younger or older;
* people with more education were more likely to seek out services for mental problems; and
* married people were less likely to use mental health services than unmarried people

Most of those who sought care for mental disorders received help from the general medical sector (primary care doctors, nurses) rather than specialized mental health services (psychiatrists, psychologists), religious or community counselors, or complementary and alternative medicine providers (including traditional healers). Among those receiving services, a substantial number of survey respondents reported that they did not receive minimally adequate services. The survey defines minimally adequate services as at least eight visits to any service sector, or being in ongoing treatment at the time of the interview, or receiving a medication for at least one month with four or more visits to a medical professional over a 12-month period.

Inadequate services were most commonly found in low-income countries, but even in some high-income countries, people received inadequate services. For example, in the United States, only 18 percent received minimally adequate services-much lower than any other high-income country. The next lowest level of minimally adequate services in a high-income country was 32 percent, in Japan. France and Germany had the highest level of adequate services, at 43 percent each.

"Although people sought and used services more in the United States, most did not receive adequate care-evidence of a striking disconnect in the U.S. mental health care system," said Dr. Wang, who conducted the research while he was at Harvard University. "We need to help developing countries implement more effective mental health care services, but we also need to do a better job at home. The global mental health care situation appears dire," concluded Dr. Wang.

NIH/National Institute of Mental Health