|Global Survey Reveals Significant Gap in Meeting
World's Mental Health Care Needs
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 and in high-income
countries, according to results from a new survey of 17 countries
conducted as part of the World Health Organizationís (WHO) World
Mental Health Survey Initiative. The results of the initiative,
partially funded by the National Institutes of Healthís National
Institute of Mental Health (NIMH), were published in The Lancet in
"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 Franceís 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
- 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
The National Institute of Mental Health (NIMH) mission is to reduce
the burden of mental and behavioral disorders through research
on mind, brain, and behavior. More information is available at
the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.