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Concerning levels of unmet needs for treatment of anxiety, mood and substance disorders

Lancet

Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries, conclude authors of an Article in this week's edition of The Lancet.

Dr Philip Wang, National Institute of Mental Health, Maryland, USA and colleagues studied data from 84850 adults in high-income* and low-/middle-income* countries taken from the World Health Organisation's mental health surveys.

They found that the proportion of respondents using any mental health services within the previous 12-months varied widely between countries -- from 2% in Nigeria to 18% in the USA. This proportion was generally lower in developing than developed countries, and tended to correspond to countries' percentages of GDP spent on health care. Although seriousness of disorder was related to service use, between just 11% (China) and 61% (Belgium) of patients with severe disorders received any care in the previous year.

For patients who had been treated, proportions receiving follow-up care varied from 70% in Germany to 95% in Italy, and proportions who received treatments meeting minimum standards for adequacy varied from 10% in Nigeria to 42% in France. Patients who were male, married, less-educated, and at the extremes of age or income were treated less.

The authors conclude: "Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources."

In an accompanying Comment, Dr Graham Thornicroft, Institute of Psychiatry, King's College London, UK, says that the data is a sobering global account of how most people who are mentally ill are not treated.

He concludes by asking: "Why do we invest so little in our mental health care? To what extent is the under-use of services due to most people with mental illness actively avoiding help? Why have we allowed this global and gross neglect to be denied for so long" Specific actions are needed now to redress this silent scandal."

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For accompanying comment: http://multimedia.thelancet.com/pdf/press/WHO.pdf

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