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Mental health systems in countries: Where are we now?

Lancet

More than 85% of the world's population lives in 153 low- and middle-income countries (LAMICs), with most of these countries allocating very scare financial resources and grossly inadequate manpower and infrastructure for mental health. In this fourth paper of The Lancet's Global Mental Health Series, Dr K S Jacob, Department of Psychiatry, Christian Medical College, Vellore, India and colleagues conclude: "Innovative approaches are needed to promote the reality of mental disorders and efficiently use available resources to ensure that basic mental health care reaches all individuals."

The authors say that many LAMICs lack mental health policy and legislation (around a third of WHO's 191 member-countries have no mental health laws), and this deficiency stops them directing their mental-health programmes and services. They add: "Mental health resources in countries seem to be related as much to measures of general health as to economic and developmental indicators, arguing for improved prioritisation for mental health even in low-resource settings."

Case-studies of Brazil, India and South Africa are studied in depth, with the authors stating that lessons can be learned from countries such as Brazil which have progressed well despite having low income -- by moving mental health care away from mental hospitals into community settings, widening access to medication and provision of universal coverage and free access to a network of services.

Furthermore, a variety of statistics reveal the huge gaps in mental health service provision between high income countries and LAMICs -- with nearly 70% of African and 50% of southeast Asian countries reporting they spend less than 1% of their health budget on mental health, while more than 60% of European countries spend more than 5% of their budgets on mental health.

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