Module 6: Barriers to Mental Health Care
Due to the complex nature of psychological disorders, successful treatment often requires regular access to mental health care professionals and a variety of support services. Unfortunately, mental health care services are often not available or are under-utilized, particularly in developing countries. In developed countries, the treatment gap (the %age of individuals who need mental health care but do not receive treatment) ranges from 44% to 70%; in developing countries, the treatment gap can be as high as 90%.(1) Common barriers to mental health care access include limited availability and affordability of mental health care services, insufficient mental health care policies, lack of education about mental illness, and stigma.
Limited Availability of Medication and Health Professionals
Unavailability of essential medicines is particularly prevalent in developing countries, and severely restricts access to treatment for psychological disorders. The World Health Organization reports that nearly 20% of countries do not have at least one common antidepressant, one antipsychotic, and one antiepileptic medication available in primary care settings.(2) This problem is compounded by a lack of mental health care professionals in low- and middle-income countries; low-income countries have a median of 0.05 psychiatrists and 0.16 psychiatric nurses per 100,000 people.(3) Even fewer resources are available for children and adolescents; the WHO reports that most low- and middle-income countries have only one child psychiatrist for every one to four million people in 2005.(4) Community-based mental health care is also rare in low-income countries; about 52% of low-income countries offer community-based mental health care programs, compared to about 97% of high-income countries.(5)
In many low- and middle-income countries, the high cost of psychiatric treatment, often due to high medication prices, poses significant financial barriers to patient care.(6) In addition, psychological disorders are not covered by insurance policies in many countries, making mental health care unaffordable for many people. The WHO also reports that 25% of all countries do not provide disability benefits to patients with mental disorders, and one-third of the world’s population lives in countries that allocate less than 1% of their health budget to mental health.(7) Furthermore, 31% of countries do not have a specific public budget for mental health.(8)
The World Health Organization cites a global lack of comprehensive mental health policies, which are crucial for implementing and coordinating mental health care services, as a key barrier to public access to mental health care. Nearly one-third of all countries, and almost half of all African nations, have no comprehensive mental health care policy or plan. Among countries with mental health care policies in place, approximately 40% have not been revised since 1990 and do not address recent developments in mental health care. Furthermore, 22% of countries do not have laws that offer legal protection of the human and civil rights of people with mental illnesses.(9) In many low- and middle-income countries, the localization of mental health care resources in large cities has also been cited as a key barrier to providing mental health care to the entire population, and geographical decentralization has been recommended to improve accessibility to mental health care in non-urban communities.(10)
Lack of Education
In developing and developed countries, limited knowledge about mental illness can prevent individuals from recognizing mental illness and seeking treatment; poor understanding of mental illness also impairs families’ abilities to provide adequate care for mentally ill relatives.(11) In 1992, data from the National Comorbidity Survey revealed that of the 6.2% of respondents who had a serious mental illness in the 12 months prior to the survey, fewer than 40% had received stable treatment. The majority of individuals with an untreated severe mental illness did not seek care because they believed they did not have a condition that required treatment. Of responders with a severe mental illness who did not receive care but recognized that they needed treatment, 52% reported situational barriers to care, 46% cited financial barriers, and 45% dropped out of care because they felt that treatment had not been effective. Furthermore, 72% of respondents who did not seek treatment chose to do so because they wanted to “solve the problem on their own”.(12) These findings suggest that lack of education about the nature of psychological disorders and the need for consistent treatment is a significant barrier to care.
Multiple studies have found that stigma associated with mental illness often prevents patients from seeking and adhering to treatment, as patients may “attempt to distance themselves from the labels that mark them for social exclusion”.(13) Please see Module 7: Cultural Perspectives on Mental Health for a discussion of the causes of stigma and discrimination.
(1) World Health Organization. “Investing in mental health”. Retrieved 29 June 2012.
(3) Saxena, S., Thornicroft, G., Knapp, M., Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet, 370: 878-89.
(4) WHO. Atlas child and adolescent mental health resources global concerns: implications for the future. Geneva, Switzerland: World Health Organization, 2005.
(5) Saxena et al. (2007)
(7) World Health Organization. “Investing in mental health”. Retrieved 29 June 2012.
(8) Saxena, S., Thornicroft, G., Knapp, M., Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet, 370: 878-89.
(10) Saraceno, B., van Ommeren, M, Batniji, R., Cohen, A., Gureje, O., Mahoney, J., Sridhar, D., Underhill, C. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. Lancet, 370: 1164-74.
(11) Saxena et al. (2007)
(12) Kessler, R.C., Berglund, P.A., Bruce, M.L., Koch, J.R., Laska, E.M., Leaf, P.J., Manderscheid, R.W., Rosenheck, R.A., Walters, E.E., Wang, P.S. (2001). The prevalence and correlates of untreated serious mental illness. HSR: Health Services Research, 36(6): 987-1007.
(13) Wahl, O.F. (2012). Stigma as a barrier to recovery from mental illness. Trends in Cognitive Sciences, 16(1): 9-10.