Falling to Pieces

It seems to me that the issues surrounding mental health occasionally crack a mention in the media but rarely receive the sustained attention required to really break the taboos around the topic. Where do we stand on a worldwide basis in terms of service delivery and gaps in services?

The area of mental health service is so enormous that I can’t cover anywhere near enough of it in this blog, rather I will provide a brief review of one article. In “Scale up services for mental disorders: a call for action” the authors summarise the evidence from the series to “provide ammunition for advocacy by stakeholders in global mental health”. (1)

The basic facts presented in the introduction of the article speak for themselves:

  • “Every year up to 30% of the population worldwide has some form of mental disorder.”
  • “In the USA… 31% of people are affected by mental disorders every year, but 67% of them are not treated.”
  • “In Europe, mental disorder affects 27% of people every year, 74% of whom receive no treatment.”
  • In low and middle income countries the figures are worse with only 11.1% of severe cases of mental disorder in China receiving any treatment, and sufferers rarely receiving adequate treatment, “as low as 10.4% in Nigeria”.

The article claims that there is plenty of evidence supporting cost-effective interventions for mental disorders in low and middle-income countries. Although some regional areas have improved services there is a lack of implementation and reporting and monitoring mechanisms are not used effectively to allow progress to be tracked.

It is also claimed that by increasing the investment to between $2 and $8 per person per year for low to middle income countries by 2015 a core package of mental health interventions could be established.

Is this achievable? Well, it will require a significant investment… take Bangladesh as an example: with a population of 160 million this package will require an investment well in excess of $300 million per year!!

Conclusion… “The time to act is now”!

A number of other interesting sources of information about mental health worldwide are available at the following links:




(1) Lancet Global Mental Health Group. Scale up services for mental disorders: a call for action. Lancet 2007; 370: 1241–52

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