Resources for mental health: scarcity, inequity, and inefficiency.
Resources for mental health include policy and infrastructure within countries, mental health services, community resources, human resources, and funding. We discuss here the general availability of these resources, especially in low-income and middle-income countries. Government spending on mental health in most of the relevant countries is far lower than is needed, based on the proportionate burden of mental disorders and the availability of cost-effective and affordable interventions. The poorest countries spend the lowest percentages of their overall health budgets on mental health. Most care is now institutionally based, and the transition to community care would require additional funds that have not been made available in most countries. Human resources available for mental health care in most low-income and middle-income countries are very limited, and shortages are likely to persist. Not only are resources for mental health scarce, they are also inequitably distributed-between countries, between regions, and within communities. Populations with high rates of socioeconomic deprivation have the highest need for mental health care, but the lowest access to it. Stigma about mental disorders also constrains use of available resources. People with mental illnesses are also vulnerable to abuse of their human rights. Inefficiencies in the use of available resources for mental health care include allocative and technical inefficiencies in financing mechanisms and interventions, and an overconcentration of resources in large institutions. Scarcity of available resources, inequities in their distribution, and inefficiencies in their use pose the three main obstacles to better mental health, especially in low-income and middle-income countries.
Saxena
Shekhar
S
World Health Organization, Geneva, Switzerland. saxenas@who.int
Thornicroft
Graham
G
Knapp
Martin
M
Whiteford
Harvey
H
D003156:Community Mental Health Services / Q000191:economics / Q000706:statistics & numerical data / Q000600:supply & distribution*; D017598:Efficiency, Organizational; D006291:Health Policy; D006301:Health Services Needs and Demand; D006806:Human Rights; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data / Q000600:supply & distribution*; D011287:Prejudice; D012923:Social Class; D014944:World Health Organization