Barriers to mental health treatment: results from the WHO World Mental Health surveys.
BACKGROUND
To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.


METHODS
Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity.


RESULTS
Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).


CONCLUSIONS
Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.
Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
L H
LH
Andrade
Health Services Research Unit, IMIM (Hospital del Mar Research Institute), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
J
J
Alonso
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon.
Z
Z
Mneimneh
Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand.
J E
JE
Wells
Al-Qadisia University College of Medicine, Diwania Teaching Hospital, Diwania, Iraq.
A
A
Al-Hamzawi
Instituto Nacional de Psiquatria Ramon de la Fuente and Universidad Autonoma Metropolitana, Mexico DF, Mexico.
G
G
Borges
Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, NY, USA.
E
E
Bromet
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium.
R
R
Bruffaerts
IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
G
G
de Girolamo
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
R
R
de Graaf
National School of Public Health Management and Professional Development, Bucharest, Romania.
S
S
Florescu
Department of Psychiatry, University of Ibadan, College of Medicine, Ibadan, Nigeria.
O
O
Gureje
National Center for Public Health and Analyses, Sofia, Bulgaria.
H R
HR
Hinkov
Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, P. R. China.
C
C
Hu
Institute of Mental Health, Peking University, Beijing, P. R. China.
Y
Y
Huang
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
I
I
Hwang
Harvard Pilgrim Health Care, Boston, MA, USA.
R
R
Jin
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon.
E G
EG
Karam
EA 4069 Université Paris Descartes and Department of Epidemiology, EHESP School for Public Health, Paris, France.
V
V
Kovess-Masfety
Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel.
D
D
Levinson
Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Germany.
H
H
Matschinger
Psychology Research Institute, University of Ulster, Londonderry, UK.
S
S
O'Neill
Pontificia Universidad Javeriana, Instituto Colombiano del Sistema Nervioso, Bogota, Colombia.
J
J
Posada-Villa
Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
R
R
Sagar
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
N A
NA
Sampson
Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar (SNSPMPDSB), Bucharest, Romania.
C
C
Sasu
Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Cape Town, South Africa.
D J
DJ
Stein
National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
T
T
Takeshima
Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
M C
MC
Viana
Mental Health Department, Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
M
M
Xavier
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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RC
Kessler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D014944:World Health Organization; D055815:Young Adult