title: The magnitude of and health system responses to the mental health treatment gap in adults in India and China.
abstract: This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK; Centre for the Control of Chronic Conditions, Guragon, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China. Electronic address: xiaosy@csu.edu.cn.
authors.forename: Shuiyuan
authors.initials: S
authors.lastname: Xiao
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hanhui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
authors.forename: Fahmy
authors.initials: F
authors.lastname: Hanna
authors.affiliation: Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
authors.forename: A T
authors.initials: AT
authors.lastname: Jotheeswaran
authors.affiliation: Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Luo
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.
authors.forename: Rachana
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Eesha
authors.initials: E
authors.lastname: Sharma
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Shamaila
authors.initials: S
authors.lastname: Usmani
authors.affiliation: Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Mental Health School of Public Health: Health Policy & Management, Emory University, Atlanta, GA, USA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Druss
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D002681:China; D003150:Community Health Workers; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007194:India; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D011320:Primary Health Care; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000191:economics / Q000628:therapy*