Global Mental Health Series: Scarcity, Inequity and Inefficiency

The featured paper is ‘Resources for mental health: scarcity, inequity and inefficiency’ by Shekhar Saxena, Graham Thornicroft, Martin Knapp and Harvey Whiteford. In this paper, which the authors describe as a selective review, they cover what are described as the three main barriers to improving mental health – scarcity, inequity and inefficiency. The authors also argue that these barriers are more pervasive in the World Bank identified low and middle income countries.

The discussion of scarcity of resources is broken down into a number of sections which include policy and infrastructure, mental health services, community, human and financial resources. In terms of policy the authors note that 22% of countries do not have mental health laws, whilst 45% of low-income countries do not provide benefits for people with mental illnesses. In the US as well, it is noted that some insurance schemes do not cover people with certain conditions. The cost-effectiveness of community services is discussed as is the relative paucity of such services in low-income countries and the relatively high cost of medication. A 200-fold increase in the number of health professionals per 100,000 of the population high versus low-income countries, for various reasons, is cause for reflection.

The discussion of inequity is broken down into sections on socioeconomic status, human rights as well as stigma and discrimination. Amongst many other issues, disparities between access to care are discussed together with public perceptions of mental illness and concealment of mental illness in people which varies according to geography and population. In the section on inefficiency the authors discuss the need to adapt services to the needs of the country, for instance older generic medications can have a higher cost-benefit than newer medications. The implications for policy and practice are then discussed including the need for investment of resources.

This is another important article in the series and raises a number of significant issues.

STT1

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