By Kimberly Leonard
July 14, 2015


Reports in recent months have pointed out a lack of services and insufficient insurance provisions for Americans who have a mental illness, but a new survey shows that globally people are much worse off. 

Across the world, nearly 1 in 10 people have a mental health disorder, yet nearly half of the world lives in a country where there is less than one psychiatrist per 100,000 people. The worldwide median for mental health workers is 9 per 100,000 people.

Despite the need for services, only 1 percent of the global health workforce is working in mental health, and the reported number of psychiatrists has declined 6 percent since 2011 – the last time the survey was published. 

The report, the Mental Health Atlas, was published Tuesday by the World Health Organization and is the fourth installment since its introduction in 2001. To assemble results, WHO sent a questionnaire to its 194 member countries, 171 of which participated. The survey, conducted in 2014, asked about the prevalence of mental health care workers, the amount spent on mental health and the availability of governments prevention programs, among other measures. 

Unsurprisingly, the report found wealthier countries have a higher number of mental hospital beds and admission rates than low-income countries, which have nearly 42 beds and 142 admissions per 100,000 population. 

Part of this is because of financial investment in services, which is more difficult for countries that have fewer resources. The report found that low- and middle-income countries – like North Korea, Eritrea, Haiti and Morocco – spend less than $2 per person, per year on mental health. High-income countries – like the U.S., Spain, Singapore and Qatar – spend $58.73 per person annually. The majority of spending, regardless of country wealth, goes to mental hospitals. 

Other than financial investment, laws and programs to raise awareness about mental illness can help people access the medical care they need. Still, less than half (41 percent) of countries WHO surveyed have at least two functioning mental health promotion and prevention programs. Of these, more than half were aimed at improving mental health literacy or combating stigma. 

WHO organized the results according to its six regions: Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia and the Western Pacific.

Part of the purpose of the report is to track improvements in care. In 2013, WHO launched its "Mental Health Action Plan," a set of goals it would aim to reach by 2020 to improve mental health care. The plan would encourage countries to report mental health indicators every two years, would increase the number of prevention programs and would broaden coverage across the world for mental disorders. 

A portion of the plan makes suicide prevention a priority, aiming to reduce its incidence 10 percent by 2020. In 2012, suicide accounted for 804,000 deaths worldwide. According to the report, suicide rates are higher in high-income countries than in low-income countries – despite government investment and programs aimed at prevention. 


Even Mild Mental Health Problems In Children Can Cause Trouble Later

Ina Yang

July 15, 2015


It's not easy for a child who has had mental health issues to make a successful transition into adulthood. But even children who have symptoms that are mild enough that they wouldn't be diagnosed are more likely to struggle with life as adults, a study finds.

Children and teenagers with a psychiatric disorder had six times higher odds of having at health, legal, financial and social problems as adults, according to a study published Wednesday in JAMA Psychiatry. Those with milder symptoms were three times more likely to have problems as adults.


We already know from previous studies that most adults with mental health issues had a previous psychiatric disorder during childhood – it doesn't have to be the same exact condition. But this study shows mental health problems that occurred during childhood can make it more likely that someone will struggle as an adult, making it more likely that they won't graduate from high school or commit a felony, for instance.

The data comes from a population study that followed children starting at ages 9, 11 or 13 in 11 mostly rural counties in North Carolina from 1993 to 2010. Participants were interviewed every year until they turned 16, then again at 19, 21 and 25.

They were tested for symptoms of common childhood psychiatric disorders such as anxiety disorder, social phobia, depression and ADHD. Those affect 1 percent of the population at any given time.

The researchers wanted to know if a common mental illness is distressing and impairing to a child or teenager at the moment, does it continue to impact after they go into adulthood, Copeland tells Shots.

"Most common chronic conditions happen in middle adulthood, with the exception of mental illness," says William Copeland, lead author of the study and an associate professor of psychiatry at Duke University School of Medicine.

But for mental illness, symptoms usually first appear in childhood, and have the biggest impact in terms of financial cost, mortality and other indicators – a term known as disease burden – on youths from 10 to 24 globally.

But there are also a lot of people who report mental health problems that are significantly impairing their lives but don't count as having a psychiatric disorder under standardized criteria for diagnosis, according to Copeland. This is no small group – as many as half of the patients who go to a doctor for psychiatric disorders do not meet the established criteria, he says.

This is no minor problem, says Copeland, "the vast majority of them aren't getting help at all because they don't meet threshold, but [the impact] is still significant enough that they need help down the road," Copeland says.

Of course, a bad environment growing up doesn't help, so Copeland and team also took into account factors such as an unstable, dysfunctional or poor family background and retested the data. The results still hold true.

It's important to understand that the data from the study is not necessarily people who think they have mental disorders, but a random sample who were tested as part of the study and shown to have these symptoms, says Daniel Klein, professor of clinical psychology at Stony Brook University. In some cases the symptoms are very mild, and people don't see themselves as having a mental disorder.

And that's a problem.

"As a society we're prone to think of childhood as a relatively carefree life, obviously with exceptions, and most of the mental disorders you think about are in adults, except ADHD and autism, but the whole gambit are there in childhood," says Klein, who was not part of the study.

"People are coming around to the notion that these [mental health] problems are significant and can have long term affects," says Copeland. "Kids continue to have problems in adulthood even if it's not psychiatric problems."

It's important that we make treatment and prevention programs accessible in childhood, Klein say. On that, "we're doing a terrible job."

An editorial in the same issue of JAMA Psychiatry echoed that thought. Ben Lahey, a professor of epidemiology at the University of Chicago, believes that we as a society don't invest enough in mental health treatment, especially when it comes to children and adolescents, to reduce the burden later in adulthood.

Lahey also points out an important missing part of the puzzle: "The paper, and several papers before it, all they establish is childhood disorders predict adult disorders, they can't tell us why. Correlation does not imply causation."

Copeland agrees, saying, "We're talking about odds and relative risks." Copeland says of the study, But he also adds, "We want to do things that reduce the rate of mental health problems in general."