Global Mental Health: Escalating Psychiatric Care Shortage

“Mental health is one of the most neglected areas of public health. Close to 1 billion people are living with a mental disorder, 3 million people die every year from the harmful use of alcohol and one person dies every 40 seconds by suicide. And now, billions of people around the world have been affected by the COVID-19 pandemic, which is having a further impact on people’s mental health.

Yet, relatively few people around the world have access to quality mental health services. In low and middle-income countries, more than 75% of people with mental, neurological and substance use disorders receive no treatment for their condition at all. Furthermore, stigma, discrimination, punitive legislation and human rights abuses are still widespread.” states WHO.

According to the Global Burden of Disease study, a comprehensive assessment of mortality and disability from mental health disease, including non-communicable diseases worldwide and neuropsychiatric disorders attribute for over 10% of the global burden of disease.

Furthermore, mental, neurological, and substance use (MNS) disorders are the leading contributors to years lived with disability.

While the physical, social, and economic burden of mental illness is great, the World Health Organization’s Mental Health Atlas reports that the median number of mental health workers globally is 9 per 100,000 population with extreme variation between low-income and high-income countries.

Monaco is one the world’s hotspots for the super rich but it’s also the country with the most psychiatrists per capita worldwide. In 2014, the tiny principality had 41 practitioners per 100,000 of its population, according to the World Health Organization.

Therapy is a big part of life in Argentina. The country has the highest number of psychologists per capita in the world, with around 198 psychologists per 100,000 inhabitants, an estimated 46% of whom are in Buenos Aires.

In contrast, the Member States with the lowest number of psychiatrists relative to the size of the population were Bulgaria (8 per 100,000 inhabitants), Poland (9), Malta and Spain (both close to 10).

The US, with only about 5% of the earth’s population, has about 30% of the world’s psychiatrists.

Rural and underserved communities in general are especially hard hit. Doing the math, AAMC determined that 5,906 psychiatrists were needed in 2017 to fill the gap, leaving demand at 13.5 percent more than supply.

Using predictive modeling, the organization predicts a shortage of 3,400 psychiatrists by 2032. Furthermore, geographic maldistribution adds to the difficulties with access to care. For example, in China about 80% of psychiatrists are in urban areas, while about 80% of the population still lives in the countryside.

Knowing how unavailable psychiatric care is for much of our own population gives even more clarity to the magnitude of the mental health care gap across most of Asia. In 1950, Asia had 44% of the world’s elderly population, but by 2050 the number will be 62% and accounts for about 50% the world’s cases of dementia.

The increasing demand for not only medical and psychiatric care for these individuals, but for social services as well is a problem for which no solution has yet been developed. With younger generations migrating to urban areas, homecare is becoming no longer an option, as traditional family care for seniors disappears.

Cambodia has about 50 psychiatrists for 10 million people, Bangladesh has 200 for 150 million, India has about 3500 for over a billion people, and China about 10,000 for over a billion.

“Professor Udomratn emphasized that much of Asia is a geologically very active area. That fact, paired with effects of climate change, he asserted, means that increasing attention to the mental health sequelae of natural disasters is of critical importance when developing the mental health system of the future.

He said that from a public health perspective of mental illness, depression, PTSD, autism spectrum disorder, dementia, delirium, and all types of addictions should receive special attention in Asia in addition to the usual attention to all other significant disorders.

On the basis of an increasing body of research, he believes that Internet addiction is a real illness that currently has significant impact in Asia, and which will be an increasing cause of morbidity in the coming years.” says Psychiatric Times.

Is a Psychiatrist the Same as a Psychologist?

The terms “psychiatry” and “psychology” are often used interchangeably, but they are quite different. A psychiatrist is a physician who has a medical degree, whereas a psychologist is a non-physician professional who has completed a doctoral degree, rather than medical school. Psychiatrists work with patients, whereas psychologists work with clients. And while a psychiatrist can prescribe medications, psychologists usually cannot.

More people are seeking mental health treatment, but there aren’t enough psychiatrists to meet the demand.

New Models of Mental Health Care

Learn what academic medicine is doing to help deliver care now and train more psychiatrists for the future.

Telepsychiatry including videoconferencing for patient evaluation, medication management, and therapy—is one effective way to deliver more care to remote areas, says James Shore, MD, an associate professor of psychiatry at the University of Colorado School of Medicine who has expertise in telemedicine.

“Telemedicine also expands the workforce,” Shore adds, “in that it offers the flexibility to work from home or in circumstances when practitioners otherwise might not be available. Also, access to more varied client populations can decrease burnout and thereby increase workforce retention.”

The concept of therapy online is growing globally and corporations have begun to use this tool for employees as part of their hiring contract packages. Working with patients online, both therapist and patient have more expanded options for access, appointment times and privacy. This may just become the new vogue to psychiatric care.

10 October is World Mental Health Day

The overall objective of World Mental Health Day is to raise awareness of mental health issues around the world and to mobilize efforts in support of mental health.

The Day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide.

NOTES:

“It is nearly 30 years since the first World Mental Health Day was launched by the World Federation for Mental Health,” said Dr Ingrid Daniels, President of the World Federation for Mental Health. “During that time, we have seen an increasing openness to talk about mental health in many countries of the world. But now we must turn words into actions. We need to see concerted efforts being made to build mental health systems that are appropriate and relevant for today’s and tomorrow’s world.

“With so many people lacking access to good quality, appropriate mental health services, investment is needed now more than ever,” said Elisha London, Founder and CEO of United for Global Mental Health.

“Everyone, everywhere can participate in this year’s campaign. Whether you have struggled with your own mental health, know someone who has been affected, are a mental health expert, or if you simply believe that investing in mental health is the right thing to do, move for mental health, and help make mental health care and support accessible for everyone.”

Five years ago it was reported: “The shortage of psychiatrists is an escalating crisis,” notes the physician search firm Merritt Hawkins in a 2017 report. The gap is of more severity than shortages faced in virtually any other specialty.”

“Our whole society is affected by untreated mental illness,” says Anna Ratzliff, MD, PhD, associate professor of psychiatry at the University of Washington (UW) School of Medicine. “It affects people’s ability to work, build relationships, and contribute to their communities.”

Mental health services are an essential part of all government responses, especially to COVID-19 or war zones. Lockdowns and quarantines must not discriminate against those with poor mental health.

Policies globally must support and care for those affected by mental health conditions, and protect their human rights and dignity.