Click here to read The World Health Report 2001. Mental Health: New understanding, new hope.

Though considerable information has recently become available on epidemiology and burden of mental disorders, very little is known about the resources available for mental health care within countries. Accurate information is crucial for programme development and serves as a baseline for monitoring changes.

Project ATLAS aims to meet this need by collecting basic information on mental health resources from all Member States to construct global and regional databases, maps and profiles. Preliminary analysis of information collected during the initial study, from October 2000 to March 2001, from 181 countries covering 98.7% of the world’s population is now available. The information was collected using a questionnaire completed by the mental health focal point within the countries.

Of the countries studied 43% have no mental health policy; 23% have no legislation on mental health; 38% have no community care facilities; in 41%, treatment of severe mental disorders is unavailable in primary health care; and more than half of the beds for mental health care are in mental hospitals.
Serious disability caused by mental disorders is often not considered for state disability benefits. Out of the 174 countries where information about disability benefits is available, more than a quarter do not provide state or public disability benefits for mental illness.

Mental Health in Primary Care and Community Care
While it is agreed that most mental disorders are best managed at the primary care level, this has proven difficult to achieve in practice.

Eighty-five per cent of countries report that mental health services are available at primary health care level, but actual treatment is reported to be available only in 59%.

A national therapeutic drug policy or a list of essential drugs is present in most countries however, in many countries, policies have been developed in the last 5 years, hence the benefits of this policy have not fully filtered down to the consumer level. More than 25% of the countries do not have the most commonly prescribed antipsychotic, antidepressant, and antiepileptic drugs considered essential for the treatment of common mental and neurological disorders at the primary health care level.

Community-based care is not available in 38% of the countries. Even in countries that have community care, the coverage is far from complete.

Human Resources and Inpatient Facilities
About 71% of all people in the world have access to less than one psychiatrist per 100,000 people. Access to psychiatric nurses is also poor; 46% have access to less than one nurse per 100,000.

While the countries in the African region of WHO have only about 1,200 psychiatrists and 12,000 psychiatric nurses for a population of about 620 million, the European region has more than 86,000 psychiatrists and 280,000 nurses for a population that is only about 36% more (total population 840 million).

Though mental hospitals with a large number of beds are not recommended for mental health care, a certain number of beds in general hospitals for acute care is considered essential. There is a wide variation in beds available for mental health care. Nearly two-thirds of the world’s population has access to less than 1 bed per ten thousand population. Even more disappointing, more than half of all the beds are still in mental hospitals. These often provide custodial care rather than mental health care.

Monitoring and Data Collection System
More than 27% countries have no system of reporting mental health data in their annual health report. Those who have such a system often lack any meaningful information. Often only the number of admissions and discharges from mental hospitals is recorded. This lack of monitoring makes detecting changes almost impossible.

Programmes for Special Populations
Programmes for special populations are present in a small number of countries. Programmes for minorities and indigenous populations are not present in the majority of the countries. Programmes for the elderly and for children are present in only 48% and 59% respectively.

Overall, the mental health resources in countries present a dismal picture of severe shortage, neglect and apathy. However, there are some rays of hope. A large number of countries have established policy, programmes and new legislation in the last 5 years. NGOs have also started becoming active. These include consumer groups and family groups that have the capacity to bring about a change in the system. A concerted action by governments, professionals and the community is needed to improve the mental health resources situation in the world.