Abstract
Neuropsychiatric disorders are leading causes of disability worldwide, accounting for 37% of all healthy life years lost from disease. They are among the most disabling conditions even in lowincome countries, where detection of emotional problems and access to treatment are lowest. Although efficacious and tolerable treatments for these disorders are increasingly available, even economically advantaged societies experience competing priorities and budgetary constraints. Knowing how to provide effective treatment is consequently a worldwide imperative. Unfortunately, most countries suffer from a lack of data to guide decisions, absent or competing visions for resources, and nearconstant pressures to cut insurance and entitlements. How can countries redesign their mental health care systems and optimally allocate resources? A first step is to document the services currently being used as well as the extent and nature of unmet needs for treatment. A second step may be to conduct crossnational comparisons of service use and unmet needs in countries with different mental health care systems. Such comparisons have the potential to help uncover optimal financing, national policies, and delivery systems for the care of mental disorders. Unfortunately, few crossnational studies of such differences are available. For these reasons, the World Health Organization established the World Mental Health Survey Initiative in 1998. Coordinated surveys of the prevalence of mental disorders, their severity, impairments, and treatments have been implemented and analysed in 24 developing and developed countries. This chapter describes the levels, types, and adequacy of mental health service use in these countries. It also examines unmet needs for treatment among strata defined by the seriousness of mental disorders. Finally, it identifies sociodemographic correlates of unmet needs for treatment to guide the design and targeting of future resources, policies, and interventions.