Mental health issues account for more than a third of total disability in the Region yet just 2% of country’s health budgets go towards preventing and treating these conditions, according to a new PAHO report.

The Burden of Mental Disorders in the Region of the Americas, 2018Washington D.C., 1 March 2019 (PAHO/WHO) – While mental illness is responsible for more than a third of total disability in the Americas, current spending is far below that required to address its public health burden, highlights a new report from the Pan American Health Organization (PAHO). PAHO is urging countries to increase mental health budgets and allocate spending towards more proven, cost-effective interventions.

The report “The Burden of Mental Disorders in the Region of the Americas, 2018” reveals that countries must increase funding in proportion to the burden of mental illness in order to address the needs of people with mental disorders. Funding gaps in mental health vary from three times current spending in high-income countries to 435 times the spending in the lowest-income country in the Region.

‘While it is clear that large funding gaps exist, much can still be achieved through the reallocation of existing funds towards the integration of mental health into primary care and community resources,” said Dr. Claudina Cayetano, PAHO’s Regional Advisor on Mental Health.

“PAHO’s report provides countries with the information and tools required to better respond to mental illness as a global health and development priority.” 
Dr. Claudina Cayetano, PAHO’s Regional Advisor on Mental Health

In Latin America and the Caribbean, mental health issues, including substance use, account for more than a third of total disability in the Region. Of this percentage, depressive disorders are among the largest cause of disability, followed by anxiety disorders. Despite this, mental health accounts for an average of just 2% of country’s health budgets and of this, around 60% is spent on psychiatric hospitals.

“Lower income countries, particularly, compound their lack of resources by allocating already meagre funding to psychiatric hospitals. This means that people with the most common mental health issues, such as depression, anxiety and pain disorders, which can all be efficiently managed in the community, are being left behind,” added Dr. Cayetano.

Investing in psychiatric hospitals is contrary to WHO recommendations, which call for the closure of these facilities, the provision of integrated services for mental illness in primary care or general hospitals, and community treatment plus social support for severely affected individuals. Not only is this more cost-effective, but it also means that those affected by mental illness are more likely to seek treatment. This is because services are easy to access locally, and do not come with the stigma and isolation often associated with psychiatric hospitals.

Funding mental health

Challenges with appropriately funding mental health services include inconsistencies in the reporting of mental health spending across countries; the underestimated burden of mental disorders; and discrepancies between how mental health budget is spent in high and low-income countries.

Lower-income countries, including those in the Region of the Americas, tend to direct the majority of their mental health budgets to funding psychiatric hospitals. The report recommends that countries could still make meaningful improvements in mental health services by diverting budget away from these hospitals and towards funding community and primary mental health services. This will target the majority of disease burden resulting from mood disorders and suicide; substance use disorders; and death by overdose or alcohol-related accidents and illnesses.

“People with mental illness continue to suffer from inadequate and ineffective treatment due to cultural stigma, outdated frameworks and organizational fragmentation.”
Dr. Cayetano

The burden of mental health in the Americas

Mental health is increasingly acknowledged as a global health and economic development priority. For example, the United Nations Sustainable Development Goal 3 explicitly refers to the commitment to achieving universal health coverage inclusive of “mental health and well-being.”

In the Region of the Americas, mental health disorders account for 34% of disability, with little country-level variation. Depressive disorders account for 7.8% of disability in the Region with South America, in general, experiencing higher proportions of disability due to this common mental illness. Central America has a larger proportion of disability due to bipolar and childhood onset disorders, as well as due to epilepsy, than other subregions; and the USA and Canada suffer a higher toll of disability from schizophrenia and dementia, as well as from rates of opioid-use disorder.


The Burden of Mental Disorders in the Region of the Americas, 2018