TREATMENT GAP IN THE AMERICAS

A report for the Pan American Health Organization Prepared by:

Robert Kohn, MD1

Professor of Psychiatry and Human Behavior

The Warren Alpert Medical School of Brown University

EXECUTIVE SUMMARY

? Well-designed epidemiological studies that provide information on the prevalence of mental illness and service utilization of mental health services exist in North America and in a number of countries in Latin America and the Caribbean (LAC) for adult populations, as well as for children and adolescents.

? Information on mental health resources and services are available for nearly all countries in the Americas from the World Health Organization (WHO) Atlas projects and the WHO-AIMS (World Health Organization Assessment Instrument for Mental Health Systems). These databases revealed that disparities continue to exist in mental health services and resources even among high-middle income countries, and that the mental hospital continues to be the focal point of care, despite that a lower treatment gap in schizophrenia is associated with outpatient programs and community follow-up.

? The availability of more representative data of the population of the Americas on mental health services and prevalence of mental illness has provided a better understanding of how wide the treatment gap has emerged for the Region.

? Among adults with severe and moderate affective disorders, anxiety disorders and substance use disorders, the median treatment gap is estimated to be 73.5% for the Americas, 47.2% for North America, and 77.9% for LAC. For all disorders regardless of severity the treatment gap in the Americas is 78.1%. The treatment gap in the United States for schizophrenia is 42.0%, whereas in LAC the treatment gap is 56.4%.

? The median treatment gap for the Americas for children and adolescents is 63.8% and 52.6% for severe mental disorders.

? Mental health services utilization studies of the indigenous population showed a very low use of formal mental health services among the mentally ill.

? Barriers to care continue to need to be bridged, and are one of the main obstacles to reducing the treatment gap.