The magnitude of and health system responses to the mental health treatment gap in adults in India and China
Abstract
This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate.
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In India, the majority of people with depression lack adequate treatment, with over 90% affected.
“Over 90% of individuals with depression in India do not receive adequate treatment (Patel et al., 2016).”
From Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India (2019) · cites this paper as Patel et al., 2016
Closing the treatment gap for mental disorders requires attention to both supply-side and demand-side barriers.
“The role of help-seeking as a variable assumes importance in the context of the growing recognition that closing the treatment gap for mental disorders requires attention to the supply-side and the demand-side barriers. 3”
From Technology-Based Interventions to Improve Help-Seeking for Mental Health Concerns: A Systematic Review (2022) · cites this paper as [3]
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Siddiqui, F., Varghese, D., Singh, P., Bapuji, S. B., Lindsay, S., Chandrasekara, D., Kulkarni, P., Wu, L., Alshehri, T., & Olivier, P. L. (2023) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3580674 · Cited by 20 · see citing works
- Authors
- Patel, V., Xiao, S., Chen, H., Hanna, F., Jotheeswaran, A. T., Luo, D., Parikh, R., Sharma, E., Usmani, S., Yu, Y., Druss, B. G., & Saxena, S.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Central South University (CN)
- Shanghai Jiao Tong University (CN)
- World Health Organization (CH)
- Public Health Foundation of India (IN)
- King George's Medical University (IN)
- Emory University (US)
- Corresponding author
- Xiao, Shuiyuan
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 388
- Issue
- 10063
- Pages
- 3074-3084
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2402573949
- Cited by
- 342
- References
- 92
- Citations by year
- 2026: 23 · 2025: 34 · 2024: 33 · 2023: 34 · 2022: 46 · 2021: 46 · 2020: 42 · 2019: 35 · 2018: 22 · 2017: 21 · 2016: 6
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Keywords
- mental health treatment gap, unmet mental health needs, adults, India, China, substance use disorders, psychosis, epilepsy, mental health resource allocation, mental health policy, community mental health services, stepped care, mental health stigma, urban-rural differences, service user engagement
- MeSH terms
- Mental Disorders, China, Community Health Workers, Health Policy, Health Services Accessibility, Health Services Needs and Demand, Humans, India, Primary Health Care, Substance-Related Disorders, Healthcare Disparities
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