Cited by 343Mental Health Treatment and AccessPsychiatric care and mental health servicesHistorical Psychiatry and Medical Practices

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The magnitude of and health system responses to the mental health treatment gap in adults in India and China

Patel, Vikram, Xiao, Shuiyuan, Chen, Hanhui, Hanna, Fahmy, Jotheeswaran, A T, Luo, Dan, Parikh, Rachana, Sharma, Eesha, Usmani, Shamaila, Yu, Yu, Druss, Benjamin G, Saxena, Shekhar·2016·The Lancet

DOI 10.1016/s0140-6736(16)00160-4

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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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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
ORCID: Patel, Vikram
Xiao, Shuiyuan
Luo, Dan
Parikh, Rachana
Yu, Yu
Druss, Benjamin G
Saxena, Shekhar
Venue: The Lancet
Publisher: Elsevier BV
Published: 2016-12
Volume: 388
Issue: 10063
Pages: 3074-3084
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(16)00160-4
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Funders: World Health Organization
Topics: Health Sciences › Medicine › Psychiatry and Mental health › 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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The magnitude of and health system responses to the mental health treatment gap in adults in India and China

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