Aliya Bashir, GPJ, Indian-Administered Kashmir

Access to Psychiatric Care Varies Widely Around World


Article Highlights

Social stigma deters Kashmiris from obtaining treatment for mental illnesses. The Institute of Mental Health and Neurosciences is the only place where Kashmiris can obtain free or low-cost medical care for mental illnesses.  

In some poor countries, you can count the number of psychiatrists on one hand. In wealthier regions, it’s easy to find someone who can treat a mental health problem.

Here’s the good news: The number of psychiatrists in Cameroon more than doubled in recent years.

The bad news? Now there are still just seven psychiatrists in that country of over 22 million people, Dr. Jean-Pierre Olivier Kamga Olen wrote in an email. In 2008, he was the third doctor there with that specialty.

Cameroon, a mostly rural nation nestled in the belly of west central Africa, where desert meets tropics, has one of the world’s lowest ratios of psychiatrists to citizens – 1:3.3 million, according to a 2011 survey by the World Health Organization.

Argentina is on the opposite end of the spectrum.

There, where mental health services are widely available and culturally accepted, there are more than 5,000 psychiatrists, according to 2005 statistics from the World Health Organization, the most recent data available.

That’s a whopping 833 times the number of psychiatrists in Cameroon, a country with half as many people.

The dearth of psychiatrists is especially acute in rural areas.

In poorer countries throughout the world, specialists are usually clustered in capital cities, says Zeinab Hijazi, a mental health and psychosocial officer with the International Medical Corps, a nonprofit organization that provides health care training.

That means huge portions of many countries, especially rural communities, have no access to mental health care.

For people with mental illnesses, being born in a low-income country – defined by the World Bank as one where gross national income per capita income is $1,045 or less – often means a life sentence of symptoms that might be easily treated elsewhere.

Per capita spending for mental health care is as low as 20 cents in low-income countries but approaches $45 in high-income nations, according to a 2011 World Health Organization report on global mental health.

Treatment isn’t perfect anywhere, but mentally ill people in countries that lack community-based mental health care often face employment discrimination and extreme poverty, the World Health Organization reports. Many are denied the right to vote, marry or have children.

But while more psychiatrists are desperately needed, simply adding to the number of psychiatrists won’t necessarily fix the problem, says Dr. Carla Marienfeld, a psychiatrist with Yale Psychiatry Residency’s Global Mental Health Program, which aims to increase awareness of global mental health issues and social disparities.

“Psychiatrists alone are neither sufficient nor appropriate to address all the mental health needs,” she says. “There needs to be a collaborative, multidisciplinary approach that is appropriate for the background and culture of the population in need.”

Mental health practitioners serving any community are most successful when they represent the community’s cultures, values and beliefs, she says.

Further, those doctors and their staffs must have access to medicinal resources, says Ellen R. Mercer, a board member with the World Federation for Mental Health. Before joining that organization, Mercer spent most of her 25 years at the American Psychiatric Association as director of the Office of International Affairs.

“If there is no way to get psychiatric medication, it is impossible to have quality mental health care,” she says.

Hijazi’s organization integrates basic mental health services into primary health care, a service that’s available in most areas.

“We want to make sure staff are able to identify mental health illnesses,” she says, adding that International Medical Corps trains general health care providers to treat basic mental health problems and refer patients with more severe illnesses to specialists.

Most mental health problems can be treated at minimal expense, Hijazi says.


“Mental health sometimes is just about people having access to basic services,” she says.