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Barriers to mental health treatment: results from the WHO World Mental Health surveys

Published online by Cambridge University Press:  09 August 2013

L. H. Andrade
Section of Psychiatric Epidemiology–LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
J. Alonso
Health Services Research Unit, IMIM (Hospital del Mar Research Institute), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Z. Mneimneh
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon Survey Methodology Program, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
J. E. Wells
Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand
A. Al-Hamzawi
Al-Qadisia University College of Medicine, Diwania Teaching Hospital, Diwania, Iraq
G. Borges
Instituto Nacional de Psiquatria Ramon de la Fuente and Universidad Autonoma Metropolitana, Mexico DF, Mexico
E. Bromet
Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, NY, USA
R. Bruffaerts
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
G. de Girolamo
IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
R. de Graaf
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
S. Florescu
National School of Public Health Management and Professional Development, Bucharest, Romania
O. Gureje
Department of Psychiatry, University of Ibadan, College of Medicine, Ibadan, Nigeria
H. R. Hinkov
National Center for Public Health and Analyses, Sofia, Bulgaria
C. Hu
Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, P. R. China
Y. Huang
Institute of Mental Health, Peking University, Beijing, P. R. China
I. Hwang
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
R. Jin
Harvard Pilgrim Health Care, Boston, MA, USA
E. G. Karam
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon
V. Kovess-Masfety
EA 4069 Université Paris Descartes and Department of Epidemiology, EHESP School for Public Health, Paris, France
D. Levinson
Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
H. Matschinger
Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Germany
S. O'Neill
Psychology Research Institute, University of Ulster, Londonderry, UK
J. Posada-Villa
Pontificia Universidad Javeriana, Instituto Colombiano del Sistema Nervioso, Bogota, Colombia
R. Sagar
Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
N. A. Sampson
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
C. Sasu
Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar (SNSPMPDSB), Bucharest, Romania
D. J. Stein
Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Cape Town, South Africa
T. Takeshima
National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
M. C. Viana
Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
M. Xavier
Mental Health Department, Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
R. C. Kessler*
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 021 15USA. (Email:



To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.


Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 636 78) and analyzed at different levels of clinical severity.


Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).


Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

Original Articles
Copyright © Cambridge University Press 2013 

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