Only seven out of 100 people worldwide receive effective treatment for their mental health or substance-use disorders

Researchers from the University of British Columbia and Harvard Medical School analyzed survey data from nearly 57,000 participants in 21 countries collected over a 19-year period, to provide the clearest picture yet of where people discontinue their path to effective treatment for nine common anxiety, mood and substance-use disorders.

The biggest barrier to effective treatment is a person not recognizing that they need it, the study showed. However, even patients who contact the healthcare system often do not receive effective treatment.

"This survey data has allowed us to create the only effective treatment indicator that exists for mental health and substance use," said lead author Dr. Daniel Vigo, associate professor at UBC's department of psychiatry and school of population and public health. "Policy decisions and allocative decisions for funding should be guided by data, and this hasn't always been the case in the realm of mental health and substance use."

The World Health Organization-World Mental Health Surveys Initiative collects data on the prevalence, severity and treatment of mental disorders worldwide. This study focused on survey participants who met criteria for a disorder under the Diagnostic and Statistical Manual of Mental Disorders-IV, a standardized classification system used by mental health professionals from 1994 to 2013.

The team, led by Dr. Vigo and Dr. Ronald Kessler of Harvard, was interested in how close participants got to receiving effective treatment that met evidence-based guidelines -- and where they might have dropped off along the way.

They analyzed four key steps, and the percentage of people who proceeded from each step to the next:

1. Recognizes their need for treatment
2. Makes contact with the healthcare system about it
3. Receives a minimum level of adequate treatment
4. Receives effective treatment

They found:

• Only 46.5 per cent of people who met the criteria for a disorder recognized their need for treatment.
• Of those who did recognize their need, only 34.1 per cent turned to the medical system for help.
• Most who sought help (82.9 percent) received a minimum level of adequate treatment.
• About 47 per cent of people who received minimally adequate treatment ended up receiving effective treatment.

Attrition at various points along this pathway meant that only 6.9 per cent ended up receiving effective treatment.

"Understanding where the bottlenecks are for each of these disorders provides a unique and previously unavailable blueprint for decision makers to understand problems objectively and try to adjust the system," said Dr. Vigo.

The study revealed a significant drop-off after patients contacted the healthcare system but before they received effective treatment. Since general practitioners and family doctors are typically their first point of contact with the system, it's essential to make sure those doctors have appropriate training, said Dr. Vigo.

"Improving the ability of these general practitioners and family doctors to diagnose and treat the mild to moderate forms, and to know when to refer more severely affected folks to specialists, becomes the cornerstone of the system," he said.