News Release

The serious shortfall of mental health workers at all levels

Peer-Reviewed Publication

The Lancet_DELETED

Human resources for mental health are inadequate in most countries of low and middle income and are likely to worsen unless substantial investments are made and effective strategies are implemented. In the fifth paper in The Lancet Series on Global Mental Health, the numbers are examined in detail, and strategies for progress suggested. The paper is by Dr Ritsuko Kakuma, Melbourne School of Population Health, University of Melbourne, VIC, Australia, and colleagues.

Evidence on the number of mental health workers comes from WHO's 2011 Mental Health Atlas, which reports data from 183 nations covering 99% of the world's population. Globally, nurses are the largest workforce category in the mental health system, with a median of 4•95 nurses per 100 000 population, followed by psychiatrists (1•27 per 100 000 population). High-income countries had far more psychiatrists, with the median number 172 times greater than in low-income countries (8•59 vs 0•05 per 100 000). High-income countries have shown the biggest median increase in psychiatrist numbers from 2005 to 2011, (by 0•65 per 100 000). The increase was smaller in upper middle-income countries (0.3 per 100 000), with no change in lower middle-income countries and a slight decline in low-income countries.

The estimated total number of mental health care workers needed in the 58 countries of low and middle income in 2005 was 362 000, representing 22•3 workers per 100 000 population in low-income countries and 26•7 workers per 100 000 in middle-income countries, comprising 6% psychiatrists, 54% nurses in mental health settings, and 41% psychosocial care providers. These data reflect an overall shortage of 239 052 mental health workers (17•3 workers per 100 000 population in low-income countries and 14•9 per 100 000 population in middle-income countries). Based on this result, a shortage of 1•18 million mental health workers was reported for all 144 countries of low and middle income.

Evidence suggests that community-based programmes and task-shifting (also called task-sharing) approaches will be the most cost-effective ways to fill this gap. The authors provide case studies from Sri Lanka, India and Indonesia to illustrate this. Sri Lanka faces a continual 'brain drain' of psychiatrists to high-income countries: in 2007, the country has just 25 psychiatrists whereas a further 142 initially trained in Sri Lanka now work in wealthy nations. Following the 2004 tsunami, a new category of worker was created: the community support officer. These 128 community support officers refer more than half of all inpatients, and also manage more than 1500 people with mental disorders in the community.

Significant financial investments are required to fill the mental health human resources gap. The annual wage bill to eliminate shortages in human resources for mental health in countries of low and middle income will be considerable. Just for wages alone the estimated bill was about US$814 million in 2005 ($894 million in 2009): $80 million for psychiatrists, $420 million for nurses in mental health settings, and $314 million for psychosocial care providers.

The authors conclude: "Human resources for mental health continue to be grossly inadequate in most countries of low and middle income. The shortage is likely to worsen unless substantial investments are made to train a wider range of mental health workers in much higher numbers. Task shifting seems to be an effective and feasible approach but it too will entail substantial investment, innovative thinking, and effective leadership."

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Dr Ritsuko Kakuma, Melbourne School of Population Health, University of Melbourne, VIC, Australia. T) +61 3 0844 0654 E) ritz.kakuma@gmail.com


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