Governments in the Americas tend to underfund and misallocate spending on mental health, according to a study recently published in The Lancet Public Health. Such imbalances result in a disproportionate burden on low-income countries and create insufficient treatment, more preventable death and disability, lower job participation, and more individual spending on health care.

This ecological, cross-sectional study included data from 30 countries from the year 2015. Data were collected from the Global Health Data Exchange, whereas the World Health Organization’s Assessment Instrument for Mental Health Systems and its Mental Health Atlas provided information on mental health spending for different countries compared with their total health spending. Linear regression in log-log form was used to investigate the 3 proportional relationships with real gross domestic product described above.

Self-harm and mental, neurological, and substance use disorders accounted for 19% of all disability-adjusted life-years within the Americas, while the broader category of noncommunicable diseases accounted for 78%. Mental health care spending accounted for 2.4% (interquartile range [IQR], 1.3-4.1) of total government spending on health, with 80% (IQR, 52-92) of this given to psychiatric hospitals.

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The proportion of disease burden to efficiently assigned spending was minimal in the USA and Canada (3:1) and maximal in Haiti (435:1; median 32:1; IQR, 12-170). Real GDP showed a positive correlation with a higher ratio of government mental health spending to total health spending (β=0.68; 95% CI, 0.24-1.13; =.0036) and an inverse correlation with higher proportions allotted to psychiatric hospitals (β=-0.5; 95% CI, -0.79 to -0.22; =.0012) and efficient spending allocation imbalance (β=–1.38; 95% CI, -1.97 to -0.78; =.0001).

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The researchers conclude that “[in] the Americas, [mental, neurological, and substance use disorders, and self-harm] are the largest subgroup cause of disease burden, both when considering disability alone and combined with mortality; they comprise a third of total [years lived with disability] and a fifth of total [disability-adjusted life-years]. …Instead of allocating most funds to specialised hospitals, countries should prioritise mental health services integrated into primary care and delivered in the community — a strategy that would target not only the direct burden resulting from [mental, neurological, and substance use disorders, and self-harm] but also the excess mortality due to treatable causes, which are ineffectively cared for because of stigma, insufficient community support, and poorly integrated health services.”


Vigo DV, Kestel D, Pendakur K, Thornicroft G, Atun R. Disease burden and government spending on mental, neurological, and substance use disorders, and self-harm: cross-sectional, ecological study of health system response in the Americas [published online November 13, 2018]. Lancet Public Health. doi: 10.1016/S2468-2667(18)30203-2