Mental Health Atlas 2017

M E N TA L H E A LT H
ATLAS
M E N TA L H E A LT H
ATLAS
Mental health atlas 2017
ISBN 978-92-4-151401-9
© World Health Organization 2018
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CONTENTS
PROJECT TEAM AND PARTNERS iv
PREFACE v
EXECUTIVE SUMMARY 1
INTRODUCTION 4
METHODOLOGY 6
RESULTS 9
1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS 10
2. MENTAL HEALTH SYSTEM GOVERNANCE 14
3. FINANCIAL AND HUMAN RESOURCES FOR MENTAL HEALTH 25
4. MENTAL HEALTH SERVICE AVAILABILITY AND UPTAKE 35
5. MENTAL HEALTH PROMOTION AND PREVENTION 48
REFERENCES 53
APPENDIX A: List of participating countries and contributors 54
APPENDIX B: Glossary of terms 60
RESULTS | 1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS iii

PROJECT TEAM AND
PARTNERS
Mental Health Atlas is a project of the World Health Organization. The overall
vision and conceptualization of the project is provided by Shekhar Saxena.
Mental health Atlas 2017 is the latest in a series of publications that first
appeared in 2001, with subsequent updates published in 2005, 2011 and
2014. This edition of Mental Health Atlas is supervised and coordinated by
Tarun Dua and Fahmy Hanna.
In WHO Member States, key project collaborators were the mental health
focal points in Ministries of Health, who provided information and responses
to the Atlas survey questionnaire and to follow-up queries for clarification. A
full list of collaborators is provided as Appendix A of this report.
Mental Health Atlas team members from WHO Regional Offices, who
contributed to the planning and collation of data and liaised with focal points
in Member States, were: Sebastiana Da Gama Nkomo (WHO Regional Office
for Africa); Dévora Kestel and Matías Irarrázaval (WHO Regional Office for
the Americas); Khalid Saeed (WHO Regional Office for the Eastern
Mediterranean); Dan Chisholm and Elena Shevkun (WHO Regional Office for
Europe); Nazneen Anwar (WHO Regional Office for South East Asia); Martin
Vandendyck (WHO Regional Office for the Western Pacific).
At WHO Headquarters, a team of staff and consultants comprising Corrado

Barbui, Antonio Lora, Tarun Dua, Fahmy Hanna, Grazia Motturi, Dan Chisholm,
Alexandra Fleishmann and Marieke van Regteren Altena provided the central
technical and administrative support to the project, including development
of the questionnaire and an associated completion guide, management of
the online data collection system, validation of information and responses,
liaison with Member States and WHO Regional Offices, as well as analysis
of data and preparation of this report. They received inputs and advice from
the following colleagues: Mark van Ommeren, Neerja Chowdhary, Chiara
Servili, Nathalie Drew, Michelle Funk, Katrin Seeher and Meredith Fendt-
Newlin. This edition of Atlas received valuable input and support from the
following WHO Interns particularly; Brandon Gray, Joseph Heng, Maike Kristin
Lieser and Peter Deli.
The development of the Atlas 2014 questionnaire and its update in 2017 was
overseen and approved by an expert group, consisting of Florence Baingana,
Harry Minas, Antonio Lora, Crick Lund, Pratap Sharan and Graham Thornicroft.
The contribution of each of these team members and partners, which has
been crucial to the success of this project, is very warmly acknowledged. IT
support and advice for the online data collection platform was provided by
Marcel Minke. The graphic design of this publication was carried out by L’IV
Com Sàrl.
iv MENTAL HEALTH ATLAS 2017

PREFACE
T
he Mental Health Atlas 2017 is remarkably significant as it is providing information and data on the
progress towards the achievement of objectives and targets of the Comprehensive Mental Health Action
Plan 2013–2020 to be measured. This Action Plan contains four objectives:
(1) To strengthen effective leadership and governance for mental health;

(2) To provide comprehensive, integrated and responsive mental health and social care services in community-
based settings;
(3) To implement strategies for promotion and prevention in mental health;
(4) To strengthen information systems, evidence and research for mental health.
Global targets were established for each of these objectives to measure the collective action and achievements
by Member States relating to the overall goal of the Action Plan. Mental Health Atlas is the mechanism
through which indicators in relation to agreed global targets, as well as a set of other core mental health
indicators, are being collected.
This edition of Mental Health Atlas also assumes new importance while WHO is embarking on a major
transformation to increase its impact at country level and to be fit-for-purpose in the era of the Sustainable
Development Goals (SDGs). The inclusion of mental health in the Sustainable Development Agenda, which
was adopted at the United Nations General Assembly in September 2015, is likely to have a positive impact
on communities and countries where millions of people will receive much needed help.
Data included in Mental Health Atlas 2017 demonstrates that progressive development is being made in
relation to mental health policies, laws, programmes and services across WHO Member States. However
extensive efforts, commitment and resources at global and country level are needed to meet the global targets.
Dr Shekhar Saxena
Director
Department of Mental Health and Substance Abuse
PREFACE v
EXECUTIVE SUMMARY
WHO’s Mental Health Atlas project, dates The 2017 version of Mental Health Atlas
back to 2000 when a first assessment of continues to provide up-to-date information
available mental health resources in WHO on the availability of mental health services
Member States was carried out (WHO, and resources across the world, including
2001). Subsequent updates have been financial allocations, human resources
published since then (WHO, 2005; WHO, and specialised facilities for mental
2011; WHO, 2014). health. This information was obtained
via a questionnaire sent to designated
focal points in each WHO Member State.
Latest key findings are presented in the
Box opposite.
KEY FINDINGS
GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS
 177 out of WHO’s 194 Member States (91%) at least partially completed the Atlas questionnaire;
the submission rate was above 85% in all WHO Regions;
 37% of Member States regularly compile mental health specific data covering at least the public
sector. In addition, 29% of WHO Member States compile mental health data as part of general
health statistics only;
 62% of Member States were able to report on a set of five selected indicators that covered mental
health policy, mental health law, promotion and prevention programmes, service availability and
mental health workforce.
MENTAL HEALTH SYSTEM GOVERNANCE

 72% of Member States have a stand-alone policy or plan for mental health and 57% have a stand-
alone mental health law;
 In the previous five years, 62% of WHO Member States have updated their policy and plan; and
40% their mental health law;
 94 countries equivalent to 68% of those countries who responded, or 48% of all WHO Member
States, have developed or updated their policies or plans for mental health in line with international
and regional human rights instruments;
 76 countries, equivalent to 75% of those countries who responded, or 39% of all WHO Member
States, have developed or updated their law for mental health in line with international and regional
human rights instruments;
 Human and financial resources allocated for implementation are limited; only 20% of Member
States reported that indicators are available and used to monitor implementation of a majority of the
components of their action plans.

FINANCIAL AND HUMAN RESOURCES FOR MENTAL HEALTH
 Levels of public expenditure on mental health are very meagre in low and middle-income countries
and more than 80% of these funds go to mental hospitals;
 Globally, the median number of mental health workers is 9 per 100 000 population, but there is
extreme variation (from below 1 in low-income countries to 72 in high-income countries).

MENTAL HEALTH SERVICE AVAILABILITY AND UPTAKE
 The median number of mental health beds per 100 000 population ranges below 7 in low and lower
middle-income countries to over 50 in high-income countries;
 Equally large disparities exist for outpatient services, child and adolescent services and social
support; globally, the median number of child and adolescent beds is less than 1 per 100 000
population and ranges from below 0.2 in low and lower middle-income countries to over 1.5 in high-
income countries.

MENTAL HEALTH PROMOTION AND PREVENTION
 123 countries, equivalent to 69% of those countries who responded, or 63% of all WHO Member
States, have at least two functioning national, multisectoral mental health promotion and prevention
programmes;
 Out of almost 350 reported functioning programmes, 40% were aimed at improving mental health
literacy or combating stigma and 12% were aimed at suicide prevention.
2 MENTAL HEALTH ATLAS 2017

The Atlas is used to track progress in the Baseline values for the year 2013 and progress
implementation of WHO’s Mental Health Action Plan values for the year 2016 are given in the Table below
2013-2020. Mental Health Atlas 2014 provided for each of the six Action Plan targets. Progress
baseline values for the Action Plan targets for 2013. values for 2016 indicate that the global targets can
This 2017 edition of Mental Health Atlas covers 2016 be reached, only if there is a collective global
data and enables monitoring of progress towards commitment that lead to substantial investment and
meeting these targets by the year 2020. expanded efforts at country level in relation to mental
health policies, laws, programmes and services
across WHO Member States.
Mental Health Action Plan 2013–2020: Baseline and progress values for global targets
Action Plan Action Plan Baseline value for 2013 Progress value for 2016
objective target (Atlas 2014) (Atlas 2017)
Objective 1: Target 1.1: 88 countries, 45% of all WHO Member 94 countries, 48% of all WHO Member
To strengthen effective 80% of countries will have States States
leadership and governance developed or updated
Value is based on a self-rating Value is based on a self-rating
for mental health their policies or plans for
checklist checklist
mental health in line with
international and regional (see Section 2.1 of report) (see Section 2.1 of report)
human rights instruments
(by the year 2020)
Target 1.2: 65 countries, 34% of all WHO Member 76 countries, 39% of all WHO Member
50% of countries will have States States
developed or updated their
Value is based on a self-rating Value is based on a self-rating
law for mental health in
checklist checklist
line with international and
regional human rights (see Section 2.2 of report) (see Section 2.2 of report)
instruments (by the year
2020)
Objective 2: Target 2: Not computable from Mental Health Not computable from Mental Health
To provide comprehensive, Service coverage for Atlas 2014 data Atlas 2017 data
integrated and responsive severe mental disorders
mental health and will have increased by
social care services in 20% (by the year 2020)
community-based settings
Objective 3: Target 3.1: 80 countries, 41% of all WHO Member 123 countries, 63% of all WHO
To implement strategies 80% of countries will have States Member States
for promotion and at least two functioning
Value is based on a self-completed Value is based on a self-completed
prevention in mental national, multisectoral
inventory of current programmes inventory of current programmes.
health-based settings mental health promotion
and prevention (see Section 5.1 of report) (see Section 5.1 of report)
programmes (by the year
2020)
Target 3.2: 11.4 per 100 000 population 10.5 per 100 000
The rate of suicide in
Value is based on age-standardized Value is based on age standardized
countries will be reduced
global estimate global estimate
by 10% (by the year 2020)
Source: WHO report on suicide, 2014 Global age standardized suicide rate
reduced by 8%
(see Section 5.2 of report)
Source: WHO Global Health
Observatory, 2018
(see Section 5.2 of report)
Objective 4: Target 4: 64 countries, 33% of all WHO 71 member states, 37% of all WHO
To strengthen information 80% of countries will Member States compile mental health Member States, compile mental health
systems, evidence and be routinely collecting specific data at least in public sector. specific data at least in public sector.
research for mental health and reporting at least Additionally, 62 Member States,
Additionally, 57 member states,
a core set of mental equivalent to 32% of all WHO member
equivalent to 29% of all WHO member
health indicators every states, compile mental health data as
states, compile mental health data as
two years through their part of general health statistics only.
part of general health statistics only.
national health and social
Value is based on a self-rated ability
information systems (by Value is based on a self-rated ability
to regularly compile mental health
the year 2020) to regularly compile mental health
specific data that covers at least the
specific data that covers at least the
public sector
public sector
(see Section 1 of report)
(see Section 1 of report)
EXECUTIVE SUMMARY 3
INTRODUCTION
WHO first produced an Atlas of Mental This new edition of Mental Health
Health Resources around the world in 2001, Atlas, carried out in 2017, assumes new
with updates produced in 2005, 2011 and impor tance as a repositor y of mental
2014 (http://www.who.int/mental_health/ health information in WHO Member States,
evidence/atlasmnh/en/). The Mental Health because it is providing much of the data
Atlas project has become a valuable of progress towards the objectives and
resource on global information on mental targets of the Comprehensive Mental
health and an important tool for developing Health Action Plan 2013 –2020 to be
and planning mental health services within measured. A total of six global targets
countries. were established for the four objectives
of the Action Plan to measure collective
action and achievement by Member States
towards the overall goal of the Action Plan
(see the left-hand section of Table 1).
As stated in the Action Plan, the indicators These fourteen indicators became the basis for the
underpinning the six global targets represent only Mental Health Atlas questionnaire and it formed the
a subset of the information and reporting needs baseline measurement for the Comprehensive Mental
that Member States require to be able to adequately Health Action Plan 2013–2020 with the data
monitor their own mental health policies and published in 2014. This Mental Health Atlas survey
programmes. Thus in addition, WHO Secretariat carried out during 2017, which reflects countries in
prepared and proposed a more complete set of 2016, will also be followed by another survey in
indicators for Member States for data collection and 2020, so that progress towards meeting the targets
reporting to WHO. of the Action Plan can be measured over time.
TABLE 1. Core mental health indicators, by mental health action plan objective and target
Action Plan objectives

Action Plan targets Action Plan indicators Service development indicators
Objective 1: Target 1.1: 1.1. 2a.
To strengthen effective 80% of countries will have Existence of a national policy/ Financial resources: Government
leadership and developed or updated their policies plan for mental health that is in health expenditure on mental
governance for mental or plans for mental health in line line with international and regional health
health with international and regional human rights instruments
human rights instruments (by the 2b.
year 2020) Human resources: Number of
mental health workers
Target 1.2: 1.2.
50% of countries will have Existence of a national law
2c.
developed or updated their law covering mental health that is in
Capacity building: Number and
for mental health in line with line with international and regional
proportion of general health care
international and regional human human rights instruments
staff trained in mental health
rights instruments (by the year
2020)
2d.
Objective 2: To provide Target 2: 2. Stakeholder collaboration:
comprehensive, Service coverage for severe mental Number and proportion of persons Number and type of formal
integrated and disorders will have increased by with a severe mental disorder who collaborations with other
responsive mental 20% (by the year 2020) received mental health care in the departments, services and sectors,
health and social care last year including service users and family
services in community- or caregiver advocacy groups
based settings
2e.
Objective 3: Target 3.1: 3.1. Service availability: Number of
To implement 80% of countries will have at Functioning programmes of mental health care facilities at
strategies for least two functioning national, multisectoral mental health different levels of service delivery
promotion and multisectoral mental health promotion and prevention in
prevention in mental promotion and prevention existence 2f.
health programmes (by the year 2020) Inpatient care: Number and
Target 3.2: 3.2. proportion of admissions for
The rate of suicide in countries will Number of suicide deaths per year severe mental disorders to
be reduced by 10% (by the year inpatient mental health facilities
2020) that a) exceed one year and b) are
involuntary
Objective 4: Target 4: 4.
To strengthen 80% of countries will be routinely Core set of mental health 2g.
information systems, collecting and reporting at least indicators routinely collected and Service continuity: Proportion
evidence and research a core set of mental health reported every two years of persons with a severe mental
for mental health indicators every two years through disorder discharged from a mental
their national health and social or general hospital in the last year
information systems (by the year who were followed up within one
2020) month by community-based health
services
2h.
Social support: Number of
persons with a severe mental
disorder who receive disability
payments or income support
INTRODUCTION 5
METHODOLOGY
The Mental Health Atlas project ending with the statistical analyses and
required a number of administrative and presentation of data. The sequence of
methodological steps, starting from the steps followed was in line with that pursued
development of the questionnaire and in 2014, and is briefly outlined opposite.
STAGE 1
QUESTIONNAIRE DEVELOPMENT AND TESTING
As described above, indicators included in the 2014 Offices e.g. questions on social care and continuity
questionnaire were based on consultations with of care after discharge.
Member States, and were developed in collaboration
with WHO Regional Offices as well as experts in the Alongside the questions, a glossary and a guide
area of mental health care measurement. The based on frequently asked questions were developed,
questionnaire was drafted in English and translated to help standardize terms and to ensure that the
into French, Russian, Spanish and Portuguese. The conceptualization or definition of resources was
questionnaire in 2017 was modified for some questions understood by all respondents. The guide and
based on response rate for variables, and feedback glossary were integrated to the online data collection
from Member States, WHO Regional and Country platform.
STAGE 2
QUESTIONNAIRE DISSEMINATION AND SUBMISSION
For each country, WHO requested Ministries of Health questionnaire submission. A WHO staff member was
or other responsible ministries to appoint a focal available to respond to enquiries, to provide additional
point to complete the Atlas questionnaire. The focal guidance, and to assist focal points in completing
point was encouraged to contact other experts in the Atlas questionnaire. The questionnaire was also
the country to obtain information relevant to answering available on-line, and countries were strongly
the survey questions. encouraged to use this method for submission.
However, a Word version of the questionnaire was
Close contact with the focal points was maintained available whenever preferred.
during the course of their nomination and through
STAGE 3
DATA CLARIFICATION, CLEANING AND ANALYSIS
Once a completed questionnaire was received, it was method, of US$ 1,025 or less in 2015; lower middle-
screened for incomplete and inconsistent answers income economies are those with a GNI per capita
(particularly in comparison to 2014 responses). To between US$ 1,026 and US$ 4,035; upper middle-
ensure quality of data, respondents were re-contacted income economies are those with a GNI per capita
and were asked for clarification and to correct their between US$ 4,036 and US$ 12,475; high-income
responses as appropriate. Subsequently a draft economies are those with a GNI per capita of
country profile with each of the 177 Member States US$ 12,476 or more.
for their further reviews and inputs.
Frequency distributions and measures of central
Upon receipt of the final questionnaires, data were tendency (e.g., means, medians) were calculated as
aggregated by WHO Region and also by World Bank appropriate for these country groupings. Rates per
income group for 2016. Lists of countries by WHO 100 000 population were calculated for a range of
Region and by World Bank income group are data points, using the official UN population estimates
provided in Appendix A. As of 1 July 2016, low- for 2015. Comparisons were made with 2014 data
income economies are defined as those with a GNI in relation to global targets and service development
per capita, calculated using the World Bank Atlas indicators.
METHODOLOGY 7
LIMITATIONS
A number of limitations should be kept in mind when Although a large number of countries submitted
examining the results. While best attempts have questionnaires for both Atlas 2014 and Atlas 2017,
been made to obtain information from countries on the list of countries completing different data points
all variables, some countries could not provide data within each of the questions was sometimes different.
for a number of indicators. The most common reason This adds some constraints for comparisons of data
for the missing data is that such data simply do not over time between the two Atlas versions. Additionally,
exist within the countries. In some situations, the based on response rates for some of the variables,
data required to complete a question may be available feedback from Member States’ WHO regional and
at a specific facility, district or regional level but not country offices, some questions were modified e.g.
aggregated nationally at central level. Also, in some questions on social care and continuity of care after
cases, it was difficult for countries to report the discharge. This has contributed to improvement of
information in the manner requested in the Mental completion rates of these questions in 2017 compared
Health Atlas questionnaire. For example, some to 2014, but these changes have limited the ability
countries had difficulty in reporting data on involuntary to make comparisons over time.
admission at hospitals and data on capacity building
programmes for mental health at primary health care Finally, it is important to acknowledge the limitations
level. The extent of missing data can be determined associated with self-reported data, particularly in
from the number of countries that have been able relation to qualitative assessments or judgements
to supply details. Each individual table or figure (often being made by a single focal point). For
contains the number of responding countries, or the example, respondents were asked to provide an
equivalent percent (out of a total of 194 WHO Member informed categorical response concerning the
States). implementation of mental health policies and laws,
and their conformity with international (or regional)
A further limitation is that most of the information human rights instruments. For some of these items
provided relates to the country as a whole, thereby it is possible to compare self-reported responses to
overlooking potentially important variability within publicly available information (such as a published
countries concerning, for example, the degree of mental health policy or budget for a country), but in
policy implementation, the availability of services and other cases the opportunity for external validation is
the existence of promotion or prevention programmes more limited.
in rural versus urban areas or remote versus central
parts of the country. Similarly, few of the reported Mental Health Atlas is an on-going activity of the
data can provide a breakdown by age or gender, WHO. As more accurate and comprehensive
despite the importance that equality of access and information covering all aspects of mental health
universal health coverage has in the articulation of resources become available and the concepts and
the Comprehensive Mental Health Action Plan 2013- definitions of resources become more refined, it is
2020. This makes it difficult to assess resources for expected that the database will also become better
particular populations within a country such as organized and more reliable. While it is clear that, in
children, adolescents, or the elderly. many cases, countries’ information systems are weak,
the Mental Health Atlas may serve as a catalyst for
further development by demonstrating the utility of
such systems.

RESULTS
1. GLOBAL REPORTING ON CORE MENTAL HEALTH

INDICATORS
2. MENTAL HEALTH SYSTEM GOVERNANCE
3. FINANCIAL AND HUMAN RESOURCES FOR

MENTAL HEALTH
4. MENTAL HEALTH SERVICE AVAILABILITY AND

UPTAKE
5. MENTAL HEALTH PROMOTION AND

PREVENTION
RESULTS
1. GLOBAL REPORTING ON
CORE MENTAL HEALTH
INDICATORS
Considerable effort has been expended by WHO While reporting and data completion levels for several
Secretariat and Member States to complete and mental health indicators or Atlas questions had
submit the Mental Health Atlas questionnaire, remarkably improved from Atlas 2014 – including
particularly as Atlas 2017 is the tool for measurement particularly those relating to mental health spending,
of progress towards the achievement of objectives workforce, continuity of care after discharge, social
and targets of the Mental Health Action Plan 2013- support for persons with mental disorders – the
2020, against baseline values provided in the 2014 response rate for other indicators, in particular items
Mental Health Atlas. relating to service coverage (treated prevalence),
visits at outpatient facilities, general health care
In total, 177 out of WHO’s 194 Member States were workers trained in mental health remains low
able to at least partially complete the questionnaire. compared to other indicators. The lower response
As shown in Figure 1.1, the global and WHO Regional rate for these indicators reflects the difficulty of
participation or Member States’ submission rate for obtaining these data especially at national level.
Mental Health Atlas 2017 is 85% or greater in all
WHO Regions and is 91% overall. Responding Mental Health Atlas 2017 requested Member States
countries account for 97.5% of the global population. to rate the availability or status of mental health
This in itself is an important marker of countries’ reporting; Figure 1.2 summarises the findings. 66%
ability and willingness to collect, share and report of all WHO Member States, or 83% of countries
their mental health situation and contribution to the responding to this question report that mental health
Mental Health Action Plan 2013–2020. In addition data is compiled in the last two years either as part
to the 177 filled questionnaires from WHO Member of general health statistics report or a mental health
States, filled questionnaires were also received from specific data report. The Member States with a mental
one WHO associate member and 16 from health specific data report compiled in the last two
geographical territories, which were not included in years for public sector or for both public and private
the analysis for the purpose of this report but will be sector represent only 37% of all WHO Member States
published as stand-alone profiles. In summary, WHO and 46% of Member States responding to this
secretariat received as part of Atlas 2017 exercise question. However, 17% (26 Member States) of
a total of 194 Atlas questionnaires, from Member responding countries reported that mental health
States, associate members and geographical data has not been compiled into any report for policy,
territories. planning or management purposes in the last
FIG. 1.1 Mental Health Atlas 2017: submission rate by Member States
100%
90%
80%
70%
60%
50% 97%
91% 92% 90% 91% 91%
85%
40%
30%
20%
10%
0%
Global AFR AMR EMR EUR SEAR WPR
(177 out of 194) (43 out of 47) (34 out of 35) (19 out of 21) (48 out of 53) (10 out of 11) (23 out of 27)
RESULTS | 1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS 11

FIG. 1.2 Mental health data availability and reporting, by WHO region
Mental health specific data compiled in last two years for public and private sector
Mental health specific data compiled in last two years for public sector
Mental health data compiled only for general health statistics in last two years
No mental health data compiled in last two years
3%
100%
14% 12% 13% 10%
90% 19%
24%
24%
80%
28%
70% 32% 40% 24%
50%
60% 36%
50% 49%
36%
40%
37% 30% 48%
30% 19%
31%
20%
10% 24% 24% 20%

17% 19%
9% 10%
0%
(N=154) (N=37) (N=25) (N=16) (N=45) (N=10) (N=21)
two years. When Member States responses are Based on actual data submitted through Mental
analysed based on World Bank income groups as Health Atlas 2017 to WHO, an assessment of
shown in Figure 1.3, approximately 20% of responding countries’ ability to report on a defined set of selected
countries belonging to both low and lower middle- mental health indicators was also made. Included
income groups are reporting no data compilation for indicators were as follows: 1) stand-alone mental
mental health indicators in the last two years health policy or plan (yes or no); 2) stand-alone mental
compared to 9% of high-income countries which health law (yes or no); 3) mental health workforce
gave the same response. (available data for at least some types of worker); 4)
service availability (data for at least some care
In low-income countries, the majority of Member settings); 5) mental health promotion and prevention
States reported that mental health data is compiled (completion of inventory, including if no programmes
as part of general statistics, but not in a specific mental present). 121 countries (62% of all Member States)
health report. Importantly, in none of the responding were able to report on all five of these items, similar
low-income countries a specific report focusing on to 2014 (117 countries, 60% of all Member States).
mental health activities in both the public and private Adding a further key indicator to the defined core
sector has been published by the Health Department set, e.g. service utilization for certain severe mental
or any other responsible government unit in the last disorders – reduces substantially the number of
two years. Reporting on mental health indicators that countries able to report, to 82 or 46% of all Member
include both public and private sectors remains a States. This is a remarkable improvement in reporting
challenge, and is below 25% in all WHO regions. compared to Mental Health Atlas 2014 where only

FIG. 1.3 Mental health data availability and reporting, by World Bank income group (2014 and 2017)
Mental health specific data compiled in last two years for public and private sector
Mental health specific data compiled in last two years for public sector
Mental health data compiled only for general health statistics in last two years
No mental health data compiled in last two years
0%
100% 5%
8% 10% 7% 11%
12% 14%
90% 22% 25%
12% 30%
80% 31%
33%
30% 31% 32%
70% 32%
60%
50% 36%
50% 56% 39%
33%
40% 36%
40% 43%
37% 41%
30%
20% 36% 23%

31% 31%
22% 23%
10% 19% 17% 17% 16%
9%
2%
0%
Global Global Low Low Lower- Lower- Upper- Upper- High High
2014 2017 2014 2017 middle middle middle middle 2014 2017
(N=160) (N=154) (N=31) (N=27) 2014 2017 2014 2017 (N=44) (N=44)
(N=39) (N=39) (N=46) (N=44)
50 countries or 26% of all Member States were able In Mental Health Atlas 2017, countries were also
to report on the above selected set of mental health asked in a specific question to report on the availability
indicators in addition to this data component. This and completeness of specific mental health indicators
latter, more stringent threshold gives a result quite to better understand the existing structures and
similar to the total number of countries who self- limitations of mental health information systems.
reported their ability to regularly compile mental health Approximately 60% of Member States responding
specific data covering at least the public sector to this question reported availability of data on mental
(71 countries, equivalent to 37% of all Member States). health beds either at mental health hospitals or
psychiatric wards in general hospitals. However only
Globally, the percentage of countries reporting that 33% of Member States responding to this question
no mental health data is compiled in last two years, identified the data available on beds as complete,
has slightly declined since Mental Health Atlas 2014 based on available data disaggregation by age,
from 19% to 14%, while the percentage of countries gender and diagnosis. This finding could possibly
reporting every two years data from public only or explain one of the factors that are contributing to the
public and private increased from 42% in 2014 to limited availability of information on service utilization
46% in 2017 as shown in Figure 1.3. Accordingly, for specific diagnoses by some Member States (Data
much effort will be required to reach Target 4 of the not shown).
Mental Health Action Plan, which states that 80% of
countries will be routinely collecting and reporting at
least a core set of mental health indicators every two
years through their national health and social
information systems (by the year 2020).
RESULTS | 1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS 13

RESULTS
2. MENTAL HEALTH SYSTEM

GOVERNANCE
2.1 MENTAL HEALTH POLICIES/PLANS
Objective 1 of the Mental Health Action Plan relates resources and specified indicators or targets needed
to strengthened leadership and governance for mental to implement and monitor implementation of their
health. The development and implementation of policies and/or plans.
well-defined mental health policies and plans
represent critical ingredients of good governance In aggregate terms, 139 countries state the existence
and leadership. The Mental Health Action Plan of a stand-alone policy or plan for mental health,
recommends that policies, plans and laws for mental equivalent to 72% of all WHO Member States or 79%
health should comply with obligations under the of responding countries (Table 2.1.1). There is little
Convention on the Rights of Persons with Disabilities variation between WHO regions although a lower
and other international and regional human rights proportion of African and Eastern Mediterranean
conventions. countries have policies/plans and fewer countries in
the African and American regions have updated them.
A mental health policy can be broadly defined as an 120 (62% of all WHO Member States) have updated
official statement of a government that conveys an their policy/plan in the previous five years (since 2013)
organized set of values, principles, objectives and with 44 countries updated their policy/plan in last
areas for action to improve the mental health of a year (2016 or after). More than 55% of countries in
population. A mental health plan is a detailed scheme any WHO region and more than 75% of Eastern
for action on mental health that usually includes Mediterranean, South East Asian, Western Pacific
setting principles for strategies and establishing and European countries reported updating their
timelines and resource requirements. policy/ plan in last five years.
Mental Health Atlas 2017 assessed whether countries Out of 36 countries stating that they do not have a
have an approved mental health policy and/or plan stand-alone policy or plan, 22 confirmed that policies
and the level and quality of its implementation. In and plans for mental health are integrated into those
addition, and in line with the Mental Health Action for general health or disability. In Atlas 2017, countries
Plan, it asked countries to complete a checklist in were also asked about the existence of a plan or
order to assess the compliance of this mental health strategy for child and adolescent mental health. Out
policy/plan with international human rights instruments. of 78 responding countries, 46% stated they had a
New indicators added in Atlas 2017 asked countries plan or strategy for child and adolescent mental
to report on the existence of human or financial health.
TABLE 2.1.1 Existence and revision status of mental health policies/plans
Countries stating they have a stand-alone mental Countries stating they have updated their policy/
health policy/plan plan in the last 5 years (since 2013)
(N=175) (N=167)
Number of countries % of responding countries Number of countries % of responding countries
Global 139 79% 120 72%
WHO region
AFR 31 72% 23 58%
AMR 27 82% 20 65%
EMR 14 78% 13 76%
EUR 39 81% 37 79%
SEAR 9 90% 8 80%
WPR 19 83% 19 86%
RESULTS | 2. MENTAL HEALTH SYSTEM GOVERNANCE 15

Concerning conformity with international (or regional) Using a total score across these five self-reporting
human rights instruments, Figure 2.1.1 shows the checklist items to evaluate the compliance of the
degree of compliance, self-rated, across five items policy in terms of human rights, almost all responding
of a constructed checklist both for 2014 and 2017 countries (97%) scored at least 3, 83% scoring 4 out
results. In Mental Health Atlas 2017, 97% of countries of 5 indicating a partial compliance, while 68%
who responded to this question consider their policy/ endorsed all five items of the checklist, indicating full
plan to promote the transition toward mental health compliance. This is equivalent to 48% of all Member
services based in the community (including mental States indicating full compliance. This represents
health integrated into general hospitals and primary only a limited progress from the baseline of 2014
care). 89% of responding countries consider their where 45% of all Member states indicated full
policy/plan to pay explicit attention to respect for the compliance. The global target to be achieved by
human rights of people with mental disorders and 2020 is 80%. Figure 2.1.2 provides a breakdown by
psychosocial disabilities and vulnerable and WHO Region. This target indicator is showing
marginalized groups. A little over 80% consider their progress from the base line of 2014, where 56%
policy/plan promotes a full range of services and endorsed all five items of checklist indicating full
support to enable people to live independently and compliance and 72% of countries scored 4 indicating
be included in the community, and the participation partial compliance.
of persons with mental disorders and psychosocial
disabilities in decision-making processes on issues In Mental Health Atlas 2017, countries were also asked
affecting them (e.g. policy, law, service reform). The whether estimates of required resources are included
comparison with 2014 data shows an increase in in their mental health policy/plan. Out of 162 responding
positive responses across the five items of the countries, a little over half state that their mental health
checklist on compliance with human rights instruments policy/plan contains estimates of financial or human
(4% to 14%).
FIG. 2.1.1 Compliance of mental health policies/plans with human rights instruments (2014 and 2017)
% of responding countries in 2014

Policy/plan promotes transition towards community-based 92%

mental health services 97%
Policy/plan pays explicit attention to respect for the human 85%

rights of people with mental disorders 89%
Policy/plan promotes a full range of services and supports 76%

to enable people to live independently and be included in
81%
community
Policy/plan promotes a recovery approach to mental 76%

health care 89%
Policy/plan promotes the participation of persons with 68%

mental disorders in decision making processes 82%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

FIG. 2.1.2 Mental health policies/plans and human rights: checklist score
Yes to all 5 items

Yes to 4 or more items
100% 100% 100% 100%

100% 97% 96%
92% 100%
89%
90%
% of responding countries endorsing checklist items
83% 82%
80% 80% 80%
80% 77%
68% 69%
70% 67% 66%
60%
53%
50%
50%
40%
30%
20%
10%
0%
(N=151) (N=30) (N=27) (N=16) (N=46) (N=10) (N=22)
resources needed to implement it. Of those countries Countries were also asked about the availability and
who state that estimates of financial or human use of indicators or targets against which
resources are contained in their plan, just more than implementation of its policy/plan can be monitored.
half of responding countries state that resources have Of 123 countries who state the existence of specified
been allocated in line with indicated resource needs indicators or targets, only 46 state that indicators
to enable implementation of the policy / plan. There were available and used in the last 2 years for some/a
is a large variation across WHO regions, with 75% of few components, while 33% state that indicators are
EUR and WPR countries stating that resources have available, but they are not used at all. Only 20% state
been allocated in line with indicated resource needs, that indicators are available and used for most or all
compared with less than 30% of AFR countries. Table components (Data not shown).
2.1.2 provides a breakdown by WHO region and World
Bank income group.

TABLE 2.1.2 Allocation of resources for mental health policies/plans
Countries reporting that

resources have been allocated
for implementation in line
with human and/or financial
Countries reporting that estimates of human and/or financial resources contained in mental
resources are contained in mental health policy/plan health policy/plan
Number of countries % of countries % of total
Global (N=169) 93 55% 53%
WHO region
AFR (N=42) 26 62% 27%
AMR (N=31) 16 52% 50%
EMR (N=17) 5 29% 40%
EUR (N=47) 27 57% 75%
SEAR (N=10) 5 50% 50%
WPR (N=22) 14 64% 77%
World Bank income group
Low (N=29) 19 66% 21%
Lower-middle (N=42) 21 50% 53%
Upper-middle (N=49) 28 57% 63%
High (N=49) 25 51% 70%
2.2 MENTAL HEALTH LEGISLATION
Mental health legislation is a further key component Pacific regions have the highest percentage (over
of good governance and concerns the specific legal 75%), which is an increase of 7% in European and
provisions that are primarily related to mental health, 10% in Western Pacific regions from 2014. The African
which typically focus on issues such as civil and and South East Asia regions have the lowest
human rights protection of people with mental percentage (44%-50%). 66 countries or 40% of
disorders, involuntary admission and treatment, responding countries have updated their mental
guardianship and professional training and service health legislation in the previous 5 years (since 2013),
structure. The Global Target 1.2 of the Mental Health most commonly in the European region however the
Action Plan, states that 50% of countries will have proportion of countries that have updated their laws
developed or updated their law for mental health in in the African region has more than doubled since
line with international and regional human rights 2014 to 21%. 20 countries have updated their stand-
instruments (by the year 2020). alone mental health law in 2016. Out of the 64
countries stating that they do not have a stand-alone
Mental Health Atlas 2017 assessed whether countries mental health law for mental health, 34 have mental
have a stand-alone mental health law and the extent health legislation that is integrated into general health
to which legislation is currently being used or or disability law.
implemented. As with mental health policy/plans, a
checklist was developed and used to assess the Regarding conformity with international (or regional)
degree to which laws fall in line with international human rights instruments, Figure 2.2.1 shows positive
human rights instruments. responses to five items of a self-rated checklist
constructed for this purpose. Between 85% and 95%
A total of 111 countries report having a stand-alone of countries who responded consider their mental
law for mental health, which represents 57% of WHO health law to: a) promote the transition toward mental
Member States and 63% of those who submitted a health services based in the community (including
response (Table 2.2.1). The European and Western mental health integrated into general hospitals and

TABLE 2.2.1 Existence and revision status of mental health legislation, by WHO region
Countries stating they have a stand-alone mental Countries stating they have updated lesgislation in
health law the last 5 years (since 2013)
(N=175) (N=164)
Number of countries % of countries Number of countries % of countries
Global 111 63% 66 40%
WHO region
AFR 19 44% 8 21%
AMR 20 61% 8 27%
EMR 11 61% 6 33%
EUR 37 77% 29 64%
SEAR 5 50% 5 50%
WPR 19 83% 10 45%
FIG. 2.2.1 Compliance of mental health legislation with human rights instruments (2014 and 2017)

Legislation promotes transition towards community-based 62%

mental health services 91%
Legislation promotes rights of people with mental 67%

disorders to exercise their legal capacity 87%
75%
Legislation promotes alternatives to coercive practice
94%
Legislation provides for procedures to enable persons with 68%

mental disorders to protect their rights and file complaints
93%
to an independent body
Legislation provides for regular inspections of human 60%

rights conditions in mental health facilities by an
74%
independent body
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

primary care); b) promote the rights of persons with countries in the Western Pacific region (67%) endorsing
mental disorders and psychosocial disabilities to all 5 checklist items.
exercise their legal capacity; c) promote alternatives
to coercive practice; d) provide for procedures to To further assess progress towards ensuring
enable people with mental disorders and psychosocial conformity of mental health legislation with international
disabilities to protect their rights and file appeals and human rights instruments, countries were asked to
complaints to an independent legal body. Just below self-rate the existence and level of functioning of a
75% of responding countries consider their laws dedicated authority or independent body to assess
provide for regular inspections of human rights compliance of mental health legislation with
conditions in mental health facilities by an independent international human rights. Figure 2.2.3 and Figure
body. Global responses to the five checklist items are 2.2.4 show a dedicated authority or independent
showing a positive increase compared to Member body either does not exist or exists but is not
States responses in 2014 which may indicate a gradual functioning in a little over half of responding countries.
progress towards alignment with international and There was large variation across regions and income
regional human rights instruments. groups. Over 65% of countries in low and lower
middle-income groups state that an authority or body
Adding up these endorsed checklist items provides does not exist or is not functioning, while over 70%
a measure of the extent to which countries’ mental of high-income countries state that they have a
health laws are partially or fully in line with international functioning authority or body. Less than 50% of
human rights instruments, (Figure 2.2.2). Out of 118 responding countries reported that this body provides
responding countries, 95% endorsed at least 3 regular or irregular inspections in mental health
checklist items, and 75% endorsed all five items, facilities and reports at least annually to stakeholders,
indicating full compliance. This is equivalent to 39% with lower percentages of countries reporting
of all Member States indicating full compliance. There inspection and reporting in South East Asian and
was some variation between WHO regions with a African regions.
lower proportion of European countries (65%) and
FIG. 2.2.2 Mental health legislation and human rights: checklist score
Yes to all 5 items

100% 100% 100%

100% 95% 94% 93% 91% 93% 93% 91%
89% 89%
90% 88% 86% 86%
% of responding countries endorsing checklist items
80% 80% 80%

80% 75%
70% 65% 67%
60%
50%
40%
30%
20%
10%
0%
(N=118) (N=17) (N=18) (N=14) (N=45) (N=5) (N=19)

FIG. 2.2.3 Existence of a dedicated authority or independent body to assess compliance of mental health
legislation with international human rights, by WHO region
Provides regular inspections in mental health facilities and reports at least annually to stakeholders
Provides irregular inspections of mental health facilities and partial enforcement of mental health legislation
Exists but is not functioning
Does not exist
0%
100%
90% 19% 22%

27% 24%
28% 33%
80% 45%
10%
12% 11%
70%
20% 17%
60% 30%
18% 24%
50%
11%
25%
40% 7% 10%
67%
30% 55% 8%
47%
20% 40% 37% 33%
10% 23%
0%
(N=159) (N=42) (N=30) (N=17) (N=40) (N=9) (N=21)
FIG. 2.2.4 Existence of a dedicated authority or independent body to assess compliance, by World Bank
income group
Provides regular inspections in mental health facilities and reports at least annually to stakeholders
Provides irregular inspections of mental health facilities and partial enforcement of mental health legislation
Exists but is not functioning
Does not exist
100%
90% 17% 21%

28% 30%
80% 3% 40%
13%
70% 17%
60% 20% 10%

24%
50%
11%
33%
40% 11%
30% 62%
56%
9%
20% 40%
35%
10% 18%
0%
Global Low Lower-middle Upper-middle High
(N=159) (N=29) (N=39) (N=46) (N=45)

2.3 STAKEHOLDER COLLABORATION
Successful coordination of mental health services implementation of policies, laws and services relating
involves many actors both within and beyond the to mental health, through a formalized structure and/
health sector and enables strengthening of care or mechanism.
pathways. It encompasses social affairs/social welfare,
justice, education, housing and employment sectors In Mental Health Atlas 2017, countries were asked
(government or non-governmental agencies), media, to identify if there is ongoing collaboration between
academia/institutions, local and international non- government mental health services and other
governmental organizations who deliver or advocate departments, services and sectors. They were also
for mental health services, private sector, professional asked to identify the number and type of stakeholder
associations, faith-based organizations/institutions, groups that are currently collaborating with
traditional/indigenous healers, service users and government mental health services in the planning
family or caregiver advocacy groups. It requires strong or delivery of mental health promotion, prevention,
leadership to ensure stakeholder collaboration and treatment and rehabilitation services.
intersectoral action.
Stakeholder collaborations were considered as a
The Mental Health Action Plan 2013–2020 identifies ‘formal’ collaboration only when at least 2 out of 3
the multisectoral approach as one of the six cross- of the following checklist items apply; a) Existence
cutting principles and approaches. The Action Plan of a formal agreement or joint plan with this partner,
outlines that a comprehensive and coordinated b) Availability of a dedicated funding from or to this
response for mental health requires partnership with partner for service provision, or c) Conduction of
multiple public sectors and other relevant sectors as regular meetings with this partner (at least once per
well as the private sector, as appropriate to the country year).
situation. A proposed action for Member States is
to motivate and engage stakeholders from all relevant Global findings relating to the number of countries
sectors, including persons with mental disorders, reporting formal stakeholder collaborations are
carers and family members, in the development and provided in Table 2.3.1. 126 countries reported having
TABLE 2.3.1 Proportion of ongoing collaboration with a formalised structure and/or mechanism, by WHO
region and World Bank income group
Number of countries stating formal collaborations % countries stating formal collaborations with
with stakeholder groups stakeholder groups
Global 126 81%
WHO region
AFR 23 68%
AMR 23 74%
EMR 15 88%
EUR 39 89%
SEAR 8 89%
WPR 18 86%
Low 15 60%
Lower-middle 33 87%
Upper-middle 39 85%
High 39 83%

at least one ‘formal’ stakeholder collaboration. The shows global percentage of identified formal
proportion of formal collaboration, varied across collaboration. The majority of responding countries
stakeholder type, region and income group. repor ted having a formal collaboration with
International Non-Governmental Organizations (67%),
There were large variations in the type of formal Local Non-Governmental Organizations (56%) and
stakeholder collaborations across income groups/ Ministry of Social Affairs (57%).
regions, ranging between 0% (SEAR) and 67% (AMR)
for countries reporting formal collaborations with the 104 countries reported ongoing collaboration with
employment sector, 11% (AFR) and 67% (AMR) service user and family/caregiver advocacy groups.
reporting formal collaborations with the housing The proportion of these countries that reported formal
sector and 0% (EUR and SEAR) and 50% (WPR and collaborations with this stakeholder group is provided
AMR) reporting formal collaboration with traditional/ in Figure 2.3.2.
indigenous healers (Data not shown).Figure 2.3.1
FIG. 2.3.1 Global percentage of responding countries that identify formal collaboration with stakeholder group
Service users/family/caregiver advocacy groups (N=104) 51%
Traditional/indigenous healers (N=48) 12%
Faith based organizations/institutions (N=82) 29%
Professional associations (N=113) 47%
Private sector organisations (N=95) 41%
International NGOs (N=97) 65%
Local NGOs (N=125) 70%
Academic sector/institutions (N=118) 55%
Media sector (N=99) 24%
Empolyment sector (N=70) 26%
Housing sector (N=49) 23%
Ministry of the interior/home affairs (N=84) 40%
Ministry of education (N=126) 65%
Ministry of justice (N=115) 55%
Ministry of social affairs/social welfare (N=138) 78%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

FIG. 2.3.2 Proportion of formal collaborations with service users/family/caregiver advocacy groups,
by WHO region
Yes No
100%
90%
80% 38% 40%

48% 50% 46%
70% 58%
67%
60%
50%
40%
30% 63% 60%

52% 50% 54%
20% 42%
33%
10%
0%
(N=104) (N=21) (N=24) (N=8) (N=30) (N=8) (N=13)

RESULTS
3. FINANCIAL AND HUMAN

RESOURCES FOR MENTAL
HEALTH
3.1 FINANCIAL RESOURCES
Financial resources are an evident requirement for In Mental Health Atlas 2017, countries were requested
developing and maintaining mental health services to estimate government’s total expenditure on mental
and moving towards programme goals. Mental health health (combined national and sub-national
spending can include activities delivered in social government expenditure). Figure 3.1.1 depicts median
care and in primary or general care, as well as in government mental health spending per capita
specialist/secondary health care. Mental health globally and by WHO regions. The global median
spending may include programme costs such as mental health expenditure per capita is US$ 2.5.
administration/management, training and supervision, Based on the WHO Global Health Expenditure
and mental health promotion activities. Estimation database, the global median of domestic general
of mental health expenditure in a country, however, government health expenditure per capita in 2015
is complex due to the range of funding sources was US$ 141, thus making government mental health
(employers and households as well as governmental expenditure less than 2% of global median of
or non-governmental agencies), diverse set of service government health expenditure. There is a large
providers (specialist mental health services, general variation between regions. For example mental health
health services and social care services) and the expenditure per capita in European region is more
diversity of services provided. than 20 times higher compared to African and South
East Asian Region. The range between high-income
FIG. 3.1.1 Government mental health expenditure per capita (US$), by WHO region
25.0
20.0
15.0
21.7
10.0
11.8
5.0
1.1
2.5 0.1 2.0 0.1
0
(N=80) (N=10) (N=18) (N=4) (N=31) (N=5) (N=12)

and low-income countries on mental health health insurance or reimbursement schemes and
expenditure per capita remains huge. As shown in 68% of these countries reported that these disorders
Figure 3.1.2, most of the reported expenditure is are explicitly listed as included conditions. On the
allocated to mental hospitals in particular, except in other hand 27% of countries reported care and
high income countries where less than 43% of treatment is not included in national health insurance
spending is on mental hospitals. or reimbursement schemes and 19% of these
countries stated that disorders are explicitly listed as
The reporting on this indicator has improved in 2017 excluded conditions from the national health insurance
as 80 countries are able to report data compared to or reimbursement schemes.
40 countries (including no low income countries) in
2014. However, still less than 50% of WHO Member In another question on how people pay for services
States are able to report on this indicator which (N=168), it was estimated by 17% and 18% of Member
represents an important limitation for this data. States that persons pay mostly or entirely out of their
own pocket for mental health services and for
73% of responding countries (N=169) reported that psychotropic medicines respectively. The biggest
care and treatment of persons with severe mental rates for out of own pocket expenditures on mental
disorders (e.g. psychosis, bipolar disorder and health were noted in African and South East Asian
moderate/severe depression) is included in national regions. See Figures 3.1.3 and 3.1.4.
FIG. 3.1.2 Government mental health expenditure and government expenditure on mental hospitals per capita
(US$), by World Bank income groups
Median government mental health expenditure per capita (US$, 2016)

Median government total expenditure on mental health hospitals (US$, 2016)
90
80
70
60
50
40 80.24
30
20
35.06
10
1.05 2.62 2.25
0.02 0.02 0.53
0
Low Lower-middle Upper-middle High
(N=11) (N=19) (N=21) (N=29)
RESULTS | 3. FINANCIAL AND HUMAN RESOURCES FOR MENTAL HEALTH 27

FIG. 3.1.3 Source of payment for mental health services, by WHO region
% of countries where persons pay mostly or entirely out of pocket towards cost of mental health services
% of countries where persons pay nothing (fully insured) or at least 20% towards cost towards cost of mental health services
100%
6%
11%
90% 17% 17%
80% 43% 40%
70%
60%
50% 100%
94%
89%
40% 83% 83%
30% 57% 60%
20%
10%
0%
(N=168) (N=42) (N=31) (N=18) (N=48) (N=10) (N=19)
FIG. 3.1.4 Source of payment for psychotropic medications, by WHO region
% of countries where persons pay mostly or entirely out of pocket towards costs for psychotropic medication
% of countries where persons are fully insured or paid at least 20% towards costs for psychotropic medication
100%
10% 11%
90% 18% 17%
30%
80% 45%
70%
60%
50% 100%
90% 89%
40% 82% 83%
70%
30% 55%
20%
10%
0%
(N=166) (N=42) (N=30) (N=18) (N=47) (N=10) (N=19)

As shown in Figure 3.1.5 and 3.1.6, there is a strong of countries at lower levels of national income are
association between total government mental health allocating an appreciable proportion of total health
spending per capita and gross national income (GNI) spending to mental health (even if not a large amount
per capita. More than 75% of the observed variance in absolute dollar terms), and vice versa for some
is explained by this association. Expressed as a higher-income countries (which devote only a small
proportion of total health expenditure, however, the proportion of their relatively large health budget to
association is much weaker (less than 25% of the mental health).
variance explained); this reflects the fact that a number
Figure3.1.5 Association between per capita mental health expenditure and gross national income
FIG. 3.1.5 Association between per capita mental health expenditure and gross national income (N = 75)
(N = 75)
$450
capita (US$, 2016)
$400
R²
R2 == 0.7751
0.7751
per spending
$350
per capita (US$, 2016)
$300
health
spending
$250
mental
$200
mental health
Government
$150
$100
Government
$50
$0
$1,000 $10,000 $100,000
$100,000
Gross national
Gross nationalincome percapita
income per capita (US$,
(US$, 2016)
2016)
FIG. 3.1.6 Association between mental health expenditure (as a percentage of total health expenditure) and
gross
Figurenational
3.1.6 income (Nbetween
Association = 69) mental health expenditure (as a percentage of total health
expenditure) and gross national income (N = 69)
12%
12%
health spending)
10%
10% RR²2 = 0.2391
0.2391
spending
(% of total health spending)
(% of total
8%
8%
spendinghealth
mental health mental
6%
6%
GovernmentGovernment
4%
4%
2%
2%
0%
0%
$1,000 $10,000 $100,000
Gross national income percapita
Gross national income per capita(US$,
(US$, 2016)
2016)

3.2 MENTAL HEALTH WORKFORCE
Member States were requested to provide estimates countries in 2014, but also adds some limitations to
of the total number of mental health professionals comparing the two complete datasets.
working in the country, broken down by specific
occupation (including psychiatrists, child psychiatrists, Median numbers of mental health workers per
other medical doctors, nurses, psychologists, social 100 000 population are shown for different WHO
workers, occupational therapists and other paid regions and for countries at different income levels
workers working in mental health). in Figures 3.2.1 and 3.2.2, respectively. Based on
these reported data, rates are estimated to vary from
A total of 149 countries, representing a little over 75% below 2 per 100 000 population in low-income
of all WHO Member States, were able to provide at countries to over 70 in high-income countries. The
least partial estimates of known mental health workers global median remains at 9 per 100 000 population,
in their country. This reflects an improved completion or less than one mental health worker per 10 000
rate for this important indicator compared to 130 population.
FIG. 3.2.1 Mental health workforce per 100 000 population, by WHO region
60
Median number of mental health workers
50
per 100 000 population
40
30
50
20
10
9 10.9 2.5 10
0.9 7.7
0
(N=149) (N=37) (N=29) (N=16) (N=38) (N=10) (N=19)

FIG. 3.2.2 Mental health workforce per 100 000 population, by World Bank income group
80
70
Median number of mental health workers
60
50
40
71.7
30
20
10 20.6
9 1.6 6.2
0

Figures 3.2.3 and 3.2.4 provide a breakdown of the As reported in 2014, the absolute number of
composition of this workforce, again by WHO region workers per 100 000 population varies enormously;
and income group. Results indicate that the proportion for example there are 11.9 psychiatrists per
of different staff categories is mostly stable across 100 000 population in high-income countries
countries at different income levels, with nurses compared to less than 0.1 in low income countries.
comprising the single largest group of workers Similarly, there are 23.5 nurses working in mental
(30–50%). Exceptionally in the American and African health per 100 000 in high-income countries
regions the proportion of psychologists and compared to 0.3 in low-income countries, 1.4 in
psychiatrists/other doctors, respectively, is reported lower middle-income countries and 6.8 in upper
to be higher than nurses. middle-income countries.
FIG. 3.2.3 Mental health workforce breakdown per 100 000 population, by WHO region
Psychiatrists Social workers

Child psychiatrists Occupational therapists
Other specialist doctors Speech therapists
Nurses (e.g. psychiatric nurse) Other paid mental health workers
Psychologists
100% 0.5
0.5 0.1 0.4
0.0 0.6 0.0
0.4
90% 0.3 11.2 2.8
0.3
0.7
80% 0.9 0.5 0.1
0.7 0.4
0.5 0.1
0.8
1.3
70% 4.6 0.2
5.4
0.0
0.1 0.1
60%
50% 3.0
3.5 0.5
23.2
7.9
40% 0.8
30% 3.5
0.1
20% 0.0
0.7
0.6
10% 1.3 9.9 0.1
1.2 0.4
1.4 1.6
0%
(N=115) (N=32) (N=21) (N=13) (N=25) (N=9) (N=15)

The number of occupational therapists and speech inpatient and outpatient mental health services, shows
therapists working in mental health is very low, with that globally 88% of the reported mental health
less than 0.25 per 100 000 in all income groups workforce are working in the government health
except the high-income group where there are 1.39 sector. This may also reflect the underreporting of
occupational therapists and 0.68 speech therapists the mental health workforce in the private sector
per 100 000. There are even fewer child psychiatrists, because of limited data availability at national level.
with less than 0.1 per 100 000 population in all income Only 78 Member States reported on the percentage
levels except the high-income group where the of government mental health workers providing child
number of child psychiatrists is 1.19 per 100 000. and adolescent mental health services. The median
rate is below 9% globally and below 20% in all WHO
The proportion of mental health workforce in gov- regions (Data not shown).
ernment mental health services providing government
FIG. 3.2.4 Mental health workforce breakdown per 100 000 population, by World Bank income group
Psychiatrists Social workers

Child psychiatrists Occupational therapists
Other specialist doctors Speech therapists
Nurses (e.g. psychiatric nurse) Other paid mental health workers
Psychologists
100%
0.51 0.05 0.28
0.03 2.09
90% 0.33 12.57
0.03
0.26 0.20
0.24
80% 0.88 0.05 0.50 0.63
1.39
2.59
1.89
70%
9.04
60%
50% 1.43
3.49
0.33
40% 6.83 23.49
30%
0.06 0.02 1.48

20% 0.03 0.02 1.19
0.18
0.09
10% 1.27 0.51 11.87
2.02
0.06
0%
(N=115) (N=25) (N=30) (N=35) (N=25)

Countries were requested to report the total number health training for primary care staff are not aggregated
of primary care staff – broken down by profession at national level at Ministries of Health (Data not
– who were trained in mental health for at least two shown).
days in the last two years. These reported numbers
were then divided by official WHO estimates of the Utilisation of Atlas datasets at successive time points
total workforce of doctors, nurses and community can provide important information and insights into
health workers in each country (that is, not just those emerging trends. Using data set of all countries
working in primary care) and the resulting data show reporting data on psychiatrists in Atlas 2011, 2014
that globally less than 2% of physicians and nurses and 2017, Figure 3.2.5 was generated. Globally,
in all WHO regions received training courses to psychiatrists still remain a rare human resource, with
recognize and to treat patients with severe and global median number of psychiatrists remaining at
common mental disorders during the last year. approximately only one psychiatrist for every 100 000
However it is important to note that this indicator population. High income countries have approximately
suffered from major underreporting and incomplete 120 times more psychiatrists than low income
responses in all regions and across all income groups. countries.
A possibility for underreporting is that data on mental
FIG. 3.2.5 Psychiatrists per 100 000 population 2011, 2014 and 2017, by World Bank income group
2011 2014 2017
14
12.7
12
Median number of psychiatrists
10
8.6
8
6.6
6
2.0 2.1
2 1.3
1.3 1.2
0.9
0.5 0.4 0.5
0.1 0.1 0.1
0

RESULTS
4. MENTAL HEALTH
SERVICE AVAILABILITY
AND UPTAKE
4.1 INPATIENT AND RESIDENTIAL CARE
Inpatient and residential care is composed of mental MENTAL HOSPITALS

hospitals, psychiatric wards in general hospitals,
community residential facilities and other residential Mental hospitals are specialized hospital-based
facilities, forensic inpatient facilities (outside mental facilities that provide inpatient care and long-stay
hospitals) and mental health inpatient facilities residential services for people with mental disorders.
specifically for children and adolescents (both in Usually these facilities are independent and stand
mental hospitals and in general hospitals). Definitions alone, although they may have some links with the
of these facility types are provided in the Glossary rest of the health-care system. In many countries,
of terms (Appendix B). they remain the main type of inpatient mental health
care facility. Table 4.1.2 provides a summary of
Table 4.1.1 provides a summary of adult inpatient indicators for mental hospital and psychiatric wards
care indicators (including mental hospitals, in general hospitals by WHO region and World Bank
psychiatric units in general hospitals, residential country income group.
facilities and forensic inpatient facilities) by WHO
region and World Bank income group. Based on Based on reported data, there are 11.3 mental hospital
reported data there are 16.4 mental health inpatient beds per 100 000 population globally. Despite the
beds per 100 000 population. High-income countries transition in a number of high-income countries
continue to have a much higher number of hospital towards psychiatric wards in general hospitals and
beds (52.60 beds per 100 000 population) compared the provision of community-based residential care,
to low-income groups 1.9 beds per 100 000 high-income countries still have a far higher number
population. High-income countries report to have of mental hospital beds (31.1 per 100 000 population)
14 times more forensic beds and 8 times more child and admission rates (163.2 per 100 000 population)
and adolescent beds per 100 000 population than than lower-income countries; this is true especially
low-income groups. for countries in the European region. Analysed by
TABLE 4.1.1 Total adult inpatient care indicators (mental hospital, forensic inpatient units, psychiatric wards,
community residential facilities) by WHO region and World Bank income group
Facilities (median rate per 100 000 Beds (median rate per 100 000 Admissions (median rate per
population) population) 100 000 population)
(N=159) (N=156) (N=134)
Global 0.22 16.4 99.1
WHO region
AFR 0.1 2.5 20.2
AMR 0.5 20.8 83.9
EMR 0.1 5.1 42.3
EUR 0.7 59.7 453.4
SEAR 0.1 3.2 35.7
WPR 0.7 18.4 114.3
Low 0.1 1.9 17.0
Lower-middle 0.1 6.3 43.8
Upper-middle 0.5 24.3 117.2
High 1.2 52.6 334.1

TABLE 4.1.2 Summary of indicators for mental hospitals and psychiatric wards in general hospitals by WHO
region and World Bank income group
Mental hospitals Psychiatric wards in general hospitals

(median rate per 100 000 population) (median rate per 100 000 population)
Facilities (N=129) Beds (N=128) Admissions (N=113) Facilities (N=139) Beds (N=128) Admissions (N=100)
Global 0.06 11.3 56.3 0.13 2.0 44.4
WHO region
AFR 0.02 2.0 10.3 0.05 0.6 9.7
AMR 0.07 16.7 33.6 0.17 1.7 48.0
EMR 0.03 4.0 21.2 0.03 0.4 21.3
EUR 0.15 34.2 89.6 0.31 12.3 160.5
SEAR 0.01 2.1 35.7 0.07 0.8 27.2
WPR 0.07 14.8 89.6 0.45 4.2 24.3
Low 0.01 1.6 8.6 0.03 0.4 6.9
Lower-middle 0.03 5.1 32.2 0.07 0.9 10.0
Upper-middle 0.07 16.7 56.3 0.15 3.4 55.0
High 0.17 31.1 163.2 0.40 13.1 156.9
WHO region, there are 34.2 mental hospitals beds 4.1.3 and 4.1.4 (for the 87 countries providing data).
per 100 000 population in the European region This shows that in all regions of the world, the great
compared to under 20 beds per 100 000 in the majority of inpatients are discharged within one year
American and Western Pacific regions and under or (global median 82% and above; 70% in all regions
equal to 4 beds per 100 000 in all other regions. except Western Pacific). However, in certain regions
including the American, African and Western Pacific
A further question requested countries to report Regions, there are still a significant proportion (20%
median percentage of duration of stay in mental or more) of mental hospital residents who have had
hospitals, results for which are shown in Figures a length of stay of more than one year or even five
FIG. 4.1.3 Duration of stay in mental hospitals, by WHO region (median percentage values)
>5 years 1–5 years <1 year
1%
100% 5% 5%
8% 5%
15% 12%
90% 10% 10% 6%
19%
10%
80% 9% 19%
70%
60%
50%
85% 85% 89%
40% 82% 80% 77%
69%
30%
20%
10%
0%
(N=87) (N=18) (N=19) (N=10) (N=26) (N=5) (N=9)
RESULTS | 4. MENTAL HEALTH SERVICE AVAILABILITY AND UPTAKE 37

FIG. 4.1.4 Duration of stay in mental hospitals, by World Bank income group (median percentage values)
>5 years 1–5 years <1 year
1%
100% 5% 5%
8% 8%
6% 12%
90% 14%
10%
80% 17%
70%
60%
50%
91% 89%
40% 82% 81%
70%
30%
20%
10%
0%
(N=87) (N=14) (N=18) (N=25) (N=30)
years. A key finding, when data regarding length of although this masks substantial differences between
stay is aggregated by income groups, is that in low regions and country income groups; for example,
income countries more than 90% of inpatient service there are over 13 beds per 100 000 population in
users are staying less than one year, which may high-income countries compared to less than 1 in
reflect an effective utilization of the available limited low-income and lower middle-income countries.
resources. Similar differences are seen for the rate of admissions
and the number of facilities.
PSYCHIATRIC WARDS IN GENERAL Globally, the involuntar y admission median

HOSPITALS percentage is 39.2% at mental hospitals and 16%
at psychiatric wards in general hospitals. This
Psychiatric wards in general hospitals are psychiatric indicator suffered from limited data availability and
units that provide inpatient care within a community- incomplete inputs which put limitations on reporting
based hospital facility (e.g. general hospital). These at regional and income group levels (Data not shown).
units provide care to users with acute psychiatric
problems, and the period of stay is usually relatively Figure 4.1.5 comparing general hospital beds using
short (weeks to months). Mental Health Atlas data sets of 2011, 2014 and
2017, shows slight increase or almost same rates
In Atlas 2017, the global rate of mental hospital beds globally and across in high income groups also,
(11.29 per 100 000 population) was reported to be there is no increase compared to 2011. Figure 4.1.6
six times more (11.29 per 100 000 population) than is showing increase in upper-middle and lower-
the rate of psychiatric ward beds. As shown in Table middle income countries utilization of psychiatric
4.1.2, globally, there are 2.0 beds per 100 000 ward beds in general hospital, in 2017 compared
population in psychiatric wards in general hospitals, to 2011.

FIG. 4.1.5 Psychiatric ward beds at general hospital per 100 000 population 2011, 2014, 2017, by World Bank
income group
2011 2014 2017
14 13.6
13.1
12 11.5
Median number of general hospital beds
10
4 3.4
2.7
2.3
2
0.9
0.6 0.5 0.4 0.4 0.6
0
FIG. 4.1.6 Psychiatric ward admissions at general hospital per 100 000 population 2011, 2014, 2017, by World
Bank income group
2011 2014 2017
200
180 175.4
160 156.9
Median number of general hospital admissions
140
126.8
120
100
80
58.6
60 55
40 36.6
20
7.8 10
6 3.62 6.93 5.7
0

COMMUNITY-BASED RESIDENTIAL region has a far higher number of facilities, beds
CARE FACILITIES and admissions than other regions, with 42 residential
care beds per 100 000 population.
Community-based residential care facilities, which
typically serve users with relatively stable and chronic Based on the data presented in Tables 4.1.1 and
mental disorders, are an almost non-existent 4.1.2, Figures 4.1.7 and 4.1.8 show the overall number
resource in low and middle-income countries of beds per 100 000 population, by WHO region
(according to submitted Mental Health Atlas data and World Bank income group respectively. This
from 64 countries). In high-income countries, by includes: children and adolescent, forensic,
comparison, there are 23 residential care beds per residential care, psychiatric unit and mental hospital
100 000 population, thereby marking them out as beds. Children and adolescent and forensic beds
an important resource in the overall provision of are very rare type of beds particularly in low and
mental health care services. Again, the European lower-middle income countries.
FIG. 4.1.7 Total median number of mental health beds per 100 000 population, by WHO region
Child and adolescent beds

Forensic beds
Residential care beds
Psychiatric unit beds
Mental hospital beds
100%
1.5
90% 2.3
Total median number of mental health beds per 100 000 population
80%
70%
42.4
60%
50%
40% 12.3
30%
5.6
20%
1.7 34.2 4.2
3.8
2.0
10% 16.8 14.8
11.3
2.2
2.0 4.0 2.1
0%

FIG. 4.1.8 Total median number of mental health beds per 100 000 population, by World Bank income group
Child and adolescent beds

Forensic beds
Residential care beds
Psychiatric unit beds
Mental hospital beds
80
Total median number of mental health beds per 100 000 population
1.6
70 2.2
60
23.3
50
40
13.1
30
1.0
0.7
2.0
20 3.4
31.1
10 0.9 16.7
0.9
5.1
1.6
0

4.2 OUTPATIENT CARE
Outpatient care is composed of hospital outpatient per 100 000 population in high-income countries
departments, mental health outpatient clinics, (7,966) is 36 times higher than in low-income
community mental health centres, and community- countries (220).
based mental health care facilities, including day-
care centres. Definitions for these types of facilities Similar discrepancies exist across regions and
are provided in Appendix B. income levels in relation to child and adolescent
outpatient visits. The global median number of visits
Mental health outpatient facilities manage mental to child and adolescent mental health outpatient
disorders and related clinical and social problems facilities is just 164 per 100 000 population with a
on an outpatient basis. Table 4.2.1 shows a summary far higher number of visits in high-income countries
of adult outpatient care facilities indicators including (1609 visits per 100 000 population) than low-income
the total number of facilities and visits relates to countries (11 visits per 100 000 population) (Data
hospital-based facilities, community-based/non- not shown).
hospital facilities and other outpatient facilities
indicators. The global median number of visits to There are 3 times more hospital-based outpatient
adult outpatient facilities is 1601 visits per 100 000 clinic visits (144 per 100 000) in low-income countries
population. compared to community-based non-hospital visits
(48 per 100 000), while in high-income countries
The availability and utilization of outpatient facilities there are a greater number of community-based
is dramatically different for countries of different outpatient visits than hospital-based outpatient
regions and income levels for both outpatient adult visits. In South East Asian, Eastern Mediterranean
and outpatient child and adolescent facilities. The and Western Pacific regions the hospital based
availability of outpatient facilities in high-income outpatients visits are remarkably higher than
countries is 30 times more than low-income community based outpatient visits, which may reflect
countries. The total number of adult outpatient visits the centralization of care at hospital-based settings.
TABLE 4.2.1 Summary of adult outpatient care facilities indicators by WHO region and World Bank country
income group (median rate per 100 000)
Total Hospital-based outpatient Community-based/ non-hospital

Facilities (N=140) Visits (N=113) Facilities (N=121) Visits (N=95) Facilities (N=80) Visits (N=63)
Global 0.90 1601 0.26 961 0.81 1071
WHO region
AFR 0.07 508 0.07 250 0.65 566
AMR 1.38 3071 0.29 1350 1.15 1645
EMR 0.45 632 0.10 448 0.33 194
EUR 1.63 8073 0.42 2571 1.21 3952
SEAR 1.21 437 0.48 437 0.93 30
WPR 2.08 693 0.95 705 0.89 167
Low 0.07 220 0.08 144 0.04 48
Lower-middle 0.50 588 0.08 204 0.48 470
Upper-middle 1.68 1993 0.31 1165 0.70 663
High 2.08 7966 0.48 3853 1.82 4323

CONTINUITY OF CARE with over 60% of responding countries stating that
discharged patients are seen within a month in more
In order to assess continuity of care – a marker for than 50% of cases. There was variation between
the quality of the mental health care system – Atlas WHO regions and income groups with almost 60%
2017 also enquired about the proportion of mental of countries in the Western Pacific region reporting
health inpatients discharged from hospitals, who that discharged patients received a follow-up
had been followed-up within one month. As shown outpatient visit within one month more than 75% of
in Figures 4.2.1 and 4.2.2 reported rates on this the time, c ompa re d w ith 25% in E aste r n
indicator (from 130 countries) were generally high, Mediterranean countries.
FIG. 4.2.1 Continuity of care: proportion of discharged patients seen within a month, by World Bank group
75% or greater 51–75% 26–50% 25% or less
100%
90%
27%
36% 32% 35%
80%
54%
70%
19%
60%
28%
50% 26% 28%
40% 27%
30% 32%
19% 24% 20%
20%
27% 4%
10% 18% 16% 18%
11%
0%
(N=130) (N=25) (N=37) (N=40) (N=28)

FIG. 4.2.2 Continuity of care: proportion of discharged patients seen within a month, by WHO region
75% or greater 51–75% 26–50% 25% or less
100%
90% 25%
26%
36% 36% 37% 33%
80%
70% 58%
22%
60%
38%
21%
50% 26%
30%
44%
40%
18% 35% 6% 16%
30% 19%
17%
20%
31% 11% 21%
24%
10% 18% 17% 17%
11%
5%
0%
(N=130) (N=33) (N=23) (N=16) (N=30) (N=9) (N=19)

4.3 TREATED PREVALENCE
Treated prevalence refers to the proportion of people national level data, while 16% used data from specific
with mental disorders served by mental health sites/localities and 6% only used regional data to
systems. The number of people per 100 000 report on service utilization for psychosis, bipolar
population who received care for mental disorders disorder and depression. 84% of reporting countries
in the various types of mental health facilities used routine health information systems and 16%
(outpatient and inpatient facilities) over the previous used periodic survey to report the data on service
year can serve as a proxy for treated prevalence in utilization for these three mental disorders. There
specialist mental health care services. Aiming to is a wide gap between treated prevalence of the
achieve a better completion rate of this important three disorders in high and low-income countries
indicator, the questionnaire was modified in 2017 as shown in Figure 4.3.1. Psychosis is showing the
to ask about depression instead of moderate to highest treated prevalence among the three
severe depression. The two other mental disorders conditions in low-income, lower-middle and upper-
included in the questionnaire were psychosis and middle countries, while depression treated
bipolar disorder. prevalence in high-income group is almost similar
as psychosis. Treated prevalence for bipolar disorder
79% of Member States responding to this section is exceptionally low across all income groups.
of the Atlas 2017 questionnaire reported using
FIG. 4.3.1 Total treated prevalence of psychosis, bipolar disorder and depression per 100 000 in mental health
services, by World Bank income group
Psychosis Bipolar disorder Depression
350
318.4 319.7
300
250
223.5
200
171.3
150 134.3 131.6
100 95.6
76.0
67.7
50 41.0 35.5 33.8 33.1

18.5 18.8
0
(N=78) (N=13) (N=16) (N=23) (N=26)

4.4 SOCIAL SUPPORT
Social support refers to monetary/non-monetary or some persons with mental disorder receive social
welfare benefits from public funds that may be support.
provided, as part of a legal right, to people with
health conditions that reduce a person’s capacity In Mental Health Atlas 2017, countries were also asked
to function. In Mental Health Atlas 2017, Member about the main types of government social support
States were requested to report on the availability provided to persons with severe mental disorders.
of government social support for persons with mental As shown in Figure 4.4.2, globally, the main types of
disorders and to include specifically persons with government social support provided to persons with
a mental disorder who are officially recorded/ severe mental disorders are social care support and
recognized as being in receipt of government income support. However responses vary significantly
support (e.g. disability payments or income support). across income groups with 85% of high-income
Member States were requested to exclude from this countries reporting that income support is provided
reporting persons with a mental disorder who are compared to only 11% of low-income countries. Other
in receipt of monetary/non-monetary support from discrepancies exist across income groups, most
family members, local charities and other non- notably that high-income countries report that
governmental organizations. significantly more employment (63% of responding
countries) and housing support (58%) is provided by
As shown in Figure 4.4.1, the availability of govern- governments than low-income countries (4%). Globally,
ment social support for persons with mental disorders education, housing, employment and legal support
is strongly influenced by income level. A far higher is less than 35% of the reported support provided.
proportion of high-income countries report that In the African region, provision of housing support
persons with mental disorders receive social support was not reported by any Member State, while in the
(96%) compared with low-income countries, where South East Asia and Eastern Mediterranean regions,
86% of countries state that no persons or only few employment support is provided in 10% and 24% of
Member States, respectively.
FIG. 4.4.1 Availability of government social support for persons with mental disorders, by World Bank income
group
Majority of persons with both severe and non-severe mental disorders

Majority of persons with severe mental disorders and also some with non-severe disorders
Majority of persons with severe mental disorders
Few or some persons with mental disorders
No persons with mental disorders
100% 5%
7%
36% 16%
90% 7% 26%
23%
80%
26%
70% 10% 31%
60%
57%
50% 19%
39%
35% 16%
40%
30% 18%
35% 28%
20%
29% 28%
10%
19% 2%
2% 4%
0%
(N=163) (N=28) (N=40) (N=49) (N=46)

FIG. 4.4.2 Main types of government social support provided for persons with mental disorders, global
percentages
100%
90%
80%
70%
60%
50%
40%
67%
30% 59%
46% 46%
20%
34% 32% 35% 33%
10%
0%
Income Housing Employment Education Social care Legal Family Other
support support support support support support support support

RESULTS
5. MENTAL HEALTH
PROMOTION AND
PREVENTION
5.1 MENTAL HEALTH PROMOTION AND PREVENTION
PROGRAMMES
WHO recommends to Member States in the Mental Global Target 3.1 is for 80% of countries to have at
Health Action Plan to lead and coordinate a least two functioning national, multisectoral
multisectoral strategy that combines universal and promotion and prevention programmes in mental
targeted interventions for: promoting mental health health (by the year 2020).
and preventing mental disorders; reducing
stigmatization, discrimination and human rights In Mental Health Atlas, to be considered ‘functional’,
violations; and which is responsive to specific a programme needed to have at least two of the
vulnerable groups across the lifespan and integrated following three characteristics: a) dedicated financial
within the national mental health and health and human resources; b) a defined plan of
promotion strategies. implementation; and c) evidence of progress and/
or impact. Programmes which did not meet this
The inclusion of mental health in the Sustainable threshold, or which were evidently related to
Development Agenda (SDGs), which was adopted treatment or care, were excluded from the analysis.
at the United Nations General Assembly in September
2015, is adding more importance to Objective 3 of In total, 123 out of 194 WHO Member States (63%)
the Mental Health Action Plan. Goal 3 of the SDGs, reported to have at least two functioning mental
is to ensure healthy lives and promote well-being health promotion and prevention programmes, more
for all, at all ages. Target 3.4 of the SDGs is by 2030 than two thirds of the way to the 2020 Global Target
to reduce by one third premature mortality from of 80%. More than 70% of responding countries in
non-communicable diseases through prevention all regions report they have at least 2 functioning
and treatment and promote mental health and well- programmes, with the exception of countries in the
being. Within the Target 3.4, the suicide rate is an African region, where less than 50% of Member
indicator (3.4.2). Objective 3 of the Mental Health States report they have at least 2 functioning
Action Plan concerns the implementation of programmes (Figure 5.1.1). A total of 356 functional
strategies for promotion and prevention in mental programmes were identified through the Mental
health, including prevention of suicide and self-harm. Health Atlas 2017 questionnaire, with 114 of those
FIG. 5.1.1 Promotion and prevention programmes: Proportion of countries with at least 2 functioning
programmes
100%
90%
80%
70%
60%
50%
40% 78% 80% 78%

71% 75%
70%
30%
48%
20%
10%
0%
(N=123) (N=25) (N=18) (N=15) (N=37) (N=8) (N=20)
RESULTS | 5. MENTAL HEALTH PROMOTION AND PREVENTION 49

in the European region (Figure 5.1.2). It is important as well as other data reported in the questionnaire,
to note that the questionnaire allowed Member are reported by national governmental focal points.
States to report a maximum of five programmes. Functional prevention and promotion programmes
This indicator is showing a remarkable increase managed jointly between the government and other
from the baseline of 2014, which was 80, 41% of all par tners represent 20% of total functioning
WHO Member States. This can be explained by programmes reported. 12% of reported functional
Member States continuing and increasing investment programmes are managed by NGOs, while those
in mental health prevention and promotion. It may managed by private sector represent only 2% of
also be explained by an improved reporting and programmes reported. Functional programmes
completion rate for Atlas indicators in general. This implemented at either district or community level
question was included as an indicator for the first represent only less than 10% of total functioning
time in Mental Health Atlas 2014, so reporting may programmes reported (Data not shown).
have improved with the enhanced availability of data
regarding prevention and promotion programmes Looking across the types of programme reported
functionality in 2017. on, a high proportion (40%) could be described as
mental health awareness or anti-stigma programmes
Over and above the regional distribution of these (Figure 5.1.3). The next most common types of
programmes, programmes were categorised programme were suicide prevention programmes
according to their geographical scope (national, (12%) and school-based promotion interventions
regional, district, community) and their ownership/ (10%). Other programmes such as Early Childhood
management (government, NGO, private, jointly Development/Stimulation programmes, Violence
managed). The majority of reported functional Prevention programmes, Parental/Maternal Mental
programmes are national programmes (76%) and Health Promotion programmes and Workplace
managed by government (66%). This may be Mental Health Promotion programmes represent
explained through the fact that these programmes, 7% of reported functional programmes.
FIG. 5.1.2 Promotion and prevention programmes (N=356): Regional breakdown
120
100
80
60 114
40
64 60
50
20 44
24
0
AFR AMR EMR EUR SEAR WPR

FIG. 5.1.3 Promotion and prevention programmes (N = 349): Main types of programme
Other
Workplace mental health

promotion
9%
7%
School-based mental 10%

health promotion Mental health
40% awareness/anti-stigma/
human rights protection
Parental/maternal mental 7%
health promotion
7%
Early childhood
development/stimulation 7% 12%
Violence prevention
(women, child abuse) Suicide prevention
5.2 SUICIDE PREVENTION
A particular prevention priority in the area of mental The global age-standardized suicide rate in 2016
health concerns suicide, which accounted for an was estimated to be 10.5 per 100 000 population.
estimated 793 000 deaths in 2016 (WHO, 2018). Target Figure 5.2.1 provides age-standardized suicide rates
3.2 of the Mental Health Action Plan 2013–2020, calls in different regions of the world in 2016 using WHO
for a 10% reduction in the rate of suicide in countries Global Health Estimates (WHO, 2018) available on
by 2020. The UN Sustainable Development Goals the Global Health Observatory. Rates are highest
(SDGs) include target 3.4 to address non-communicable in the WHO European, South-East Asia, and African
diseases and mental health with an indicator to reduce regions.
suicide mortality by a third by 2030.
FIG. 5.2.1 Age-standardized suicide rates per 100,000 population, by region, 2016
Males Females Both sexes
25
21.2
20
16.6
15.4
15 14.5
13.7 13.4
12.9
12 11.5
10.5
10 9.3 9.5
8.4
7.5 7.8 7.5
5.6
5
5 4.3 4.3
2.9
0
RESULTS | 5. MENTAL HEALTH PROMOTION AND PREVENTION 51

Mental Health Atlas 2017, asked countries to report that currently close to 10% of low- and lower-middle
on the availability of a suicide reporting system income countries have a stand-alone government-
system. Out of 148 Member States who responded adopted strategy, while about one-third of upper-
to this question, 59% reported the availability of middle and high-income countries report having
suicide mortality data from a vital registration system. such a strategy. This means that there has been a
The reported responsible bodies for ascertainment slight increase in the number of countries reporting
of suicide include: medico legal authorities (49%) having a national suicide prevention strategy since
who ascertain suicide, followed by a coronial system the Mental Health Atlas 2014. In addition, there are
(21%) (Data not shown). some countries with a national framework, national
programmes for specific sub-populations, or where
Member States were also asked whether they had suicide prevention is integrated into the mental
a national suicide prevention strategy. Results show health or other health plan.

REFERENCES
WHO (2001). Mental health resources in the world 2001. World Health Organization, Geneva.
WHO (2005). Mental Health Atlas 2005. World Health Organization, Geneva.
Lora, A. et al. (2012). Service availability and utilization and treatment gap for schizophrenic disorders: a survey
in 50 low- and middle-income countries. Bulletin of World Health Organization, Geneva.
WHO (2013). Mental Health Action Plan. World Health Organization, Geneva. http://www.who.int/mental_health/
publications/action_plan/en/.
WHO (2014). Preventing suicide: a global imperative. World Health Organization, Geneva. http://www.who.
int/mental_health/suicide-prevention/world_report_2014/en/.
WHO (2015). Mental Health Atlas 2014. World Health Organization, Geneva.
WHO (2018). Global Health Expenditure Database. [online] Available at: http://apps.who.int/nha/database/
Regional_Averages/Index/en accessed 15 April 2018.
WHO (2018). Global Health Observatory (GHO) data. [online] Available at: http://www.who.int/gho/en/, accessed
15 April 2018.
REFERENCES 53
APPENDIX A
PARTICIPATING COUNTRIES
AND CONTRIBUTORS
World Bank
WHO Member States WHO region income category Contributors to Atlas 2017
Afghanistan EMR Low Bashir Ahmad Sarwari
Albania EUR Upper-middle Emanuela Tollozhina
Algeria AFR Upper-middle Mohamed Chakali
Angola AFR Lower-middle Massoxi Adriana G. Vigário
Antigua and Barbuda AMR High Teri-Ann Joseph
Argentina AMR Upper-middle Andre Blake
Armenia EUR Lower-middle Samvel Torosyan
Australia WPR High Natasha Cole
Austria EUR High Alexander Grabenhofer-Eggerth
Azerbaijan EUR Upper-middle Fuad Ismayilov
Bahamas, The AMR High Eugenia Combie
Bahrain EMR High Eman Ahmad Haji
Bangladesh SEAR Lower-middle Faruq Alam
Barbados AMR High Joy St. John
Belarus EUR Upper-middle Alexander Startcev
Belgium EUR High Pol Gerits
Belize AMR Upper-middle Eleanor Bennett
Bhutan SEAR Lower-middle Mindu Dorji
Bolivia (Plurinational State of) AMR Lower-middle Boris Flores Viscarra
Bosnia and Herzegovina EUR Upper-middle Drazenka Malicbegovic
Botswana AFR Upper-middle Patrick Zibochwa
Brazil AMR Upper-middle Quirino Cordeiro Junior
Brunei Darussalam WPR High Jacob John
Bulgaria EUR Upper-middle Hristo Hinkov
Burkina Faso AFR Low Somda Kuessome Paulin
Burundi AFR Low Joselyne Miburo, Jérôme Ndaruhutse
Cambodia WPR Lower-middle Chhit Sophal
Cameroon AFR Low Menguene Laure
Canada AMR High Sarah Lawley
Cape Verde AFR Lower-middle Aristides
Central African Republic AFR Low Caleb Kette
Chad AFR Low Bolsane Egip
Chile AMR High Mauricio Gomez Chamorro
China (People's Republic of) WPR Upper-middle Leilai YI
Colombia AMR Upper-middle Jose Fernando Valderrama Vergara
Comoros AFR Low Aboubacar said Anli
Congo (the) AFR Lower-middle Kitembo Lambert
Cook Islands WPR Upper-middle Valentino Wichman
Costa Rica AMR Upper-middle Allan Rimola Rivas
Côte d'Ivoire AFR Lower-middle DELAFOSSE
Croatia EUR Upper-middle Neven Henigsberg
Cuba AMR Upper-middle Carmen Borrego
Cyprus EUR High Yiannis Kalakoutas
Czech Republic (the) EUR High Petr Winkler
Denmark EUR High Sine Almholt Hjalager
Dominican Republic AMR Upper-middle Angel Almanzar
Ecuador AMR Upper-middle Roberto Enriquez Anaya
Egypt EMR Lower-middle Hisham Ahmed Ramy
APPENDIX | A. LIST OF PARTICIPATING COUNTRIES AND CONTRIBUTORS 55

World Bank
El Salvador AMR Lower-middle Arturo Carranza Rivas
Equatorial Guinea AFR Upper-middle Alicia Oyensue
Eritrea AFR Low Ghidewon Yirgaw
Estonia EUR High Ingrid Ots-Vaik
Ethiopia AFR Low Dereje Assefa
Fiji WPR Upper-middle Irene Lata
Finland EUR High Helena Vorma
France EUR High Emmanuelle Jouy
Gabon AFR Upper-middle Mbungu Mabiala
Gambia (the) AFR Low Bakary Sonko
Georgia EUR Lower-middle Ekaterine Adamia
Germany EUR High Robert Schlack
Ghana AFR Lower-middle Priscilla Elikplim Tawiah
Greece EUR High D.Ploumpidis, K. Moschovakis
Grenada AMR Upper-middle Tomo Kanda
Guatemala AMR Lower-middle Ninette Alburez de von Ahn
Guinea AFR Low Kemo Soumaoro
Guinea-Bissau AFR Low Jeronimo Enrique Te
Guyana AMR Upper-middle Util Richmond-Thomas
Haiti AMR Low René Dormesant
Honduras AMR Lower-middle Carolina Padilla
Hungary EUR High Tamas Kurimay
Iceland EUR High Ingibjörg Sveinsdóttir
India SEAR Lower-middle Sujeet K. Singh
Indonesia SEAR Lower-middle Antony Azarsyah
Iran (Islamic Republic of) EMR Upper-middle Ahmad Hajebi
Iraq EMR Upper-middle Emad Abdulrazaq
Ireland EUR High Michael Murchan
Israel EUR High Daphna Levinson
Italy EUR High Teresa Di Fandra
Jamaica AMR Upper-middle Maureen Irons-Morgan
Japan WPR High Toshihiro Horiguchi
Jordan EMR Lower-middle Fateen Janim
Kenya AFR Lower-middle Simon Njuguna Kahonge
Kiribati WPR Lower-middle Arite Kathrine Kauongo
Kyrgyzstan EUR Lower-middle Sabira Musabaeva
Latvia EUR High Toms Pulmanis
Lebanon EMR Upper-middle Rabih El Chammay
Liberia AFR Low F. Boffa Washington
Libya EMR Upper-middle Amjad Shagrouni
Lithuania EUR High Ona Davidoniene
Luxembourg EUR High Juliana D’Alimonte
Madagascar AFR Low Raharinvo Mbolatiana
Malaysia WPR Upper-middle Nurashikin Ibrahim
Maldives SEAR Upper-middle Saneefa Hassan Manik
Mali AFR Low Cheikna Tounkara
Marshall Islands WPR Upper-middle Marita Edwin
Mauritania AFR Lower-middle Yahafdou El Mouhab
Mauritius AFR Upper-middle Ameenah Sorefan

World Bank
Mexico AMR Upper-middle Guadalupe Del Carmen Villegas Perez
Micronesia (Federated States of) WPR Lower-middle Benido Victor
Monaco EUR High Dominique De Furst
Mongolia WPR Lower-middle Kazantseva Elena
Montenegro EUR Upper-middle Aleksandra Raznatovic
Morocco EMR Lower-middle Maaroufi Abderahman
Mozambique AFR Low Palmira Fortunato dos Santos
Myanmar SEAR Lower-middle Tin Oo
Namibia AFR Upper-middle Celia Kaunatjike
Nauru WPR Upper-middle Albertina Barandonga
Nepal SEAR Low Mohammad Daud
Netherlands (the) EUR High Paulien Seeverens
New Zealand WPR High Barry Welsh
Nicaragua AMR Lower-middle Roger Montes Gonzalvez; Guillermo
Niger AFR Low Boureima Abdou
Nigeria AFR Lower-middle Alison Abdullahi
Niue WPR Lower-middle Thomas Pita
Norway EUR High Gitte Huus
Oman EMR High Amira Al Raidan
Pakistan EMR Lower-middle Fareed Aslam Minhas
Panama AMR Upper-middle Ricardo Goti
Paraguay AMR Upper-middle Mirta Mendoza Bassani
Peru AMR Upper-middle Miguel Angel Hinojosa Mendoza
Philippines WPR Lower-middle Gerardo Bayugo
Poland EUR High Marek Stańczuk
Portugal EUR High Álvaro Carvalho
Qatar EMR High Susan Clelland
Republic of Korea (the) WPR High Hyo Yeong Yu
Republic of Moldova (the) EUR Lower-middle Jana Chihai
Romania EUR Upper-middle Botezat Antonescu Ileana
Russian Federation EUR Upper-middle Anna Korotkova
Rwanda AFR Low Frederic Nsanzumuhire
Saint Kitts and Nevis AMR High Tomo Kanda
Saint Lucia AMR Upper-middle Alicia St Juste
Saint Vincent and the Grenadines AMR Upper-middle Diana Bailey
Samoa WPR Upper-middle George Tuitama
Sao Tome and Principe AFR Lower-middle Marta Maria Posser da Costa Neto
Saudi Arabia EMR High Abdulhameed A. Al-Habeeb
Senegal AFR Low Aida Sylla
Serbia EUR Upper-middle Dusica Lecic-Tosevski
Seychelles AFR High Gina Michel
Sierra Leone AFR Low A Wurie
Singapore WPR High Lay Tin ONG
Slovak Republic EUR High Ivan Doci
Slovenia EUR High Matej Vinko
Solomon Islands WPR Lower-middle Orotaloa
Somalia EMR Low Zeynab Ahmed Noor
South Africa AFR Upper-middle Melvyn Freeman, Sifiso Phakathi
South Sudan AFR Low Atong Ayuel, Joseph Lou K. Mogga
APPENDIX A. | LIST OF PARTICIPATING COUNTRIES AND CONTRIBUTORS 57

World Bank
Spain EUR High José Rodriguez
Sri Lanka SEAR Lower-middle Chithramalee de Silva
Sudan EMR Lower-middle Hoyam Ibrahim
Suriname AMR Upper-middle Bharti Manurat
Swaziland AFR Lower-middle Violet D. Mwanjali
Sweden EUR High Martin Jeppsson
Switzerland EUR High Lea Meier
Syrian Arab Republic EMR Lower-middle Ramadan Mahfouri
Tajikistan EUR Lower-middle Khurshed Kunguratov
Thailand SEAR Upper-middle Chosita Pavasuthipaisit
The former Yugoslav Republic of Macedonia EUR Upper-middle Antoni Novotni
Timor-Leste SEAR Lower-middle Helder Juvinal Neto da Silva
Togo AFR Low Kolou Dassa
Tonga WPR Upper-middle Pita Pepa
Trinidad and Tobago AMR High Lawrence Jaisingh
Tunisia EMR Lower-middle Wahid Melki
Turkey EUR Upper-middle Ugur Ortac
Uganda AFR Low Ndyanabangi Sheila
Ukraine EUR Lower-middle Serhii Shum
United Arab Emirates (the) EMR High Muna Al Kuwari
United Kingdom of Great Britain and EUR High Shipton-Yates
Northern Ireland (the)
United Republic of Tanzania (the) AFR Low Ayoub Magimba
United States of America (the) AMR High Mary Fleming
Uruguay AMR High Jorge Quian
Uzbekistan EUR Lower-middle Grigoriy Kharabara
Vanuatu WPR Lower-middle Jerry Iaruel
Venezuela (Bolivarian Republic of) AMR Upper-middle Xiomara Vidal
Vietnam WPR Lower-middle La Duc Cuong
Yemen EMR Lower-middle Mohammed Yahya Alashwal
Zambia AFR Lower-middle Friday Nsalamo
Zimbabwe AFR Low Dorcas Shirley Sithole

Associate Members, Areas and Territories*
Anguilla Aisha Andrewin, Maeza Demis-Adams
Sint Maarten Irad Potter
Tokelau Silivia Tavite
West Bank and Gaza Strip Samah Jabr
American Samoa Motusa Tuileama Nua
Bermuda Anna Neilson-Williams
British Virgin Islands Irad Potter
Cayman Islands Janett Flynn
China, Hong Kong, SAR Kellie SO
Curaçao Beulah Mercera
French Polynesia Mathis
Kosovo Besnik Stuja
Macao Chi-Veng HO
Montserrat Marguerite Joseph, Donique Layne
Northern Mariana Islands, Commonwealth of the Glenda Sablan George
Turks and Caicos Islands Alicia Malcolm
* Associate Members, Areas and Territories were not included in the WHO regional and World Bank income group analyses. However short descriptive
profiles of each of these countries as well as all participating WHO Member States will be published in the WHO Mental Health and Substance Abuse
website.
Note: Although care has been taken to include names of all contributors, information on any omissions or inaccuracies can be communicated to WHO
Secretariat at [email protected].
APPENDIX A. | LIST OF PARTICIPATING COUNTRIES AND CONTRIBUTORS 59

GLOSSARY OF TERMS
TYPES OF FACILITY  Excludes: Community-based psychiatric inpatient

units; forensic inpatient units and forensic
Forensic inpatient unit: hospitals. Facilities that treat only people with
An inpatient unit that is exclusively maintained for alcohol and substance abuse disorder or
the evaluation or treatment of people with mental intellectual disability without an accompanying
disorders who are involved with the criminal justice mental disorder diagnosis.
system. These units can be located in mental
hospitals, general hospitals, or elsewhere. Psychiatric ward in a general hospital:
A psychiatric unit that provides inpatient care for
Mental hospital: the management of mental disorders within a
A specialized hospital-based facility that provides community-based facility. These units are usually
inpatient care and long-stay residential services for located within general hospitals, they provide care
people with mental disorders. Usually these facilities to users with acute problems, and the period of stay
are independent and standalone, although they may is usually short (weeks to months).
have some links with the rest of the health care
system. The level of specialization varies considerably:  Includes: Both public and private non-profit and
in some cases only long-stay custodial services are for-profit facilities; psychiatric ward in general
offered, in others specialized and short-term services hospital; psychiatric unit in general hospital,
are also available (rehabilitation services, specialist community-based psychiatric inpatient units for
units for children and elderly, etc.) children and adolescents only; community-based
psychiatric inpatient units for other specific groups
 Includes: Both public and private non-profit and (e.g. elderly).
for-profit facilities; mental hospitals for children
and adolescents only and mental hospitals for  Excludes: Mental hospitals; community residential
other specifics groups (e.g., elderly) are also facilities; facilities that treat only people with
included. alcohol and substance abuse disorder or mental
retardation.
Mental health community residential facility: but that are not planned with their specific needs
A non-hospital, community-based mental health in mind; day treatment facilities for inpatients are
facility that provides overnight residence for people excluded
with mental disorders. Usually these facilities serve
Mental health outpatient facility:
users with relatively stable mental disorders not
requiring intensive medical interventions. A facility that focuses on the management of mental
disorders and the clinical and social problems related
 Includes: Supervised housing; un-staffed group to it on an outpatient basis.
homes; group homes with some residential or
visiting staff; hostels with day staff; hostels with  Includes: Community mental health centres;
day and night staff; hostels and homes with mental health ambulatories; outpatient services
24-hour nursing staff; halfway houses; therapeutic for specific mental disorders or for specialized
communities. Both public and private nonprofit treatments; outpatient clinics located in mental
and for-profit facilities are included. Community hospitals or general hospitals ; mental health
residential facilities for children and adolescents outpatient departments in general hospitals;
only and community residential facilities for other mental health policlinics; specialized NGO clinics
specifics groups (e.g. elderly) are also included. that have mental health staff and provide mental
health outpatient care (e.g. for rape survivors or
 Excludes: Facilities that treat only people with a homeless people). Both public and private non-
diagnosis of alcohol and substance abuse disorder profit and for-profit facilities are included. Mental
or intellectual disability; residential facilities in health outpatient facilities for children and
mental hospitals; generic facilities that are adolescents only and mental health outpatient
important for people with mental disorders, but facilities for other specifics groups (e.g. elderly)
that are not planned with their specific needs in are also included.
mind (e.g. nursing homes and rest homes for
elderly people, institutions treating neurological  Excludes: Private practice; facilities that treat only
disorders, or physical disability problems). people with alcohol and substance abuse disorder
or intellectual disability without an accompanying
Mental health day care facility: mental disorder diagnosis.
A facility that typically provides care for users during
Other residential facility:
the day. The facilities are generally: (1) available to
groups of users at the same time (rather than A residential facility that houses people with mental
delivering services to individuals one at a time), (2) disorders but does not meet the definition for
expect users to stay at the facilities beyond the community residential facility or any other mental
periods during which they have face-to-face contact health facility defined for this instrument (community-
with staff (i.e. the service is not simply based on based psychiatric inpatient unit, community residential
users coming for appointments with staff and then facility, forensic inpatient unit, mental hospital).
leaving immediately after the appointment) and (3)
involve attendances that last half or one full day.  Includes: Residential facilities specifically for
people with intellectual disabilities, for people with
 Includes: Day centres; day care centres; sheltered substance abuse problems, or for people with
workshops; club houses; drop-in centres; dementia. Included are also residential facilities
employment/ rehabilitation workshops; social that formally are not mental health facilities but
firms. Both public and private non-profit and for- where, nevertheless, the majority of the people
profit facilities are included. Mental health day residing in the facilities have diagnosable mental
treatment facilities for children and adolescents disorders.
only and mental health day treatment facilities for
other specifics groups (e.g. elderly) are also OTHER TERMS USED
included.
Admissions:
 Excludes: Facilities that treat only people with a The number of admissions in one year is the sum
diagnosis of alcohol and substance abuse disorder of all admissions to the facility within that year. This
or intellectual disability without an accompanying number is a duplicated count; in other words, if one
mental disorder diagnosis; generic facilities that user is admitted twice, it is counted as two
are important for people with mental disorders, admissions.
APPENDIX | B. GLOSSARY OF TERMS 61

Mental health legislation: Patients treated in a mental health
Legal provisions related to mental health. These outpatient facility:
provisions typically focus on issues such as: civil The number of users with at least one outpatient
and human rights protection of people with mental contact with the facility. A contact refers to a mental
disorders, treatment facilities, personnel, professional health intervention provided by a staff member of
training, and service structure. a mental health outpatient facility, whether the
intervention occurs within the facility or elsewhere.
Mental health plan:
A detailed scheme for implementing strategic actions Primary health care clinic:
that addresses the promotion of mental health, the A clinic that often offers the first point of entry into
prevention of mental disorders, and treatment and the health care system. Primary health care clinics
rehabilitation. Such a plan allows the implementation usually provide the initial assessment and treatment
of the vision, values, principles and objectives defined for common health conditions and refer those
in the policy. requiring more specialized diagnosis and treatment
to facilities with staff with a higher level of training.
Mental health policy:
Mental health policy is an organized set of values, Psychiatrist:
principles and objectives for improving mental health A medical doctor who has had at least two years
and reducing the burden of mental disorders in a of post- graduate training in psychiatr y at a
population. It defines a vision for future action. recognized teaching institution. This period may
include training in any sub-specialty of psychiatry.
Other health or mental health worker:
A health or mental health worker that possesses Psychologist:
some training in health care or mental health care A professional having completed a formal training
but does not fit into any of the defined professional in psychology at a recognized, university-level school
c ate gor ie s (e.g. me dic a l doctor s, nur se s, for a diploma or degree in psychology.
psychologists, social workers, occupational
therapists). Social worker:
A professional having completed a formal training
 Includes: Non-doctor/non-nurse primary care in social work at a recognized, university-level school
workers, professional and paraprofessional for a diploma or degree in social work.
psychosocial counsellors, special mental health
educators, and auxiliary staff. Nurse:
A health professional having completed a formal
 Excludes: This group does not include general training in nursing at a recognized, university-level
staff for support services within health or mental school for a diploma or degree in nursing.
health care settings (e.g. cooking, cleaning,
security). Occupational therapist:
A health professional having completed a formal
Patients treated in a mental hospital: training in occupational therapy at a recognized,
(a) the number of patients in the mental hospital at university-level school for a diploma or degree in
the beginning of the year plus (b) the number of occupational therapy.
admissions during the year.
User/consumer/patient:
Patients treated in a community residential A person receiving mental health care. These terms
facility: are used in different places and by different groups
(a) the number of users in the facility at the beginning of practitioners and people with mental health
of the year plus (b) the number of admissions to the conditions.
facility during the year.
Patients treated through a mental health

day treatment facility:
The number of users with at least one attendance
for treatment at the facility within the year.

The Mental Health Atlas project has become a valuable resource
on global information on mental health and an important tool for
developing and planning mental health services within countries.
The Mental Health Atlas 2017 is remarkably significant as it is
providing information and data on the progress towards the
achievement of objectives and targets of the Comprehensive
Mental Health Action Plan 2013–2020.
For more information,

please contact:
Department of Mental Health and
Substance Abuse
World Health Organization
Avenue Appia 20
CH-1211 Geneva 27
Switzerland
Email: [email protected]
http://www.who.int/mental_health/
evidence/atlasmnh/en/
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M E N TA L H E A LT H

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PROJECT TEAM AND PARTNERS iv

1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS 10

2. MENTAL HEALTH SYSTEM GOVERNANCE 14

3. FINANCIAL AND HUMAN RESOURCES FOR MENTAL HEALTH 25

4. MENTAL HEALTH SERVICE AVAILABILITY AND UPTAKE 35

5. MENTAL HEALTH PROMOTION AND PREVENTION 48

APPENDIX A: List of participating countries and contributors 54

APPENDIX B: Glossary of terms 60

RESULTS | 1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS iii

At WHO Headquarters, a team of staff and consultants comprising Corrado

iv MENTAL HEALTH ATLAS 2017

(1) To strengthen effective leadership and governance for mental health;

MENTAL HEALTH SYSTEM GOVERNANCE

2 MENTAL HEALTH ATLAS 2017

Action Plan objectives

8 MENTAL HEALTH ATLAS 2017

1. GLOBAL REPORTING ON CORE MENTAL HEALTH

2. MENTAL HEALTH SYSTEM GOVERNANCE

3. FINANCIAL AND HUMAN RESOURCES FOR

4. MENTAL HEALTH SERVICE AVAILABILITY AND

5. MENTAL HEALTH PROMOTION AND

RESULTS | 1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS 11

10% 24% 24% 20%

12 MENTAL HEALTH ATLAS 2017

20% 36% 23%

RESULTS | 1. GLOBAL REPORTING ON CORE MENTAL HEALTH INDICATORS 13

2. MENTAL HEALTH SYSTEM

TABLE 2.1.1 Existence and revision status of mental health policies/plans

RESULTS | 2. MENTAL HEALTH SYSTEM GOVERNANCE 15

% of responding countries in 2014

Policy/plan promotes transition towards community-based 92%

Policy/plan pays explicit attention to respect for the human 85%

Policy/plan promotes a full range of services and supports 76%

Policy/plan promotes a recovery approach to mental 76%

Policy/plan promotes the participation of persons with 68%

16 MENTAL HEALTH ATLAS 2017

Yes to all 5 items

100% 100% 100% 100%

RESULTS | 2. MENTAL HEALTH SYSTEM GOVERNANCE 17

Countries reporting that

2.2 MENTAL HEALTH LEGISLATION

18 MENTAL HEALTH ATLAS 2017

% of responding countries in 2014

Legislation promotes transition towards community-based 62%

Legislation promotes rights of people with mental 67%

Legislation provides for procedures to enable persons with 68%

Legislation provides for regular inspections of human 60%

RESULTS | 2. MENTAL HEALTH SYSTEM GOVERNANCE 19

Yes to all 5 items

100% 100% 100%

80% 80% 80%