Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 6, Issue 3, 2003. Pages: 135-143 Published Online: 30 Oct 2003 Copyright © 2003 ICMPE.

*Correspondence to: Dr. Shekhar Saxena, Co-ordinator, Mental Health: Evidence and Research, Department of Mental Health and Substance Dependence, World Health Organization, CH - 1211, Geneva - 27, Switzerland.
Tel.: +41-22-791 3625
Fax: +41-22-791 4160
E-mail: saxenas@who.int

Source of Funding: The authors are WHO officials.

Abstract

WHO's Project Atlas collected information on policies, programmes, budget and financing, and resource indicators related to mental health care from all countries. Of  the 89 countries that provided the requisite information, 36% spent less than 1% of their total health budget on mental health. Out-of-pocket expenditure was the primary method of financing mental health care in many (16.4%) countries. Counties categorized based on the proportion of mental health budget to health budget, differed significantly in terms of income-levels (World Bank classification), policy on disability benefits and mental health resource indicators (beds, personnel, services for special populations and availability of drugs). To meet the substantial burden of neuropsychiatric disorders, most countries need to increase their mental health budgets and use resources more efficiently and judiciously, by supporting equitable ways of financing mental health care, integration of services, and provision of appropriate training.

Background: Very little information is available on budget and financing of mental health services in the world. Aims of the Study: During year 2001, WHO collected information from all countries on resources available for mental health care as a part of Project Atlas. The present report seeks to describe the situation regarding federal budgets and financing of mental health care at the country level. It also examines the association between relative allocation of health budget to mental health and mental health policy, programme and resource indicators in 89 countries. Method: The information was collected through a questionnaire (with an accompanying glossary) that was sent to the mental health focal point in the Ministry of Health of each country. Eighty nine countries provided information on their mental health budget as a proportion of health budget. In addition, information was obtained on policy, programme and mental health resource indicators (beds, personnel, services to special population and availability of drugs). Results: The results showed that 32% of 191 countries did not have a specified budget for mental health. Of the 89 countries that supplied the requisite information 36% spent less than 1% of their total health budget on mental health. Many countries from Africa (79%) and the South East Asia (63%) were in this subgroup. Comparison with the Global Burden of Disease data showed a marked disparity between burden and resources. Lower income countries allocated a lesser proportion of their health budget on mental health in comparison to higher income countries. The primary method of financing mental health care in most countries was tax-based (60.2%), but many low-income countries depended on out-of-pocket expenditure (16.4%). The presence of mental health policies and programmes in general was not associated with the proportion of health budget allocated to mental health. Counties categorized based on the proportion of mental health budget to health budget, differed significantly in terms of policy on disability benefits and mental health resource indicators (beds, personnel, services for special populations and availability of drugs). Discussion and Limitations: Federal allocation for mental health care in most countries is low compared to the burden of these disorders. There is also a large disparity among countries and regions. Limitations of the study were, an exclusive reliance on government sources and the difficulty some governments faced in providing accurate information on federal mental health budget as it was not identified separately. Implications for Health Care Provision and Use: To use resources more efficiently and judiciously, countries should support integration of services, reallocation of mental health beds, training in mental health to providers and services for special populations. Implications for Health Policies: Most countries need to increase their mental health budgets in order to provide necessary services. Countries with out-of-pocket payment as the primary method of mental health financing should seek to establish social insurance mechanisms. Implications for Further Research: More research needs to be conducted to gather specific information on mental health financing in relation to policy and service planning.

Received  21 May 2003; accepted  28 May 2003

Copyright © 2003 ICMPE