We carried out a systematic review using the steps recommended in the PRISMA statement. for papers published in English or Chinese between Jan 1, 2005, and Dec 31, 2014. We searched MEDLINE, Embase, PsycINFO, PubMed, the Cochrane Library, and the Web of Science; we also searched country-specific databases including IndMED, the only database of Indian medical journals, many of which are not indexed on any other international database, and SinoMed, the most comprehensive electronic database of
SeriesThe magnitude of and health system responses to the mental health treatment gap in adults in India and China
Introduction
In recognition of the large gap between the need for treatment of mental disorders and the provision of that treatment, WHO's Mental Health Action Plan calls for an increase in service coverage for severe mental disorders by at least 20% by the year 2020.1 The reduction of the treatment gap in India and China, the two most populous countries in the world, is crucially important for achievement of this goal. Systematic assessment of the scale of and health system response to the treatment gap could not only help these two countries to improve their mental health system performance, but also shed light on how other countries might achieve their mental health goals. In this Series paper we address four issues: estimation of the magnitude of the treatment gap; description of the response of the mental health-care systems; identification of the barriers to addressing the treatment gap; and identification of innovations with potential to overcome these barriers. We undertook a systematic review of the indexed literature and a non-systematic review of so-called grey literature on these four issues for depression, psychosis, bipolar disorder, epilepsy, dementia, and alcohol and drug use disorders, all deemed priority adult mental disorders by the WHO Mental Health Gap Action Programme.2 We have focused on biomedical (modern) medicine, as traditional health-care systems, which are popular in both countries, are addressed in a dedicated paper in this Series.3
Section snippets
The magnitude of the treatment gap
We used two indicators to estimate the magnitude of the treatment gap: contact coverage to measure service use, and effective coverage to further measure the extent to which the service has effectively improved the health of people who used it.4
Governance and organisation
Nine papers from China28, 41, 42, 43, 44, 45, 46, 47, 48 and eight papers from India49, 50, 51, 52, 53, 54, 55, 56 addressed the health system response, in accordance with grey literature. Table 3 summarises the mental health-care systems in the two countries. Both countries have embarked on a restructuring of their mental health-care systems and advocating community-based care. However, health system responses, both across and within the two countries, vary substantially. The centralised
Barriers to improving access to care
In both India and China, some demand-side and supply-side barriers contribute to the treatment gap and limit timely access to mental health-care.79, 80
Innovations to improve access to care
A major strategy for addressing workforce shortages has been the use of task-sharing. Growing evidence has shown that non-specialists can be trained to identify, diagnose, and treat people with mental health problems, improving adherence and clinical outcomes in a range of mental disorders.17, 26, 110, 114 For example, a programme in Haryana, India, used peer educators to lead outreach activities for male drug users. In this programme, the proportion of injecting drug users who shared needles
Discussion
This Series paper describes the first systematic effort to review the unmet mental health needs for adults with priority mental disorders in China and India. Evidence shows that contact coverage for common mental disorders and alcohol use disorders, which together account for more than 60% of the mental health related burden of disease in the two countries, is very low.123 Effective coverage is even lower, not only for common disorders but also for severe problems such as psychotic disorders
Search strategy and selection criteria
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