Less than 7% of people worldwide get effective mental health or substance abuse treatment

Over the last decade, a number of high profile campaigns have aimed to get people to open up about their mental health. Some have rightfully pointed out that contact with mental health services doesn't guarantee someone will receive adequate help. A recent study, published in JAMA Psychiatry, finds that for a surprisingly large number of people, help is difficult to come by at all.

According to their research, which drew from health data from around the world, very few people receive effective treatment for mental health and substance use disorders. These findings, the team argues, highlight the need for higher quality treatment – and for more recognition from clinicians that help is needed for poor mental health.

Data came from 56,927 participants of the World Mental Health surveys, which provide a snapshot of mental health diagnoses and treatment across 21 countries in Europe, North America, South America, Africa, and Asia. Between 2001 and 2019, these participants gave a face-to-face interview, which researchers used to assess for nine major mental health disorders, as well as look at factors like the number of therapy sessions attended, whether people took their medication, and any engagement with healthcare professionals, complementary practitioners, or self-help groups.

These interviews also explored barriers to care: whether participants themselves felt they needed help, if any financial limitations stopped them accessing care, or if they had experienced stigma. Participants' answers were also linked with data on country-level factors like healthcare spending and available mental health resources for further analyses.

When analysing this data, the team found that around 13.8% of participants met the criteria for a mental health diagnosis, the most common being anxiety (9.3% of participants), phobias (5.9%), mood disorders (5.4%), major depressive disorder (4.3%) and substance use disorders (2.3%).

From here, the team identified several bottlenecks in treatment. Of the 46% of people who met the criteria for a diagnosis and recognised their need for help, only 34% actually asked for it from services – and of those who received a minimum level of adequate treatment, only 47% received effective treatment for their condition. This means that, overall, only 6.9% of people received effective treatment.

There was also significant variation in treatment across diagnoses: just 1.4% of those with alcohol use disorder received treatment, compared to 12% for generalised anxiety. Similarly, there were interesting variations in who received effective care: women were 1.5 times more likely to receive good care than men, for example. Likewise, people aged between 30 and 59 and those with higher education had better odds of receiving adequate treatment.

On a country level, more hospital beds, more doctors, and increased healthcare spending correlated with better treatment rates, though societal stigma (perhaps surprisingly) didn't significantly affect access. However, even in well-resourced countries, major gaps remained in people's ability to access mental health care.

From the data, the team identified four key steps which could help prevent such bottlenecks. The first is helping people recognise their need for treatment – something that could be addressed through ongoing anti-stigma campaigns.

Next, healthcare systems themselves have to recognise their need. According to the authors, this should be a key consideration for healthcare workers, in particular those who act as a first point of contact like GPs: "improving the ability of general practitioners to diagnose and treat the mild to moderate forms, and to know when to refer more severely affected folks to specialists, becomes the cornerstone of the system," said lead author Daniel Vigo.      

Finally, patients need to receive not only a minimum level of adequate treatment, but actively effective treatment. This means that patients have access to either ongoing psychotherapeutic treatment and/or medication. Whether healthcare systems worldwide are able to create capacity for this, however, is a different matter entirely.

Ultimately, despite awareness of mental health conditions growing, the study's findings reinforce the fact that access to effective treatment is still hard to come by. And as the team points out, addressing this gap requires a multi-faceted approach – not just encouraging individuals to seek help, but actually making sure that healthcare systems can respond to their needs when they do.

Read the paper in full:
Vigo, D. V. et al. (2025). Effective Treatment for Mental and Substance Use Disorders in 21 Countries. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2024.4378

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