Treatment Gap in Mental Health Care among Low- and Middle-income Countries: A Narrative Review

Introduction: Mental, neurological, and substance use disorders are showing an increasing trend and currently constitute a 16% global burden of disease. Patient and systems-related factors contribute to the treatment gap in mental disorders of public health importance. Low- and middle-income countries (LAMIC) have unique factors contributing to the treatment gap. Methods: We report this review to summarize the prevailing treatment gap of mental disorders in LAMIC. We identified studies using PubMed and Google Scholar as search engines and by hand-searching journals. The initial search produced 3193 articles; after filtering for language, title, abstract, and full-text, we could identify 23 articles that are included in the review. There was heterogeneity in study methodology, study populations, sample size, and duration of treatment gap reported, making synthesis of data difficult. Results: Community-based mental health surveys have highlighted the immense treatment gap of mental disorders in LAMIC (86% low-middle-income countries; 78% high-middle-income countries). The treatment gap in alcohol use disorders in India and Ethiopia remains at 86% and 87%. We discuss patient- and mental health systems-related factors reported in the included studies contributing to the treatment gap. Conclusion: The current treatment gap for mental disorders is huge in LAMIC. Studies have identified symptom attribution, poor awareness, prevailing stigma, and other barriers contributing to this treatment gap. There is a need to address patient and mental health system-related issues contributing to the treatment gap, which can equitably improve service accessibility and availability in LAMIC.