Multiple Barriers against Successful Care for Depressed Patients at Mental Hospitals

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A study of 21 countries with the World Health Organization (WHO) Mental Health Surveys has concluded that only 52.6% of persons with depressive disorders in low-income countries have received treatment. Studies have recognized more than a few difficult consequences of mental disorders going untreated such as: pre-mature mortality, unemployment, poverty, homelessness, co-morbid substance abuse, addiction, poor physical health and suicide. Some initiatives have been taken up recently to reduce the gap in mental health treatment which mentally ill persons avail of at mental hospitals and in other such IPD settings.

However, the gap is still large and there is a huge dearth of mental health practitioners, especially in low and middle-income countries (LMICs). Understanding the reasons why people with mental disorders drop out of or fail to seek treatment could help in developing policies and plans to overcome these barriers to effective mental health treatment at mental hospitals. A plethora of factors are supposedly responsible for impeding mental health treatment, some of which are: a lack of apparent need, stigma, not knowing where to go for treatment (which mental hospital to go to), belief that the problem will be resolved on its own, desire to deal with the problem oneself, inability to afford treatment expenses, doubting the effectiveness of the treatment, and lack of availability of services.

Although safe and effective treatment of depression is available, many individuals with a diagnosis of depression do not get their condition treated. Many adults diagnosed with depression do not receive treatment, despite the availability of safe and effective psychological and pharmacological treatments.

Recent data from the World Health Organization (WHO) suggests that only 16.5% of individuals with major depressive disorder each year receive minimally adequate treatment.

The financial cost of non-engagement is high, and antidepressant use among patients with mental illness is associated with reduced mortality and rate of completed suicide.

Pragmatic, real life physical barriers include perceived or real inability to pay (or lack of insurance coverage), lack of child care or transport, and not knowing where to go for treatment of depression.

Psychological barriers include stigmatization associated with depression (both public stigma & self-stigma), doubting the treatment (assuming treatment is ineffective), or concerns that others may find out which will lead to public stigma, Culture-specific nuances, can also complicate the detection of depression and the uptake of treatment.

It has been established now that treatment uptake is a substantial barrier that prevents universal screening efforts from reaching their full potential for improving mental health of a large population. The utility of the depressive disorder treatments depends on the first step of treatment initiation, and is usually undertaken by mental health practitioners at mental hospitals.

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