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Analysis Universal Health Coverage

Achieving universal health coverage for mental disorders

BMJ 2019; 366 doi: (Published 23 September 2019) Cite this as: BMJ 2019;366:l4516

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  1. Vikram Patel, Pershing Square professor of global health and Wellcome Trust principal research fellow,
  2. Shekhar Saxena, professor of practice
  1. Harvard TH Chan School of Public Health, USA
  1. Correspondence to: V Patel vikram_patel{at}

Vikram Patel and Shekhar Saxena discuss strategies for integrating mental disorders, and other chronic conditions, into primary healthcare to achieve universal health coverage

Key messages

  • All countries have failed to achieve universal health coverage for mental disorders, owing to barriers related to budget and stigma

  • The architecture of primary healthcare in most countries is simply not fit for the integration of mental disorders (or any chronic condition)

  • Integration can be achieved using an approach that is person centred, collaborative, compassionate, engaged with the community, and that includes long term planning

  • These principles could be applied across the full range of chronic conditions

Mental disorders are the leading contributor to the global burden of years lived with disability.1 The burden and cost of untreated mental disorders is immense for individuals, families, communities, and ultimately the world.2 A key strategy to tackling this burden is universal coverage of cost effective interventions for mental disorders,3 one target of the sustainable development goals. We analyse key questions related to this goal: why have countries failed to achieve universal health coverage for mental disorders? How can mental health interventions be integrated in primary healthcare, the foundational platform of delivery of universal health coverage? What are the lessons for integrating other chronic conditions into primary healthcare?

Why have countries failed to achieve universal mental health coverage?

In the context of mental healthcare, all countries are “developing” to some extent. Even in high income countries, the coverage gaps for common conditions like mood and anxiety disorders often exceed 50%; in low income countries, the gap exceeds 90%.4 Quality gaps (a measure of the effectiveness of the coverage) are even larger. Across all income categories, countries invest tiny fractions of their healthcare budgets on mental health, disproportionately less than the burden of mental disorders.5 This results in an inadequate number of mental health professionals per …

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