Mental disorders are highly prevalent globally, affecting 20-25% of individuals annually and up to 50% over a lifetime. Despite the availability of evidence-based treatments, a significant treatment gap exists, with only a minority receiving services. To understand this, the researchers analyzed data from the World Mental Health (WMH) Surveys. These surveys, conducted across numerous countries, are designed to estimate the true prevalence, correlates, and unmet need for treatment of common mental disorders. Previous WMH reports detailed aspects of the mental disorder treatment cascade, including recognition of need, initial treatment, and treatment adequacy. This study focused on barriers to initial treatment among individuals with 12-month disorders who perceived a need for treatment, building upon prior work demonstrating that perceived need is crucial in obtaining treatment. The study utilized a framework distinguishing predisposing factors (beliefs/attitudes about treatment and stigma), enabling factors (financial and nonfinancial), and low perceived disorder severity to categorize barriers.

Prior research consistently identified various barriers to mental health treatment, often categorized using frameworks that include predisposing factors (beliefs about treatment effectiveness and stigma), enabling factors (financial and non-financial resources), and low perceived disorder severity. Studies have shown that financial barriers, while significant, are not the only impediment. Beliefs about treatment ineffectiveness and the stigma associated with seeking mental healthcare play a substantial role. Practical barriers, such as access to services and scheduling difficulties, also significantly contribute to the treatment gap. The existing literature highlights the complexity of barriers and emphasizes the need for multi-faceted approaches to address them.

Data were obtained from face-to-face interviews in 22 community surveys across 19 countries (n=102,812 respondents aged ≥ 18 years). The analysis focused on 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders and a perceived need for treatment. Respondents who did not receive treatment (n=2,444) were asked about barriers, while those with delayed treatment (n=926) were asked about barriers leading to delays. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess disorders. Perceived need for treatment was assessed through specific questions in the interview. Treatment was defined as any contact with the treatment system in the past 12 months. Fourteen barriers were assessed across five domains: low perceived severity, financial barriers, nonfinancial barriers (enabling factors), low perceived treatment effectiveness, and perceived stigma. Statistical analyses included cross-tabulations and regression analyses to examine the associations of predictors (socio-demographics, disorder characteristics, treatment history, country-level factors) with treatment outcomes and barriers. A mediation analysis was conducted to assess the extent to which barriers explained the associations between predictors and treatment.

Most respondents reported multiple barriers to treatment. The most common barrier among those who did not receive treatment was low perceived disorder severity (52.9%), followed by perceived treatment ineffectiveness (44.8%), nonfinancial barriers (40.2%), financial barriers (32.9%), and stigma (20.6%). For respondents with delayed treatment, the rank order was similar, but higher proportions reported each barrier. Barriers were predicted by factors such as low education, disorder type, age, employment status, and financial obstacles. Predictors varied by barrier type. Mediation analysis revealed that lower education's association with treatment was mediated by perceived treatment ineffectiveness and nonfinancial barriers. Health insurance's positive association with treatment was mediated by financial barriers. Low perceived severity mediated the association of GAD with treatment, while financial and nonfinancial barriers mediated the association of BD with treatment. The associations of some disorder types and severity with treatment were not mediated by any of the examined barriers. However, the strong positive associations between having seen multiple providers in the past and treatment were somewhat reduced but remained significant even after accounting for each barrier individually.

The findings highlight the multifaceted nature of barriers to mental health treatment. While financial barriers are important, they are not the sole determinant. Subjective perceptions, such as beliefs about treatment effectiveness and the perception that the problem will resolve spontaneously, significantly influence help-seeking behavior. Practical barriers also play a major role. The study emphasizes the need for multi-component interventions that target both objective and subjective barriers. These interventions should incorporate screening, public education to improve mental health literacy and challenge inaccurate beliefs, and increased accessibility of services.

This study confirms the existence of a wide range of barriers to mental healthcare, even when a need is recognized. These barriers are diverse and not solely tied to socio-economic factors. Multi-component interventions are needed to address multiple barriers simultaneously, focusing on increasing perceived need, promoting help-seeking behaviors, challenging inaccurate beliefs about treatment effectiveness, and addressing practical obstacles.

The study relied on self-reported data, which is susceptible to biases like memory bias. The analysis focused on a limited number of mental disorders, potentially limiting generalizability. Some analyses had limited statistical power due to small subsamples. The study design limited exploration of comorbidity's impact and reasons for treatment dropout. Cross-national variations were not examined, potentially masking country-specific influences.