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Challenges Facing Mental Health Social Services

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Challenges Facing Mental Health Social Services

Mental health is an important health consideration in every state. However, mental health

care systems in most countries experience deficiencies and weaknesses, mainly in middle-

income and low-income countries. Medium and high-income countries also have mental health

models that sometimes become inaccessible and inefficient for various reasons. Mental disorders

are a problem not only for the family but also for the health system of a state. Currently, mental

disorders account for almost thirteen percent of the disease burden (Carbonell et al., 2020). This

figure is expected to reach fifteen percent by 2030 if inadequate interventions are not

implemented. Over four hundred and fifty million in the world have mental disorders, and over

twenty-five percent of the global population suffers from a mental illness at some point in their

lives, according to the World Health Organization (2017) report. In the face of the increasing

prevalence of mental disorders or illnesses, mental health care systems in most countries are

typically non-existent or deficient. It is estimated that twenty-eight percent of countries in the

world do not have a budget for mental health. Of the countries with a specific budget for mental

health, thirty-six percent allocate less than one percent of their total health budget to mental

health (Kpobi et al., 2018). Another study showed that twenty-five percent of countries today do

not have legislation on mental health and that forty percent have not developed healthcare

policies on mental health (Rathod et al., 2017). The collateral effect of lack of budgetary

allocations and legislation leads to limited access to mental health services, significant treatment

gaps, and patients and family members having to shoulder high costs in both psychological and

financial terms. Other than financial and legislative limitations, various other limitations limit the

access to mental health services that social workers experience, which will be the focus of this

review.
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Limited Availability of Medication and Health Professionals

The complex nature of physiological disorders calls for regular access to mental health

services, including professionals, medicine, and various support services. However, these mental

services are often unavailable and underutilized in the countries where they are available.

According to the World Health Organization, only fourteen percent of African countries had at

least one psychotropic medicine available in all public health facilities. It noted that in Nigeria,

for instance, even after carrying out a fifteen-year program that focused on scaling up mental

healthcare treatment in primary care settings, essential medications such as psychotropics were

not readily available in public hospitals. (WHO, 2017). Iseselo & Ambikile (2017) studied

Temeke Municipal Hospital in Dar es Salaam, one of the fastest growing cities in East Africa

with a population of approximately two million people. According to the study's report,

budgetary allocations and the long process of ordering medication for mental health patient by

public hospitals hinders the availability of medicines in hospitals. Hospitals also operate under

strict budgetary constraints, making it impossible to buy medicine for many mental health

patients visiting public hospitals.

The lack of enough adequate health professionals is also another hindrance facing mental

health services in most countries across the world. In the United States, for instance, about thirty-

seven percent of the population lives in areas with a shortage of mental health professionals. This

is about one hundred and twenty million people (Hubbard, 2021). Many of these people live in

rural or partially rural neighborhoods. The worst affected states are Wyoming and Utah, with the

highest shortage at ninety-six and eight three percent, respectively. A report prepared by the

World Health Organization, there is a projected shortfall of approximately fifteen million health

professionals by the year 2030(WHO, 2022). The shortage of mental professionals results from
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various factors such as funding, governance, and lack of legislative policies. Other shortages

include unfair treatment of mental health workers, unsafe working conditions, lack of autonomy,

and perceptions of unfair treatment (Yanchus et al., 2016), leading to high turnover rates. WHO

reported that in 2020 only fifty-one percent of its member states had their mental health policies

in line with regional and international human rights instruments.

Limited Affordability

Limited affordability is another factor that affects mental health services a social worker

experiences when dealing with mental cases. In many middle and low-income countries, the cost

of accessing mental health services or psychiatric treatment is often high due to the high cost of

medication (Coombs et al., 2021). The cost is a significant financial barrier to patient care.

Additionally, insurance companies rarely cover mental disorders in many countries, which drives

mental health care away from deserving individuals (Kanagaraj, 2020). Mental health is a

considerable burden to the government. For instance, one in every five Americans has a mental

condition in the United States. In 2019, over two hundred billion dollars was used to provide

mental health services. The amount was a rise of over fifty percent since 2009. The costs include

medication, therapy, and hospital admissions in rehabilitation or substance abuse cases. Other

related costs include the workforce's lowered participation rates and decreased productivity. The

worst mental disorder currently in the United States is depression which accounts for over forty

billion dollars. An hour-long therapy costs between sixty to two hundred dollars for an individual

without insurance. For severe cases of depression, on average, a patient can spend approximately

ten thousand dollars in a year, a figure which is twice for patients battling diabetes (Leonhardt,

2021). These amounts are way above the reach of many families living in rural areas, and many

prefer to handle mental cases at home.

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Policy Limitations

In many developing countries, there are no policies put in place for a comprehensive

mental health care system. The policies are crucial for implementing and coordinating mental

health care services, a critical barrier to public access to mental health services. According to the

World Health Organization report (2020), almost one-third of all countries have mental health

care policies. However, only about sixty percent of these countries have revised their mental

health services since 1990, meaning that forty percent of the countries have not implemented

recent developments in mental health care. In addition to these figures, about twenty percent of

countries worldwide do not have laws and regulations that protect individuals suffering from

mental disorders. The World Health Organization also reported that in all its member states, only

fifty-one percent had policies aligned to international and regional human rights standards. In

addition, many low- and middle-income countries localize mental health care resources in urban

or large cities, leaving poor neighborhoods and rural areas with insufficient mental health

services. Such a state makes it hard to cater to the entire population in the country since the

inadequate facilities lead to fewer services for the whole population.

Lack of Education

In both developed and developing countries, limited knowledge of mental diseases is a

barrier to accessing mental health services. The poor understanding of mental health is an

impairment to families and society in providing adequate care for mentally ill individuals. They

also do not know the causes of mental disorders and, in most cases, link the disease to myths. In

addition, family members might think that the health facility they are taking their loved ones

does not have adequate healthcare services, for instance, medications and healthcare

professionals. In various countries, especially in Africa, mental disorders and healing are
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relegated and subjected to traditional healers. Therefore, many people do not seek professional

mental services because they lack sufficient education about mental health. Lack of education on

psychological disorders and the need for consistent treatment is a major barrier to mental health

care. Essentially, when people lack knowledge of the disorders, they are most likely to ignore

symptoms or interventions that could have led to worsening the conditions.

Stigma

Stigma is perhaps the number one limitation that affects access to mental health services

even in countries that have sufficient mental health professionals and policies in place for mental

health. Stigma was first identified in 1963 by Erving Goffman, who identified it as any attribute

or characteristic by which a person is devalued, discredited, or considered shameful (Subu et al.,

2021). When applied to mental health, stigma is the social disapproval, disgrace, or social

discrediting of a person who develops a mental disorder. Given that one in every five adults in

the United States suffers from a mental health disorder, the stigma associated with this number

could be very high.

Stigma among young people is usually high than in older adults. In the world, it is

estimated that one in five young adults experience a mental disorder, and many of them undergo

one kind of stigmatization. In the United States, Japan, and Greece, young people's stigma

includes social distancing and discriminatory cultural beliefs. In other cases, victims with mental

disorders are subjected to violence leading to physical injuries. Various cultural aspects are

associated with mental disorders, varying among families, countries, individuals, and ethnicity.

For instance, religious and cultural teachings influence the nature and origin of mental diseases,

which in many cases lead to stigmatization in the form of social distancing (Zolezzi et al., 2018).

Mental health-related stigma has a negative effect on people seeking help because they are
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subjected to discrimination and violence. Pervasive stigma, therefore, is likely to lead to poor

outcomes.

Alternative Progressive Reforms

Mental health services must undergo various reforms to cater to the huge population with

various mental disorders. Among the issues noted on the limitations is affordability. Many

developed and developing countries face economic issues that make the accessibility to mental

health care outside the reach of poor individuals. As noted in the limitations, mental health is

more expensive than other diseases like diabetes, which is almost half the total amount used

annually. For progressive availability reform, the government needs to formulate policies and

legislative reforms to have budgetary allocations in the health budget to cater to mental health

expenses. Additionally, insurance companies should be legislated to cover expenses arising from

mental health care. In such a scenario, there would be increased access to care for people with

mental health cases, which will consequently improve their health outcomes.

The shortage of mental health professionals in various countries is also a limitation. The

shortage has resulted from inadequate funding, governance, and a lack of legislative policies.

These are factors that governments would enable to have adequate policies that enhance the

provision of mental health care for the whole population. The analysis noted that most mental

health professionals are concentrated in large cities or urban areas. Therefore, it is important to

have mental health services decentralized so that people living in rural areas can also benefit.

Education is also an essential factor that was noted in this discussion. Many people,

especially in developing countries, lack the knowledge to identify mental illness, its causes, and

when to seek help. It is crucial for society and the government to carry out regular education

about mental health, causes, and where to seek help if an individual becomes a victim. Education
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is also critical in fighting other areas, such as stigmatization. As noted, stigmatization mainly

arises from cultural and religious teachings that construe mental disorders' root causes.

Conclusion

Mental health is a critical issue in health but is often overlooked by many health systems

worldwide. It has been affected by various issues such as funding, affordability, mental health

professionals, and medication availability. All these limitations, however, can be changed if

governments are willing to have legislative and policy reforms in mental health care. Policy

implementation is key to all the limitations observed in this analysis because it surpasses

education, budgetary allocation, decentralization, education, and stigma. The World Health

Organization has put clear guidelines to establish mental health services in its member countries

by the year 2030; it noted that if the guidelines were not adhered to, there would be a shortage of

mental health professionals of about fifteen million. In addition to governments putting in

policies, societies and individuals need to come together and find workable solutions to the

limitations discussed, such as stigma and affordability.

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