These countries were chosen because they have the necessary data, have mental health systems familiar to the authors, and provide a suitable test of whether increasing services improves population mental health. The aim of the present paper is to review evidence from four industrialized English-speaking countries – Australia, Canada, England (most of the UK population) and the US – on whether increases in treatment provision have been associated with a reduction in prevalence of common mental disorders. Simulation data suggested that extending the provision of evidence-based treatment would reduce the population burden of mental disorders 4 and provide an economic return on investment 5. The “treatment gap” is of such concern that the 2001 World Health Report made ten recommendations for addressing it, including making mental health treatment more accessible in primary care, making psychotropic drugs more available, and increasing the training of mental health professionals 3. It has been proposed that treatment services need to be expanded to reduce the prevalence and impact of mental disorders 2. In industrialized countries, 36-50% of serious cases are untreated in the previous year, whereas in developing countries the situation is even worse, with 76-86% untreated. However, many cases are untreated, even among people with the most serious disorders. National surveys in a range of countries have found that mental disorders are common and are a major source of disability 1. There is also a need for nations to monitor outcomes by using standardized measures of service provision and mental disorders over time. Reducing the prevalence of common mental disorders remains an unsolved challenge for health systems globally, which may require greater attention to the “quality gap” and “prevention gap”. Lack of attention to prevention of common mental disorders may also be a factor. A more strongly supported hypothesis for the lack of improvement is that much of the treatment provided does not meet the minimal standards of clinical practice guidelines and is not targeted optimally to those in greatest need. However, there was little evidence relevant to the hypothesis that improvements have been masked by increased reporting of symptoms because of greater public awareness of common mental disorders or willingness to disclose. There was no support for the hypothesis that reductions in prevalence due to treatment have been masked by increases in risk factors. Several hypotheses for this lack of improvement were considered. These data show that the prevalence of mood and anxiety disorders and symptoms has not decreased, despite substantial increases in the provision of treatment, particularly antidepressants. To evaluate the effects of reducing the treatment gap in industrialized countries, data from 1990 to 2015 were reviewed from four English-speaking countries: Australia, Canada, England and the US. Modelling has suggested that closing this “treatment gap” should reduce the population prevalence of those disorders. Many people identified as having common mental disorders in community surveys do not receive treatment.
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