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Population need is informed by epidemiological information
on mortality, prevalence, severity, impairment, risk factors (e.g.
gender and social class) burden associated with mental illness
within general populations and service utilization of people with
mental illness. While prevalence statistics are of limited value
to mental health in terms of causal inquiry they do provide the
descriptive statistics that are highly informative as indicators
of population need and can assist in developing accurate needs-based
policy and planning.
(62).
Population demand is informed by epidemiological
information on the level of intervention that is sought by members
of the population to assist with an identified mental health need.
Population demand is influenced by factors such as mental health
literacy, social and cultural attitudes to mental illness, gender
and stigma. (63)
Kessler (64)
cautions that contemporary psychiatric epidemiology has focused
on the description of mental disorders and prevalence rates and
has not addressed issues of risk, prevention and cross-country
comparisons. Within psychiatric epidemiology there exists "uncertainty
regarding diagnostic categories and criteria and underreporting
due to respondent reluctance to admit symptoms …and….additional
problems exist in studies of special populations." As a result
population need and demand data has been limited in its scope.
Weiss et. al.2001 emphasize "The need for additional frameworks
to clarify cultural features of illness in a cultural epidemiology
of illness experience, meaning and behaviour" that can contribute
to the shaping of "policy and practice in diverse settings or
among diverse populations " (65)
The World Mental Health 2000 (WMH200) Initiative,
a project of the Assessment, Classification and Epidemiology (ACE)
Group of WHO and the Consortium for Psychiatric Epidemiology stress
the need for a move from epidemiological estimates and projections
"based largely on literature reviews and limited and isolated
studies rather than on cross-national epidemiological surveys"
to "general population surveys that estimate the prevalences of
mental disorders, evaluate risk factors for purposes of targeting
interventions , study patterns of and barriers to service use,
and validate estimates of burden world-wide."(66,67)
Existing epidemiological data and future work will
contribute to the policy maker's understanding of the severity,
chronicity, morbidity and mortality associated with mental illness.
It will contribute to the understanding of the impact of mental
illness on the population. It will also highlight risk factors,
and provide data regarding the type and quantity of treatment
needs, patterns of demand and help seeking behaviour. Such data
can assist in the formulation of policy in areas of population
mental health, promotion and prevention, service resourcing, and
provision that is evidence-based and assists in the development
of realistic policy goals and objectives at varying degrees of
geographical aggregation. (68)
Examples 1, 2, 3 & 4 highlight the importance of
epidemiological data for policy makers in understanding population
need and demand at national and cross-national levels and in formulating
evidence based policy. They highlight some of the ongoing challenges
associated with the compiling and use of this data.
Example
"The increase in psychiatric morbidity in the 21st century will
have important repercussions for the social development of Latin
American countries and in the planning and provision of health
services. The complexity of psychosocial factors in the causation
and triggering of mental health disorders calls for the establishment
of clear policies for prevention, education and rehabilitation.
Broadening of services may be based not only on demographic growth
but also on the increase of prevalence rates." (69)
Example
Studies of the determinants of help-seeking in the USA show that
"financial barriers are important impediments to treatment and
that treatment rates increase substantially when these barriers
are removed". (70)
At the same time, "a recent comparative study of help-seeking
in the USA and Canada found that the same low proportion of people
with mental disorders seek treatment in the two countries even
though Canadians enjoy free access to mental health treatment
while people in the USA do not." (71)
An investigation of the reasons for not seeking treatment carried
out in this comparative study found that the typical mentally
ill person not in treatment reported a number of reasons for not
seeking help, including perceived lack of efficacy of treatment
believing that the problem will eventually go away by itself,
and the feeling that he/she wants to handle the problem himself/herself
without outside help.
"These and related findings in other epidemiological
studies of the help-seeking process strongly suggest that misunderstandings
about the nature of mental illness and perceived stigma continue
to interfere with the help-seeking process. Public education campaigns
have been launched in some countries to address these problems."
(72)
Example
"Use of alcohol and other drugs has significant consequences for
morbidity and mortality but does not necessarily lead to dependence.
Ambivalent attitudes toward abuse and the abuser, the stigma associated
with substance abuse and the criminal nature of the drug trade
have led to a serious and pervasive lack of systematic, objective,
comparable, and precise data-gathering among countries." (73)
In addition, "the results obtained from many country epidemiological
surveys cannot be compared because of the differences in sampling
and research methods, and the lack of a standard nomenclature
such as ICD-10. Consequently pure distinctions between varying
levels of use and dependence are not clear." (74)
Example
In many Eastern European countries need and demand data are either
not collected or difficult to access and highly sensitive. What
data is available is frequently invalid and there are "official"
and "real" versions of the same data. No country in Eastern Europe
has national incidence data and statistical data regarding registered
patients often pertains to patients who have not been treated
for long periods, sometimes many years. (5th ANAP
Working Conference, Vilnius, Lithuania, March 30 - April 3, 2001)
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