By Benedict Carey

New York Times

The growing burden of untreated mental disorders in the world’s two most populous countries, India and China, cannot be adequately addressed without changes to their health care systems and by training folk healers to become collaborators, a new report has found.

The analysis, published as a part of a series in the journals The Lancet and The Lancet Psychiatry, draws on years of medical surveys in those countries. It represents the latest effort by an international coalition of researchers to put mental health care at the center of the global health agenda; last month, the World Bank and the World Health Organization convened hundreds of public officials, doctors and other specialists in a landmark meeting in Washington to focus attention on global mental health.

The new research, presented in three papers, found that less than 10 percent of people in India and China with a mental disorder received effective treatment, and that the resulting burden of disability from those two countries was higher than in all Western countries combined.

“India and China together represent more than a third of world’s population, and both countries are at a remarkable stage of epidemiologic and demographic transition,” said a co-author of one of the papers, Dr. Vikram Patel, a professor of international mental health and co-founder of a community-based mental health center, Sangath, in Goa state in India, in a recorded interview accompanying the articles.

One lesson, experts not involved in the research said, is that investment is still lagging well behind spending on other medical conditions. Both countries spend less than 1 percent of their total medical budget on mental health.

“I think politicians and service planners will find this research valuable,” said Dr. Alex Cohen, the course director of the global mental health program at the London School of Hygiene & Tropical Medicine. “But if you don’t have the resources to treat more than 2 percent of the people who need it,” then the overall burden can seem overwhelming.

In the past decade, both India and China have taken steps to expand access to mental health care. In China, a government program started in 2004 reportedly has trained 10,000 psychiatrists and built hundreds of community mental health centers, in what some consider a historic investment in better psychiatric care. An Indian government program to increase care in communities has effectively reduced hospital costs, in some areas, though implementation has been spotty at best, experts said.

But particularly in rural areas, the majority of people in both countries still have little means or access to psychiatrists or therapists.

“Very few Chinese with common mental illnesses such as depression and anxiety ever seek treatment,” Dr. Michael Phillips, of Shanghai Jiao Tong University and Emory University, said in a statement. ” And the country as a whole is ill prepared for the coming epidemic of dementia as the population ages rapidly.”

One group of practitioners that is very accessible — and one the researchers said policymakers should consider potential allies — include traditional healers, herbalists and spiritual guides. In China, many doctors get some training in traditional healing arts, like herbal treatments, acupuncture and qigong. In India, likewise, many doctors incorporate yoga, and Ayurveda medicine.

A collaboration makes good sense for another reason, the researchers wrote: “In view of the popularity of traditional, complementary and alternative medicine, it is likely that even if sufficient biomedical mental health services were available, people would continue to access other therapeutic systems.”

Yet the evidence that medical doctors and folk healers can work together closely to provide effective mental health care is scarce, experts said. A recent review of the role of traditional healing for mental disorders, led by Dr. Oye Gureje of the University of Ibadan in Nigeria, found that healers “have more readily adopted conventional psychiatric diagnoses such as depression or anxiety” than disorders like schizophrenia or bipolar disorder, which are thought to be spiritual in nature by the healers. And in some developing countries, traditional healers routinely use shackles, isolation and fasting — methods that “might fail to meet widespread understandings of human rights and humane care,” the paper concluded.

The growing burden detailed in the new papers was due largely to aging and population growth. Some diagnoses, like attention deficit disorder in China, declined between 1990 and 2013; others, like dementia and abuse of drugs and alcohol have risen. For reasons no one understands, suicide rates have fallen sharply in China in that time, and risen steadily in India.