The situation in low- and middle-income countries
These steps forward, however, are mainly taking place in high-income countries. In low- and middle-income countries, child psychiatry remains in a much poorer state, with a single child and adolescent psychiatrist often serving thousands of children. For example, in India, one of the most populous countries in the world, there is approximately one adolescent psychiatrist per 100,000 children (7).
Paradoxically, low- and middle-income countries are much ‘younger countries’, with the majority of the world’s children residing there. Approximately 90 % of the world’s 2.2 billion children and adolescents reside in these countries, where many are also exposed to difficult socio-economic circumstances as well as various crises and, at times, extreme suffering (1). Poverty, war, natural disasters, forced migration and resettlement, and other crises – all have a serious impact on a child’s psychological well-being (2), (8–11).
Even in low- and middle-income countries, with the largest populations of children, and the potential for extreme suffering, there is a clear disparity between the dire need for care and the limited, or completely unavailable, mental health services. This is despite the fact that 194 countries have committed to provide such services by ratifying the Convention on the Rights of the Child. Article 24 of this treaty, ‘Health and Health Services’, explicitly states that children have the right to good quality healthcare – the best healthcare possible. In addition, the treaty states, “...rich countries should help poorer countries achieve this” (12). With the global community’s commitment to the treaty having further established the need for collaboration in order to provide all children with their fundamental human right to holistic healthcare, we must now hold each other accountable.
In 2000, many countries committed to the Millennium Development Goals, but unfortunately not all of the goals were attained. In 2015, the United Nations expanded upon these goals, creating the Sustainable Development Goals, leading to a new recognition of the severity of the current global mental health epidemic and the need for countries to focus resources on addressing it. The United Nations elevated mental health to a high priority to be addressed by the global community, by all countries, not only those that bear the brunt of the burden (13).
While each nation is impacted by global health burdens differently, vulnerable populations and low-resource areas need the most attention from the global community. A global burden is a responsibility of all, so it is necessary to focus our efforts where they are most needed and will be most beneficial for the future of our international community as a whole.