MENTAL health remains chronically underfunded, particularly in low- and middle-income countries where it accounts for less than four percent of total health spending, a new study has indicated.

This observation is among findings of an international study recently published in the journal ‘Epidemiology and Psychiatric Sciences,’ comparing patient-level data from Germany, Israel, India, Uganda and Tanzania.

The study summary indicates that it has uncovered stark global inequalities in the cost of mental health treatment, where those with severe mental health conditions face vastly different levels of care depending on their country of residence.

It found wide disparities in spending on mental health care, with high-income countries like Germany investing far more per patient than low-income nations such as Tanzania, even in the face of a growing global mental health crisis.

The summary says that the survey is the first international study to use patient-level data to analyze the cost of illness for severe mental disorders across countries with varying income levels.

It tracked 615 participants over six months through the UPSIDES project, ‘using peer support in developing empowering mental health services,’ where Ifakara Health Institute (IHI) Donat Shamba, a PhD candidate in Infectious and Tropical Diseases at the London School of Hygiene & Tropical Medicine (LSHTM) was a key participant.

He points at how limited investment in lower-income countries too often implies restricted access and fragmented care, as adjusted for purchasing power, mental healthcare in Germany costs more than 33 times what is spent per patient in Tanzania (based on the 2021 value of the US dollar by purchasing power).

But spending more does not necessarily mean delivering care more effectively, the researcher affirms, noting among other authors that in both Germany and Uganda, over 70 percent of mental health budgets were allocated to inpatient, hospital-based services. In contrast, Israel stood out for its emphasis on community-based and outpatient services, with just 15percent of its mental health spending going to inpatient care, the data indicates, a pattern suggesting that while national income predicts how much is spent, it doesn’t determine how those funds are used.

“National income is correlated with the total cost of illness in people living with mental disorders,” the summary affirms, hinting that it is all the same a poor predictor of how expenditures are distributed across sectors.

The study also uncovered cost differences based on age, gender and diagnosis, where in Tanzania, women incurred lower treatment costs than men.

In India, patients with depression had significantly lower treatment costs than those with schizophrenia, likely due to differences in treatment complexity, it further noted, asserting that in Tanzania, treatment costs rose slightly with age—by around 3.6percent for every additional year.

Notably, the researchers found no consistent relationship between a patient's level of social disability and the cost of their care, which they explained by influences of specific healthcare systems determining access, not clinical need alone.

Greater investment in primary and community-based services could help bridge access gaps and improve outcomes in a more cost-effective way, the authors assert, urging for more research into how health system design and spending patterns impact treatment quality and long-term recovery.

As mental illness appears to be rising on the global health agenda, the study provides penetrating evidence of entrenched inequality in mental care funding and access to care.

It points to the urgent need for mental health systems that are well adequately funded but also designed to foster access equity by being patient-centered and sustainable, the authors stressed.

Without smarter investment and system reform, millions around the world will still face inadequate care regardless of national income, the study intoned.