Indicators for clinicians have been devel oped and

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indicators for clinicians have been devel- oped and also should be monitored as the mental health systems in countries are strengthened. Limitations. The data presented are es- timates of prevalence and the treatment gap for the Region of the Americas. Data were available only on a few countries in Latin America, and none of the non-Latin Caribbean. In North America, both the United States and Canada were repre- sented. A similar methodology was used for each of the prevalence studies; yet, there are marked differences in the rates of prevalence. Methodological issues can- not be fully dismissed. The Chile study is older than the others, and data on treat- ment seeking was based on 6 not 12 months, which may have over-estimated that country’s treatment gap. A more re- cent study in Chile (55) found that 21.2% were treated with antidepressants in the past year, suggesting that the older study over-estimated the gap. The three differ- ent estimates of the treatment gap pre- sented (mean, median, and weighted) illustrate that countries in the same subre- gion differ in treatment gap. It is not fully clear whether these estimates would re- main relatively similar if all of the coun- tries of the Americas were included. Conclusions The mental health treatment gap in the Americas is a public health priority. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The global burden of mental health and the prevalence of mental illness are high, and in part, reflect the treatment gap. A metric that is not available in these studies, one that could be used to measure progress in subsequent national, psychiat- ric, epidemiological studies, is the number of those in treatment who no longer meet criteria for 12-month prevalence, but who have had a lifetime prevalent disorder. As mental disorders are often chronic, a rise in this remission metric would illustrate success in reducing the treatment gap. Although concerted efforts are being made at the local level to address the treat- ment gap by scaling up and task-shifting overall, with a few exceptions there has been little progress. Mental health should be a priority at the national level across the Americas. Verifiable quality indicators are needed to demonstrate progress. Funding. Victor Puac-Polanco is sup- ported in part by grant R49CE002096 (PI: Li, G) from the United States Centers for Disease Control and Prevention. The funder had no role in the study design, data collection, or analysis, decision to publish, or preparation of the manuscript. Conflict of interests. None declared. Disclaimer. Authors hold sole respon- sibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/ PAJPH and/or PAHO. REFERENCES 1. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82(11):858–66. doi: /S0042–96862004001100011 2. Kohn R. Trends and gaps in mental health disparities. In: Okpaku SO, ed. Global mental health: essential concepts. New York: Cambridge University Press, 2014.
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