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are delivered through an underfunded, underresourced, and uncoordinated net- work of institutional providers isolated from the larger health care system. The indigenous population in Latin America, although only represented by two studies (one of which was a small sample survey), highlight a marked dif- ference in the treatment gap with the general population. The needs of the in- digenous population, however, do not differ from the non-indigenous (46). Countries in Latin America have in- vested less in mental health care com- pared to other subregions and countries of similar income (47). Key factors that have continued to impede improving mental care, decreasing the treatment gap, and reducing the global burden of disease include weak political will to im- plement reforms; a low allocation of health budgets to mental health; absence of legislation to protect the human rights of people with mental disorders; the per- sistence of inappropriate, but costly sys- tems of hospital care; and a slow shift in investment from a mental hospital-model to community model (47). In addition, there are individual barriers to care, such as the belief that the problem will resolve on its own or that the individual can solve the problem, stigma, lack of mental health literacy, financial burdens, lack of trust in the health care system, and the belief that treatment is not helpful. The Pan American Health Organiza- tion, Regional Office of the World Health TABLE 4. Percent utilizing mental health services by severity of mental disorders and type of service provider Country Total Any disorder Severe Moderate Mild No disorder Argentina-WMHS General medical 3.8 11.2 10.8 10.5 12.3 2.4 Mental health 8.0 18.2 21.5 23.5 11.3 6.2 Any health care 10.9 26.3 27.8 31.3 21.0 8.2 Non-health care 1.7 3.3 4.2 2.2 3.7 1.4 Any treatment 11.6 27.8 30.2 32.5 22.1 8.7 Brazil-WMHS General medical 3.3 8.6 12.0 7.7 5.9 1.1 Mental health 5.6 14.0 23.2 12.3 6.4 2.0 Any health care 8.0 19.7 30.2 17.2 11.6 3.0 Non-health care 2.0 5.2 9.5 4.6 1.5 0.7 Any treatment 9.0 21.9 32.8 20.0 12.7 3.6 Canada-CCHS General medical 5.4 17.5 42.0 17.7 4.6 2.8 Mental health 5.4 16.4 40.3 16.6 4.0 3.0 Any health care 8.3 24.1 55.5 2.5 7.5 4.8 Non-health care 2.9 7.6 18.8 7.0 2.2 1.8 Any treatment 9.5 25.9 58.0 27.1 8.5 5.8 Chile-CPPS General medical 17.7 34.1 57.5 41.9 17.4 12.9 Mental health 5.6 13.1 29.4 9.6 5.0 3.5 Any health care 20.1 38.5 65.0 44.3 20.3 14.8 Non-health care 1.2 2.7 1.0 4.8 3.1 0.8 Any treatment 20.1 38.5 65.0 44.3 20.3 14.8 Colombia-WMHS General medical 2.3 6.0 9.3 6.1 2.7 1.4 Mental health 3.0 7.7 27.8 10.3 7.8 3.4 Any health care 5.0 13.2 25.7 11.5 8.4 3.0 Non-health care 0.7 1.7 4.6 0.8 0.4 0.5 Any treatment 5.5 14.0 27.8 10.6 8.2 3.4 Guatemala-CIDI General medical 2.2 6.3 9.1 6.1 0.4 2.8 Mental health 3.0 3.8 2.3 4.6 6.6 2.1 Any health care 4.5 8.9 9.4 10.6 7.1 4.2 Non-health care 5.7 10.4 8.1 19.1 10.5 5.3 Any treatment 8.7 15.1 13.1 19.1 17.1 8.3 Mexico-WMHS General medical 1.7 6.5 8.1 6.8 4.9 1.1 Mental health 2.8 10.2 25.8 17.9 11.9 1.8 Any health care 4.2 15.8 20.2 18.6 10.2 2.7 Non-health care 1.2 3.9 3.6 4.1 3.5 0.9 Any treatment 5.1 18.6 23.8 20.8 12.6 3.4 Peru-WMHS General medical 1.9 5.0 7.7 5.3 3.1 1.6 Mental health 3.9 12.0 21.4 8 11.5 2.8 Any health care 5.8 16.7 27.8 13.3 14.6 4.4 Non-health care 1.9 5.6 9.7 6.3 2.6 1.4 Any treatment 7.2 20.1 32.8 18.1 15.4 5.6 USA-NCS-R General medical 9.3 22.8 32.1 23.6 18.9 4.7 Mental health 8.8 21.7 41.9 20.7 13.3 4.4 Any health care 15.3 36.0 52.3 34.1 22.5 8.1 Non-health care 5.6 13.2 Any treatment 17.9 41.1 59.7 39.9 26.2 10.1 Source: Prepared by the authors from the study results and in part from the following references 22 – 27.
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