‘Mental health needs’ is a vague term usually mentioned as a justification for the development of a mental health service or program. The term might be referring to the needs for care that should be provided to people who have mental disorders. It might also refer to the input that mental health sciences could or should make to render socioeconomic development more humane. Or, it could describe what action is needed to make relationships between people more cordial, mutually supportive and respectful. The focus of this paper will be mental health needs understood as the estimation of the quantity and quality of services to be provided to people with mental illness in a given community.
In order to define what mental health services should do, it is necessary: (i) to define what will be considered a mental disorder; (ii) to determine what treatments are available (whose effectiveness has been proven by appropriate trials); and (iii) to establish what the population considers as being a condition for which mental health services have an answer.
The first of these requirements has been met by the programs on the diagnosis and classification of mental disorders carried out by the World Health Organization and by professional societies, such as the American Psychiatric Association. The most recent definition of a mental disorder is included in the DSM-5, produced by the American Psychiatric Association in collaboration with scientists and practitioners in many countries. The definition underlines the fact that a mental disorder is an impairment of mental functioning that is often accompanied by distress and disability. Mental disorders differ from each other by the symptoms that express the impairment of function. Although they show variations in different cultural settings, they can be reliably assessed and it is possible to show a high rate of agreement on diagnosis of mental disorders among well-trained psychiatrists living and working in countries differing in their cultural characteristics. The first requirement for the assessment of mental health needs is thus – as far as our knowledge goes – satisfied.
The second of the requirements concerning various therapeutic options that can be used to treat mental disorders is also reasonably well established. Many of the treatments used in mental health care have been examined and it is possible to list treatments that have shown to be effective in dealing with symptoms of mental illness. There are treatments for which the evidence of effectiveness is lacking but which are nevertheless used by psychiatrists and other mental health workers. Among them are treatments that, because of methodological and practical difficulties, have so far not been evaluated by randomized controlled trials – for example, long-term psychoanalytic psychotherapy and some forms of culture-specific treatments. These treatments, however, are being used and the justification for their use is the experience that those who use them have assembled as well as the results of some less rigorous tests of treatment effectiveness.
The third prerequisite for the definition of mental health needs refers to the type of condition that individuals and societies consider to be a mental illness in need of treatment. In some instances, the governments have defined the limits of mental illness. Government-issued definitions were sometimes based on edicts that dissidence and disagreement with the political system are clear signs of madness that needs to be treated. In other circumstances, governments have left the definition of mental illness in the hands of psychiatrists. The population also has their definition of mental illness, which does not necessarily agree with the definition used by psychiatrists. Persons who have a mental disorder usually recognize that they need help but sometimes they do not; conversely people without a mental disorder will consult psychiatrists believing that they might have a disorder or that consultations with psychiatrists can make them better able to cope with problems they encounter.