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Introduction
Mental disorders pose tremendous burden on national economies largely because many of those with mental illness are not treated despite the availability of effective treatments. Treatment gap represents 'the difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder'. Alternatively, treatment gap may be defined as the percentage of individuals who require care but do not receive treatment (Kohn et al. 2004). Mental disorders when untreated could in time become more severe and treatment refractory (Post & Weiss, 1998); single disorders often progress to complex comorbid disorders that are more difficult to treat (Kessler & Price, 1993); and studies have found this to be associated with adverse outcomes like school failure, teenage child-bearing, unstable employment, marital violence, and instability (Kessler et al. 1995, 1997a, 1998a; Forthofer et al. 1996).
The phenomena of wide treatment gaps is worldwide: in a World Health Organization compilation of 37 community-based psychiatric epidemiological studies around the world, the treatment gap for schizophrenia was 32%, depression 56%, dysthymia 56%, bipolar disorder 50%, generalized anxiety disorder (GAD) 58%, obsessive compulsive disorder (OCD) 60%, and alcohol abuse and dependence 78% (Kohn et al. 2004; WHO, 2005). There is a fairly wide variation in treatment gaps among different countries. Generally, the treatment gap is wider in developing than in developed countries with the proportion of those receiving help corresponding with the countries' overall spending on health care in particular mental health care (Saxena et al. 2003). However, even in the world's biggest economy, this under treatment is still considerable: 31% of the US population is affected by mental illness every year and 67% of them are not treated (Kessler et al. 2005). In Europe where mental illness affects 27% of people yearly and 74% of them receive no treatment (Alonso et al. 2007). This gap seems even more glaring when in comparison only 8% of people in Europe with diabetes mellitus received no care (Alonso et al. 2007; Thornicroft, 2007).
Singapore's first National Mental Health Blueprint was implemented in 2007 with the aims of improving the services and mental health of its population - and as suggested by Kessler et al. (1997b), in...