Written by: Research Writer – Nishwah Nadeem
If you live in a country where mental health is not recognized in law, where there are no trained professionals near you, where your family would face shame if they found out you were struggling, and where your government spends less on mental healthcare than the cost of a cup of tea per person per year, getting help is not just difficult. It is nearly impossible. That is not a hypothetical situation. For hundreds of millions of people across South Asia, East Asia, and the Middle East, this is the actual reality of mental healthcare.
Mental health is not just a personal issue. It is shaped, at every level, by the laws and policies that governments put in place, or choose not to put in place. What gets funded, what gets criminalized, what gets ignored, what gets stigmatized through the silence of legislation: all of this determines whether someone in distress gets help or gets nothing. Growing up in a region where mental health is rarely talked about openly, let alone legislated for, makes this feel less like an abstract policy debate and more like a question about the people around us. This article looks at how laws and policies across South Asia, East Asia, and the Middle East affect mental health, what the gaps are, and why they matter to anyone who cares about the people living inside them.
The Numbers Tell the Story First
Before getting into specific regions, some global figures are worth sitting with. According to the WHO Mental Health Atlas 2024, governments worldwide spend a median of just 2.1 percent of their health budgets on mental health (World Health Organization, 2024). That number has not meaningfully changed since 2017. High-income countries spend up to $65 per person per year on mental health. Low-income countries spend $0.04. That is not a typo. Four cents.
The workforce gap tells the same story. There is roughly one psychiatrist per million people in low-income countries. High-income countries have around 70 times more. The Lancet Commission on Global Mental Health estimated that 76 to 85 percent of people with mental disorders in low- and middle-income countries receive no treatment at all (Patel et al., 2018). These are not numbers that can be explained by personal choice or individual circumstances. They are the direct result of policy decisions, or more accurately, the result of mental health being consistently left out of policy decisions altogether.
South Asia: A Quarter of the World’s Mentally Ill, Most of Them Untreated
South Asia, which includes Pakistan, India, Bangladesh, Sri Lanka, Nepal, and several other countries, may be home to nearly a quarter of the world’s population living with mental illness. Around 150 to 200 million people in this region are estimated to have a psychiatric condition at any given time. The vast majority of them receive no care (Arafat & Kar, 2024).
The reasons go beyond funding, though funding is a major part of it. Many South Asian countries still operate under mental health legislation that was shaped, directly or indirectly, by British colonial-era laws dating back to the 1845 Lunacy Act. A study comparing mental health legislation in Bangladesh, India, Pakistan, and Sri Lanka found that while all four countries have made efforts to update their laws, the frameworks still vary considerably in how they handle involuntary admission, patient rights, and access to care. In some cases, the laws on paper tend to be more progressive than what happens in practice, because there simply are not enough trained professionals or facilities to implement them.
Pakistan, for example, has published mental health policies and legislation, but implementation has been limited by inadequate funding, a shortage of psychiatrists, and the concentration of what few services exist in urban centers (Javed et al., 2020). Research on mental healthcare in Pakistan has consistently found that most people with mental illness seek help from religious leaders or traditional healers first, not because they distrust modern medicine, but because it is often the only accessible option available to them. This is not a failure of awareness alone. It is a failure of infrastructure, and infrastructure is a policy outcome.
Bangladesh faces a documented service gap of over 90 percent for mental health disorders. India, despite having a larger economy, has fewer than 0.3 psychiatrists per 100,000 people (Patel et al., 2018). Sri Lanka has made comparatively more progress in integrating mental health into primary care, but still faces resource constraints that can limit what those laws achieve in practice. Across the region, a common thread runs through all of it: governments have acknowledged the problem, passed legislation in some cases, and then not followed through with the investment and workforce development needed to make any of it real.
East Asia: Stigma as Policy Failure
In East Asian countries including China, Japan, and South Korea, the story is different but not necessarily better. These are countries with considerably more economic resources than South Asia, and in some cases more developed healthcare infrastructure. The barrier to mental healthcare here tends to be less about the complete absence of services and more about whether people will actually use them.
Stigma can be deeply embedded in East Asian cultural attitudes toward mental illness, and it may function as an unofficial policy that no law has yet fully overturned. In China, there are widespread fears that a mental health diagnosis recorded in official health records could affect future employment opportunities (Zeng et al., 2019). This fear is not paranoid or irrational given how records are used in China’s social systems. The result is that people may avoid seeking help even when services are accessible. In Japan, stigma remains persistent despite significant policy reform, including the legal recognition of mental illness as a disability and the introduction of stricter oversight for involuntary admissions following documented human rights violations in psychiatric institutions. Even with those changes, people with psychiatric conditions in Japan often do not seek help because social attitudes have not caught up with the legal framework (Ito et al., 2012).
A systematic review examining stigma and anti-stigma activities in China, Hong Kong, Japan, Singapore, South Korea, and Thailand found that stigma and discrimination remain significant contributors to the treatment gap across all six settings (Zeng et al., 2019). South Korea has established a Mental Health Policy Innovation Committee and is working with the World Bank on system improvements, and Singapore launched its Beyond the Label campaign in 2018 to reduce public stigma. These are meaningful steps. But a social media campaign does not override a culture where mental illness can be associated with weakness, shame, or family dishonor. Changing that tends to require sustained policy commitment over years, not one-off initiatives.
“Stigma and discrimination related to mental illness remain pervasive across low- and middle-income countries… and represent major barriers to help-seeking and access to care.” — Semrau et al. (2015)
Reading something like that, it is hard not to think about how many people we know personally who have never sought help simply because of what others might think. That is not a medical problem. It is a cultural and political one, and it needs political solutions.
The Middle East: Six Countries With No Mental Health Law at All
In the Middle East, the policy landscape for mental health is among the most inconsistent in the world. The region covers 15 countries with a combined population of over 500 million people, and as of recent data, six of those countries still have no mental health legislation at all. The legal traditions across the region are diverse, covering civil law, Sharia-based frameworks, and hybrid systems, which means that even when laws exist, how they are interpreted and enforced can vary significantly.
Egypt updated its mental health legislation in 2009 and Saudi Arabia in 2014, both representing genuine steps toward rights-based frameworks. But research has identified a structural problem that may run across the region: cultural and religious dynamics, including stigma, reliance on family-based decision-making, and certain religious interpretations of mental illness, can mean that legal protections on paper do not always translate into actual help-seeking in practice. People in the region may show a stronger preference for seeking support from religious consultants or family members than from formal mental health services, partly because of stigma and partly because formal services simply do not exist at the scale needed (Sidiq et al., 2019).
Conflict compounds everything. Countries including Syria, Yemen, Iraq, and Lebanon have experienced sustained war and instability that have simultaneously created massive need for mental health support and decimated the infrastructure that might provide it. Research on policy gaps in conflict-affected Middle Eastern countries has identified professional workforce shortages, dysfunctions in referral systems, and funding limitations as the most common structural barriers. These are policy failures operating in the worst possible conditions.
Mental health research capacity in the Arab region also remains critically underdeveloped. A call for action published in The Lancet Psychiatry identified challenges including scarce institutional and funding resources, inadequate publishing opportunities, insufficient training in mental health research, and a shortage of reliable assessment tools adapted for Arabic-speaking populations (Sidiq et al., 2019). Without research, policies cannot be built on evidence. Without evidence, funding is hard to justify. Without funding, nothing changes.
Why Governments Deprioritize Mental Health
A question worth asking directly is why mental health continues to be underfunded and underlegislated in so many countries, even when governments have signed international commitments to address it. Researchers Tomlinson and Lund (2012) applied a political science framework to this question and identified several contributing factors: mental health may lack powerful advocacy groups compared to other health issues, the burden of disease from mental illness can often be invisible or disputed, mental health problems may frequently be misunderstood as personal or moral failures rather than medical conditions, and politicians may not see strong electoral incentives to prioritize it.
“Despite a high disease burden, mental illness has thus far not achieved commensurate visibility, policy attention, or funding.” — Tomlinson & Lund (2012)
That sentence was written over a decade ago, and it remains accurate today. This political neglect has a feedback loop built into it. When mental health is underfunded, awareness stays low. When awareness is low, stigma stays high. When stigma is high, people do not seek help. When people do not seek help, the scale of the problem appears smaller than it is. And when the scale appears smaller, there is even less political pressure to address it. Breaking that loop requires deliberate policy choices, not the natural progression of events.
What Actually Changes Things
The evidence is fairly consistent on what works. Integrating mental health into primary care is among the most cost-effective ways to close the treatment gap, particularly in settings where specialist services will never be available at scale (Keynejad et al., 2018). The WHO’s Mental Health Gap Action Programme provides tools for non-specialist health workers to identify and manage priority mental health conditions. Where governments have invested in training primary care staff in these tools and built them into national health policy, access has tended to improve.
Anti-stigma legislation and public awareness campaigns can show mixed results on their own, but may work better when embedded in broader systems change. Japan’s renaming of schizophrenia, Singapore’s Beyond the Label campaign, and South Korea’s policy reform efforts all suggest that combining legal change with sustained public communication and workforce investment may produce more movement than any single intervention alone.
Rights-based legislation that puts the dignity and consent of people with mental illness at its center, rather than treating mental illness primarily as a public safety concern, also tends to correlate with better outcomes. The joint WHO and OHCHR guidance published in 2023 makes this case directly: building systems that people actually want to use is not just an ethical goal, it is a practical one (WHO & OHCHR, 2023).
Final Thoughts
Laws and policies are not background details in the story of mental health. They are the plot. Whether someone in Pakistan can find a psychiatrist within 100 kilometers of where they live, whether someone in China may fear that seeking help will cost them a job, whether someone in Lebanon can access any formal mental health support at all during a crisis, these outcomes are shaped by policy. Spending four cents per person on mental health is a policy choice. Leaving six countries without any mental health legislation is a policy choice. Allowing stigma to run unchallenged while passing laws that exist only on paper is a policy choice.
The people most affected by these choices rarely have the political power to change them. But awareness is not nothing. Understanding what the choices are, and what the evidence says about what works, is a starting point. For those of us living in regions where mental health has been consistently underserved, these are not abstract policy debates. They are questions about whether the people around us can get help when they need it. Mental health belongs in law, in budgets, in primary care, and in public conversation. In too much of the world, it is still absent from all four.
References
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