Mental Health — A Comparison No One Makes

This post was originally published on Elephant in the Room.

I have been treated psychiatrically. Psychosis. That's not a secret and not a cry for help, but the reason this topic interests me. When you've been in psychiatric care yourself, at some point you ask: What does it actually look like elsewhere? Are people here better or worse off than in the rest of the world?

I had no thesis. I just wanted to see numbers.

The numbers — and why you can't trust them blindly

The first problem: measuring mental health isn't like measuring a fever. Every country measures differently. Australia has been running detailed population studies for years and lands at 42.9 percent who have had a mental illness at some point in their lives. Japan lands at 8 percent — not because the Japanese are doing better, but because no one there talks about it.

The most comparable data comes from the Global Burden of Disease Study (IHME, 2019), which estimates the current prevalence of mental illness in each country using the same method:

Italy is at the EU average, the USA and Australia above, Japan clearly below. But these numbers tell only half the story.

Suicide

Then I looked up the suicide rates. The WHO publishes data from 2021, age-adjusted, per 100,000 inhabitants:

This surprised me. Italy has the lowest suicide rate in all of Western Europe. And the male-female gap is enormous everywhere — men kill themselves two to four times more often.

But then South Tyrol.

South Tyrol — Italian on paper, alpine in reality

There is no separate psychiatric population study for South Tyrol. No special ASTAT publication, no separate data. What we do know: Trentino-South Tyrol has a suicide rate well above the Italian average — estimates range from 10 to 12 per 100,000, possibly twice the national average. But regional variation within Italy is large, and without clean data specifically for South Tyrol, that remains an approximation.

Research points to a so-called "alpine suicide pattern": mountain regions in the Alps — whether Tyrol, the Swiss Alps, or Savoy — show higher suicide rates than lowland areas in several studies. Theories range from geographic isolation to access to firearms to possible effects of altitude on serotonin balance. There is no scientific consensus, but the correlation keeps showing up.

Culturally, South Tyrol is closer to Austria than to Italy. The Germanic reserve around mental health probably operates more strongly here than the Italian family dynamic that functions as an informal safety net in other parts of Italy.

At the same time, as part of Italy, South Tyrol has inherited one of the thinnest psychiatric networks in Europe: four mental health centers for the entire province — in Bolzano, Merano, Brixen, and Bruneck. A few dozen acute psychiatric beds for 540,000 people.

The Basaglia Law — Italy's radical experiment

The thing about the few beds has a reason. In 1978, Italy became the first country in the world to pass a law to gradually close all psychiatric clinics. Law 180 — named after psychiatrist Franco Basaglia — replaced the institutions with community-based centers. Internationally celebrated. In numbers: Italy today has 7.7 psychiatric beds per 100,000 inhabitants (Eurostat, 2023). The EU average is around 70. Germany has 133.

The idea was that community and family would take over the care. Critics say: the community was never adequately funded. Italy spends about 3.5 percent of its health budget on mental health — little, even by global standards, although such numbers are hard to compare depending on definition.

For South Tyrol this means: few beds, plus a culture in which you don't easily see a psychiatrist.

The USA — Deaths of Despair

The USA is the outlier. 23.1 percent of adults have a diagnosed mental illness — the highest rate among industrialized nations. But the real scale shows up elsewhere.

Since 2021, more than 100,000 people in the USA die each year from overdoses, most from synthetic fentanyl. The economists Anne Case and Angus Deaton coined the term "Deaths of Despair" for this — suicide, drug overdoses, and alcohol-related liver disease, concentrated among white workers without a college degree.

Depending on the study, 40 to 60 percent of the mentally ill in the USA receive no treatment at all. In some rural counties there isn't a single therapist. Firearms are the most common method of suicide and account for more than half of all suicides.

Japan — low numbers, high price

Japan reports one of the lowest rates of mental illness: about 8 percent. At the same time a suicide rate of 14.6 — the highest in this comparison. In 2003 there were 34,427 suicides in a single year.

That doesn't add up, and the reason is no secret: in Japan, mental health problems are so heavily stigmatized that they are not spoken about. The concept of "meiwaku" — not being a burden to others — prevents people from seeking help.

Suicide is the leading cause of death in Japan among 10- to 39-year-olds. That is almost unique worldwide.

Then there's Hikikomori: an estimated more than a million people who completely withdraw from social life, for months or years. The exact number varies by study and definition. And Karoshi — death from overwork — officially recognized as a work-related death.

And one detail I wouldn't have expected: with around 260 psychiatric beds per 100,000 inhabitants, Japan has the highest rate worldwide. Average length of stay: 270 days. In most EU countries it's 25. Italy has 7.7 beds. Japan locks people up, Italy has nothing at all. Both extremes don't work.

Germany and Austria

Germany has the highest density of psychiatrists in the EU: around 28 per 100,000. Since the Psychotherapists Act of 1999, psychotherapy is a statutory health insurance benefit — cognitive-behavioral, depth-psychological, and psychoanalytic. Even so: three to six months waiting time for a slot. And the suicide numbers are rising — according to Destatis there were more than 10,000 suicides in 2024, well above the ten-year average.

Austria had one of the highest suicide rates in Western Europe in the 1980s — around 20 per 100,000. Since then almost halved. One reason: after a cluster of subway suicides, Vienna introduced media guidelines determining how newspapers may report on suicides. The cases dropped measurably — a connection known in suicide prevention as the "Werther effect" and used internationally as a model ever since.

Australia — the most honest numbers

Australia reports the highest numbers: 42.9 percent lifetime prevalence. Among 16- to 24-year-olds, almost 40 percent within a single year.

That sounds dramatic, but it mostly shows that Australia looks more closely than others. With organizations like "Beyond Blue" and the youth network "Headspace", there is an openness that is missing elsewhere.

Still: the indigenous population has twice the rate of psychological distress. The intergenerational trauma of the "Stolen Generations" still has an effect today. In rural areas, suicide rates are significantly higher, services are sparse, and the culture of toughness prevents men from seeking help.

What remains

No country has this under control. The USA has money, but no functioning system. Japan has beds, but no openness. Germany has therapists, but not enough appointments. Italy pushed through the most radical reform, but never funded it to the end. Australia measures best, but still struggles.

And South Tyrol? Sits between the chairs. Culturally Germanic, administratively Italian, geographically alpine. With a presumably much higher suicide rate than the Italian average, but the thinnest psychiatric network in Europe. Without its own data, without its own study, without its own debate.

That may be the most striking thing about the whole research: we don't know. Not because the question is unimportant, but because no one asks it.

Sources: WHO Global Health Estimates 2024, IHME Global Burden of Disease Study 2019, Eurostat 2023, NIMH/SAMHSA NSDUH 2022, ABS National Study of Mental Health and Wellbeing 2020–2022, Destatis cause-of-death statistics 2024, WHO Mental Health Atlas 2020. Fact check: ChatGPT (OpenAI, May 2025), Gemma 4 26B (local).