A study presented at the European Psychiatric Association Congress 2025 reveals deep socioeconomic inequalities in reported need for mental health care across the European Union. The research highlights how financial barriers disproportionately affect lower-income individuals, with significant disparities also linked to education level, whether the person lives in a city or in the countryside, and geographic location.

Led by Dr. João Vasco Santos, a public health physician, health economist, and professor at the University of Porto, the cross-sectional analysis used data from the 2019 European Health Interview Survey (EHIS), covering 26 EU member states. The survey among others asked participants whether they had gone without needed mental health care in the previous 12 months due to financial constraints.

Measuring Unmet Needs: A Financial Lens

The EHIS captures self-reported experiences, focusing specifically on financial reasons as a barrier including to accessing mental health services.

Across the EU, the proportion of self-reported unmet needs for mental health care varied widely — from as low as 1.1% in Romania to as high as 27.8% in Portugal, with a median of 3.6%.

Dr. Santos emphasized that while many European countries have moved toward mixed health systems — blending elements of Beveridge- and Bismarck-style models — financial protection remains inconsistent. Even in countries with universal coverage, out-of-pocket costs for medications, therapy, diagnostic testing, or medical devices can create substantial barriers.

“This is not just about whether care is public or private,” explained Dr. Santos. “Even in systems that are largely public, co-payments can be a burden. And sometimes, vulnerable groups—like migrants or asylum seekers—are excluded altogether.”

Cultural Perceptions Shape Reporting

One of the most striking findings was the stark contrast between Romania and Portugal. Dr. Santos cautioned against interpreting these figures at face value.

“It’s not just about the availability of services — it’s also about awareness and cultural perception,” he said. He noted that in Portugal, “we’re increasingly open about mental health and the mental health service.”

Portugal has been one of the countries that is spearheading the new perception of mental health care. “The UN Convention on the Rights of Persons with Disabilities laid the foundation for the much-needed paradigm shift in mental health. From an exclusively medical approach to one based on the respect of the human rights of persons with mental health conditions and psychosocial disabilities,” Ms Marta Temido, Minister of Health of Portugal told during a United Nations consultation meeting in 2021.

Ms Marta Temido stressed that “In Portugal, we have been making significant efforts to align our laws, policies and practice with human rights.”

She specifically pointed out that “We have clearly made an option for community-based mental health services instead of institutionalization. We have been improving access to outreach care, through the launching of community teams for adults and for children and adolescents.”

In countries like Romania, stigma remains high, and is influenced by a long history of institutionalized care that fails to meet basic human standards. It should be obvious that if the psychiatric system hasn’t evolved much beyond large psychiatric institutions with reported human rights violations, one might think twice before reporting need of help.

Dr. Santos noted that in countries where mental illness is stigmatized or misunderstood, individuals may avoid reporting symptoms altogether. In some cases, people may not perceive a need for care because of limited exposure to mental health education or fear of discrimination.

Education and Inequality

The study also revealed a strong correlation between educational attainment and unmet needs. In 15 out of 26 countries analyzed, individuals with only primary education were significantly more likely to report going without mental health care than those with tertiary education.

“In Bulgaria, Greece, Romania, and Slovakia, this disparity is especially pronounced,” Dr. Santos noted. The pictures across the European countries however is quite complex, as exemplified with France where the opposite is the case. In France people with tertiary education showed a higher unmet need of mental health care. This indicate that further studies may be needed which could look at adjusting for income and other factors. The study conducted only considered the educational related inequalities.

Pandemic Impact and Future Trends

Although the study drew on pre-pandemic data (from 2019), Dr. Santos warned that the pandemic likely exacerbated existing inequalities.

“We know that mental health deteriorated during the pandemic — there was increased violence, isolation, and trauma,” he said. “At the same time, access to care was disrupted. I suspect the next wave of data will show a rise in unmet needs, particularly among lower-income and marginalized groups.”

However, he stressed that longitudinal comparisons must be made carefully, noting that changes in survey design over time can affect results.

Policy Recommendations addressing socioeconomic inequalities

To address these systemic challenges, Dr. Santos outlined a series of priorities that require coordinated action at both national and regional levels.

First, he emphasized the importance of expanding universal coverage to ensure that all individuals — including migrants and asylum seekers — have access to essential mental health services without facing financial hardship. He called for reforms that would exempt low-income and chronically ill populations from co-payments, even in systems where care is otherwise publicly funded.

Second, he advocated for a shift toward community-based care models, which improve accessibility, reduce stigma, and foster integrated, person-centered treatment approaches.

Third, Dr. Santos underscored the need for national and regional mental health strategies that incorporate public education campaigns aimed at improving health literacy.

“The goal must be to leave no one behind,” he concluded. “Health is an investment — not just in individuals, but in the resilience and equity of society as a whole.”

Originally published at Almouwatin.com

In the neon-lit corners of London’s underground rave scene, a quiet crisis is unfolding. While cocaine and ecstasy remain staples of Britain’s nightlife, a more insidious trend is gaining traction: ketamine, once relegated to the fringes of the drug world, is surging in popularity among young people. Public health officials, clinicians, and law enforcement agencies warn that its use is escalating into an epidemic with severe consequences for physical and mental health, straining already overburdened treatment systems.

The Data: A Stark Rise in Use

Official figures from the Crime Survey for England and Wales (CSEW), published in January 2024 by the Office for National Statistics (ONS), reveal a troubling trajectory. Ketamine use among 16- to 24-year-olds has nearly doubled since 2019, with 2.1% of respondents reporting use in the past year—a figure experts believe underestimates the true scale. Urban areas tell an even grimmer story. A 2023 study in The Lancet Regional Health—Europe found that in London, ketamine accounted for 12% of all new drug treatment admissions in 2022, up from 4% in 2018. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) now ranks the UK as having the highest prevalence of ketamine use in Western Europe, surpassing France and Germany.

Why Ketamine? Accessibility and Misconceptions

Ketamine’s dual identity—as both a legally prescribed medication and an illicit substance—fuels its accessibility. Originally developed as a veterinary anesthetic, it remains a medically approved painkiller and antidepressant. However, illicit versions, often diverted from veterinary supplies or produced in clandestine labs, have flooded black markets. The National Crime Agency (NCA) seized a record 3.4 tons of ketamine in 2023, a 40% increase from 2021, with much of the supply traced to illegal manufacturing in China and India.

Affordability amplifies its appeal. A gram of ketamine costs as little as £10 ($13) in clubs or online, compared to £30 ($39) for a gram of cocaine. For young people navigating soaring living costs, this price gap is a critical factor. Meanwhile, misconceptions about safety persist. Unlike opioids, ketamine does not suppress breathing, leading many users to underestimate its risks. Yet studies confirm that its long-term effects—though less immediately lethal—can be equally devastating.

Health Consequences: Bladders, Brains, and Mental Health

Chronic ketamine use exacts a severe physical toll. The drug is linked to “ketamine bladder syndrome,” a condition causing painful ulcers, incontinence, and kidney failure. A 2022 review in Nature Reviews Urology found that 20–30% of regular users develop urinary symptoms, with some requiring surgical intervention. Hospitals report a surge in cases: urologists at University College London Hospital note a sharp rise in young patients needing catheters or bladder reconstructions, often in their early 20s.

Mental health risks are equally alarming. Ketamine’s dissociative effects—inducing out-of-body experiences—can trigger psychosis, paranoia, and depression. A 2023 longitudinal study in Psychological Medicine tracked 500 young users over five years and found that 40% developed persistent psychiatric symptoms, with 15% requiring hospitalization. Neurological research underscores that while ketamine does not cause addiction in the traditional sense, it alters the brain’s reward system, creating psychological dependence.

Social Drivers: Isolation, Economic Anxiety, and the Digital Age

The surge in ketamine use intersects with broader societal shifts. Post-pandemic mental health data reveals a crisis among young people, with rising rates of loneliness and anxiety. A 2024 Institute for Public Policy Research (IPPR) report found that 60% of young ketamine users cited loneliness or anxiety as key motivators for use. Economic pressures compound these issues: stagnant wages, housing insecurity, and the gig economy’s instability create fertile ground for escapism.

The digital age further fuels the trend. Online communities on platforms like Reddit and TikTok glamorize ketamine’s hallucinogenic effects, while encrypted apps facilitate discreet purchases. The National Crime Agency notes that encrypted messaging services now dominate ketamine distribution, enabling buyers to bypass traditional street-level dealers.

Policy Paralysis: A Legal Gray Area

Despite the crisis, ketamine remains a Class C drug in the UK, carrying a maximum penalty of two years in prison for possession. Critics argue this classification downplays its harms. Academic analyses, including studies from the University of Kent, highlight that Class C sends a misleading signal about risk. Reclassification to Class B—a move that would increase penalties and unlock additional treatment funding—has been debated but not enacted.

Government efforts to address the issue remain fragmented. A £2 million ($2.6 million) allocation in 2023 aimed to expand ketamine-specific treatment programs, but advocacy groups describe this as insufficient. Waiting times for specialized care often stretch to six months, and many clinics lack staff trained in ketamine-related disorders.

The Road Ahead: A Call for Urgency

The ketamine crisis demands a multifaceted response. Stricter regulation of online sales, expanded mental health services, and public awareness campaigns targeting schools and parents are critical. Research from the University of Exeter stresses the need to destigmatize conversations about ketamine’s risks, particularly among educators and families.

For now, the human cost continues to mount. In Bristol, a 22-year-old student, who requested anonymity, described her three-year ketamine addiction as “a slow-motion car crash.” After losing her university place and developing severe bladder pain, she entered rehab in 2023. “I thought I was invincible,” she said. “But ketamine took everything.”

As Britain grapples with this hidden epidemic, the stakes grow higher with each passing month. Without decisive action, the next generation may pay the price.