Introduction

The World Health Organization released its Mental Health Atlas 2024 in September 2025, offering the most comprehensive global picture of mental health resources, policies, and gaps in service provision. For Europe—and particularly for Italy—the data reveals both progress and persistent challenges in accessing quality mental health care.

As a psychotherapist working with international clients in Milan, I see these statistics reflected daily in my practice: expats struggling to find English-speaking therapists, professionals facing burnout without adequate workplace mental health support, and families navigating fragmented mental health services across different European countries.

Source: WHO Mental Health Atlas 2024

Key Findings from the WHO Atlas 2024

1. Mental Health Workforce Crisis Across Europe

The WHO Atlas reveals significant disparities in mental health workforce availability across European countries:

• Global median: 13.5 mental health workers per 100,000 population
• WHO European Region median: 80.4 workers per 100,000 (including 9.9 psychiatrists, 28.4 mental health nurses, and 9.3 psychologists)
• High-income countries globally: 67.2 workers per 100,000
• Low-income countries: as few as 1.1–2.4 workers per 100,000

For Italy specifically, data from the European Observatory on Health Systems and Policies (2023) indicate approximately 8.5 psychologists per 100,000 population in the public sector — a figure that has declined since 2013 — and around 8–10 psychiatrists per 100,000. Significant regional disparities persist: northern regions such as Lombardy tend to perform above the national average, while southern regions can fall 30–40% below.

These structural shortfalls help explain why many patients report waiting times of several months for public mental health services in cities like Milan, even in one of Italy’s best-served regions.

Sources:

• WHO Mental Health Atlas 2024 – Table 19

• WHO/Europe Mental Health Fact Sheet 2024

• European Observatory on Health Systems – Italy HSPM 2023

2. Mental Health Budget Allocation Remains Insufficient

The Atlas documents that despite increased awareness post-COVID-19:

• Global median: 2.1% of total health budget allocated to mental health (unchanged since 2017)
• WHO European Region median: 4.5% of total health budget
• Italy’s allocation: approximately 3.3% of total healthcare expenditure (2022 data)
• High-income countries globally: median 4.3%

Italy’s 3.3% allocation is significantly below the European regional median and reflects a structural gap that the newly approved National Mental Health Plan 2025–2030 aims to address.

This chronic underfunding creates a two-tier system: long waits for public services versus immediate access through private care—which many cannot afford. The gap is particularly acute for specialized services like trauma therapy, eating disorder treatment, and LGBTIQ+-affirmative counseling.

Sources:

• WHO Mental Health Atlas 2024 – Table 18

• European Observatory – Italy: Towards a New Model of Mental Health Care (2025)

• OECD/European Commission – Italy Country Health Profile 2023

3. Digital Mental Health Services: Uneven Adoption

The Atlas reveals a significant acceleration in telehealth adoption following the pandemic:

• 63% of responding countries globally report that telehealth services are available and in use
• In the WHO European Region, 83% of responding countries report telehealth availability—the highest of any WHO region
• However, quality standards and reimbursement frameworks for digital mental health services remain inconsistent across member states

Italy introduced a Psychological Support Bonus (“Bonus Psicologo”) in 2022, which partially subsidizes psychotherapy costs including online sessions. The program was made permanent through the 2023 Budget Law, though the total funding envelope—currently €8 million annually—remains modest relative to need.

For patients, especially expats or those with mobility limitations, the availability of teletherapy in their native language can be a critical enabling factor for accessing appropriate care.

Sources:

• WHO Mental Health Atlas 2024 – Figure 30

• European Observatory – Italy HSPM 2023: Response to the Mental Health Crisis

• OECD Digital Health

Expert Analysis: What These Numbers Mean in Practice

The Expat Experience in Italy

International data helps explain a pattern I observe frequently in my clinical work: highly educated, professionally successful expats in Milan often struggle to access appropriate mental health support, despite living in one of Europe’s wealthiest and most resource-rich cities.

According to WHO/Europe, as many as 1 in 3 people with a mental health condition in the European Region do not receive the treatment they need. For expats and migrants, that ratio is likely worse — compounded by language barriers, unfamiliarity with local systems, and the psychological weight of displacement itself.

Consider these scenarios:

An American executive relocated to Milan begins experiencing panic attacks. She speaks limited Italian. The local public mental health service (CPS – Centro Psico-Sociale) has a waiting list of several months — consistent with data from the Italian Ministry of Health’s SISM 2023 report — and services are primarily delivered in Italian. Private English-speaking therapists are available, but fees typically range from €80 to €150 per session and are often not covered by Italian insurance plans. As a result, she delays seeking help at a time when early support would be most beneficial.

An LGBTQI+ international student in the process of gender transition faces significant bureaucratic barriers across multiple healthcare pathways — including access to psychological support and, separately, to the endocrinological treatment required within Italy’s national health system. These delays, compounded by the difficulty of finding English-speaking providers, can contribute significantly to distress, isolation, and difficulties concentrating on their academic work.

These experiences are not unique to Milan. Across Europe, migrants and expats frequently encounter structural, linguistic, and cultural barriers when seeking mental health support. Access to language-concordant care remains inconsistent, and in many countries, multilingual mental health provision is limited.

This is why access to culturally sensitive, language-attuned psychological support is not simply a preference—it is often essential for effective care. For many expats, being able to speak freely in their native language allows for deeper emotional work, greater clarity, and a stronger sense of safety within the therapeutic relationship.

What This Means for You

If you’re reading this and recognizing your own struggles in these statistics, here’s what you should know:

1. Your Difficulty Finding Help is Systemic, Not Personal

The WHO data confirms: the barriers you face aren’t because you’re not trying hard enough or because “it’s not that bad.” Europe’s mental health systems are genuinely underfunded and understaffed. Waiting months for an appointment is a policy failure, not a personal one.

2. Language-Concordant Care Matters

Research consistently shows that psychotherapy is more effective when conducted in a person’s native language — a finding supported by studies published in Lancet Psychiatry and confirmed by the APA Guidelines for Telepsychology (2024) — or in a language they feel fully emotionally fluent in.

From a psychological perspective, language is not simply a tool for communication—it is closely tied to how we experience, organise, and make sense of our emotional world. Our first language is often the language in which early relationships were formed, and in which emotional life first took shape. Feelings such as fear, loss, shame, love, or belonging may therefore be more readily accessed and experienced in that language.

When therapy takes place in a second language, it is of course still possible to do meaningful work. However, some clients notice a subtle distance from their emotional experience, or find themselves speaking in a more intellectual or detached way. Important nuances, associations, or memories may be harder to reach spontaneously.

Working in one’s native language—or in a language that feels emotionally natural—can allow for greater depth, authenticity, and immediacy. It can help clients feel more fully understood, and more able to express aspects of themselves that might otherwise remain unspoken.

This can be particularly valuable when working with anxiety, trauma, grief, identity, and relationship difficulties, where emotional precision and safety are essential.

Many international clients describe this difference in simple terms:

“I can function perfectly well in Italian, but when it comes to my inner world, English feels like home.”

Official Resources & References

Primary Sources

• WHO Mental Health Atlas 2024 (Full Report)

• WHO Comprehensive Mental Health Action Plan 2013–2030

• WHO European Framework for Action on Mental Health 2021–2025

• WHO/Europe Mental Health Fact Sheet 2024

• Italian Ministry of Health – Mental Health Report SISM 2023

• OECD/European Commission – Italy Country Health Profile 2023

• EU Comprehensive Approach to Mental Health (2023)

Supporting Research

• European Observatory on Health Systems – Italy HSPM 2023

• European Observatory – Towards a New Model of Mental Health Care in Italy (2025)

• OECD Digital Health

• European Parliament Resolution on Mental Health (2023)

• Lancet Psychiatry: Service coverage for major depressive disorder (2024)

• APA: Telepsychology Guidelines

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