Table 4. Summary results on health system inputs.

	Egypt	Germany	Jordan	Lebanon	Sweden	Switzerland	The Netherlands	Türkiye
Leadership and governance
Mental health policy	Yes	Yes	Yes	Unknown	Yes	No	Yes	Yes
Mental health plan	Yes	No	Yes	Unknown	Yes	Yes	Yes	Yes
Mental health legislation	Yes	No (covered in other laws)	No	Yes	Decentralised to municipalities	No (covered in other laws)	Yes	Yes
Financing
% GDP on health	5.6%	11.4%	7.7%	6.0%	10.8%	11.9%	9.9%	4.1%
% health expenditure on mental health	0.5%	11.0%	Unknown	4.8%	Unknown	Unknown	10.7%	Unknown
% mental health expenditure towards mental hospitals	Unknown	11.3%	Unknown	54.0%	Unknown	Unknown	59.2%	Unknown
% funding sources for health system	Unknown	77% social security	8.8% social security, 30.7% out-of-pocket	52.5% social security, 36.4% out-of-pocket	Regional taxes, 13.8% out-of- pocket	71.5% social security, 26.8% out-of-pocket	93.0% social security, 10.1% out-of-pocket	Unknown
Costs utilising MHPSS services for refugees	None	None, but coverage varies	Same as uninsured Jordanians and coverage varies; no cost at UNHCR facilities	LBP 3,000 – 5,000 (1.75 – 3 EUR) for consultation at UNHCR facilities	Largely none, same cost as for Swedish citizens; can apply for reimbursement of out-of-pocket fees	None if approved by a doctor or psychiatrist	Same as Dutch citizens, pay the cost of monthly insurance premiums and out-of- pocket costs	Once registered, same as Türkiye’s citizens.
Facilities and services	Ministry of Health main mental health service provider. MHPSS is not yet fully integrated into PHC, and so refugees either pay specialists or utilise NGO services in the parallel system.	All psychosocial services are available in the public sector. Alternatively, refugees have access to the parallel system in which many organisations offer counselling.	Syrian refugees can access MHPSS through primary care, which is increasingly integrated, or through UNHCR and NGO facilities that are accessible at no cost.	NGOs are extensively involved in care provision (in 2006, over 80% of the 110 PHC centres and 734 dispensaries are owned by NGOs). A variety of MHPSS is offered to the general population.	Refugees are identified and treated for mild mental health issues within PHC; Syrian refugees may be referred to providers who specialise in treating this group, who may be in a parallel system.	Syrian refugees with mental health needs are referred by nurses/social workers in asylum centres to PHC, where GPs can diagnose, treat, and refer. Referral is possible to general socio- psychiatric facilities, outpatient clinics for traumatised migrants, or tertiary care.	Early detection of mental health issues through prevention/ refugee integration programmes in the social domain; screenings at asylum centres; PHC providers in asylum centres or communities. GPs can treat or refer patients to secondary or tertiary care levels.	Syrians with temporary protection status can access PHC and community mental health centres for diagnosis, treatment, and referral. Those without temporary protection status can access emergency care in hospitals.
Medicines
Essential drugs list	Yes	Yes	Yes	Yes	Yes, determined at the county level	Yes	No, but registered drugs list available and measures to keep them affordable.	Yes
Psychotherapeutic medicines included in the list	Yes	Yes, under ‘neurological diseases’	Yes	Yes	Dependent on county	Yes, under ‘neurological diseases’	N/A	N/A
Cost of psychotherapeutic medicines	Unknown; 80.0% of the population have free access	Covered by insurance	Unknown	Not covered by social insurance schemes, free at UNHCR facilities (but must pay consultation fee)	Up to €109 annually for drugs within the national insurance scheme, or €218 for drugs not covered	Unknown	Up to €385 annually	Unknown
PHC doctors authorised to prescribe psychotherapeutic medicines	Unknown	Yes	Unknown	Yes	Yes	Yes	Yes	Yes
Health workforce
Mental health workers per 100,000	8.40 mental health workers, 1.6 psychiatrists, 0.26 psychologists, 4.8 mental health nurses, 0.45 social workers	27.45 psychiatrists, 49.55 psychologists, 56.06 mental health nurses	7.8 mental health workers, 1.125 psychiatrists, 1.266 psychologists, 3.297 mental health nurses, 0.218 social workers	1.21 psychiatrists, 3.8 psychologists, 3.14 mental health nurses, 1.33 social workers	20.86 psychiatrists, 0.93 psychologists, 50.57 mental health nurses, 18.42 social workers	41.42 psychiatrists, 40.78 psychologists	24.23 psychiatrists, 90.76 psychologists, 2.87 mental health nurses	1.64 psychiatrists, 2.54 psychologists, 0.76 social workers
Distribution of mental health professionals between urban and rural areas	Uneven	Uneven	Relatively even	Unknown	Uneven	Unknown	Unknown	Unknown
Mental health or cultural competency training	Covers psychological first aid and basic mental health care	None for undergraduate; majority of PHC doctors have not received official in-service mental health training in last 5 years	Insufficient	3% of training for doctors, and 6% of training for nurses, is dedicated to mental health	Unknown, although nurses receive theoretical and clinical training in mental illness	Cultural competency training is provided in under- and postgraduate curricula for medical students and residents	Care for patients with psychological complaints is part of GP training; nurses can specialise in mental health	Majority of PHC doctors have not received official in- service mental health training in last 5 years
Information
Data on the epidemiology of mental disorders collected at the national level	Unknown	Yes	Unknown	Yes	Yes	No	Yes	Unknown
Mental health data disaggregated refugees	Unknown	No	Future plans to disaggregate health data by refugee status; Unknown if includes mental health	No	Unknown	No	No	Unknown
NGO collection of refugee mental health data	Unknown	Unknown	Unknown	Database of the Lebanon Crisis Response Plan encourages partners to collect disaggregated data for displaced Syrians, although includes limited data on mental health indicators	NGOs involved in MHPSS for refugees publish data within their annual reports	Unknown	NGOs involved in social support do not consistently publish data, aside from the Dutch Refugee Council. Knowledge centres Pharos and ARQ active in gathering and distributing information on refugee mental health	Unknown

Sources: WHO (especially Mental Health Atlas and WHO-AIMS reports), UNHCR, World Bank, Eurostat, reports by national governments. See Supplementary File 6 for more detailed overview of findings on context and inputs, including sources used.