By Dr. Badri Narayanan Gopalakrishnan and Monika IES
Globally, every eighth person suffers from some form of mental disorder (WHO, 2022). Mental illness is said to be the next biggest epidemic worldwide, and if neglected could have dire consequences for the economy in particular and mankind in general. Mental health disorders contribute to 15% of the global disease burden and morbidity (WHO, 2022). Depression is one of the leading causes of disability. It is important to note that suicide is the fourth leading cause of death among 15–29 year age worldwide. The same WHO (2022) report also states that India has one of the world’s largest populations of people with mental issues in one shape or another. Our own economic analysis published by the Wilson Center in the USA, using the IHME (Institute for Health Metrics and Evaluation) dataset on Disability Adjusted Life Years (DALY) finds that depression alone may account for about 61 billion USD worth of annual economic losses in India by 2030.
And as per the National Mental Health Survey (2016), about 11 percent of the Indian population was found to have a diagnosable mental illness at any given time; this translated to about 14.96 crore people. But it is crucial to acknowledge that surveys like this often suffer from a significant downward bias due to underreporting. A recent study by Lancet (2021) on mental health presents a rather grim picture, reflecting that 74% of Indians suffer from stress while 88% suffer from some kind of anxiety disorder. It is worth noting that most Indian patients who have a mental illness (>80%) remain untreated (NMHS, 2016).
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The gap between people needing care and those who can access care is quite high in India. There exist many challenges both from the Demand side and Supply side. The demand for mental health services is often hindered by a lack of awareness about diseases, myths & stigma related to it, lack of knowledge on the treatment availability, and limited affordability. On the supply side, we see a severe shortage of mental health professionals like psychiatrists and psychologists, low budget expenditure on mental health, and inadequate policy attention to mental health. As per the National Mental Health Survey (2016), there exist mere 0.77 psychiatrists, 0.21 clinical psychologists, and 0.23 psychiatric nurses per 100,000 population.
Viksit Bharat goal
The mental health situation in India demands urgent attention and active policy interventions by the government. For India to achieve the goal of Viksit Bharat, it is imperative to have a healthy and thriving human capital base. As multi-dimensional determinants influence the treatment gap for mental ailments, the interventions must also address multiple factors.
To start with, building credible and granular data is crucial for evidence-based policymaking for mental healthcare. Periodic data on State, Urban/Rural, gender, age group, and occupation, etc of mental health patients can give a more realistic picture of the problem and facilitate the development of targeted interventions.
To address the supply-side challenges, the government along with the relevant stakeholders should come up with a holistic infrastructure plan to ensure the availability and accessibility of minimum mental healthcare for all, particularly to the most vulnerable and underprivileged sections of the population. Most of the state-run mental hospitals in the country were established long ago and are now dilapidated. Therefore, it becomes imperative for the government to modernize State Run Mental Hospitals in a mission mode. Government can provide incentives to healthcare providers to encourage them to invest in mental health infrastructure.
Budgeting for mental well-being
The healthcare budget must prioritise the allocation of adequate resources for promoting mental well-being. The focus should be to increase the strength of mental health professionals by first ensuring that each medical college has a department of psychiatry and then by gradually increasing the number of seats in the psychiatry wings of the medical colleges. The mental healthcare component should be integrated with Primary healthcare. For this, we need innovative models to deepen the penetration of services and staff pertaining to mental health.
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For instance, the Accredited Social Health Activist (ASHA), a crucial link between the healthcare system and the local people, can be leveraged to provide mental healthcare services. ASHA workers can play a vital role in promoting mental health awareness, reducing the stigma associated with mental illnesses, encouraging local people to seek professional help, and referring them to appropriate healthcare providers
Besides, there is also a pressing need to strengthen the human resources at the administrative level (i.e., in the Directorate of Health Services) and have dedicated and full-time officers to look after mental health at a grassroots level of Districts/Zila/Village & Block level in the states/UTs. Here, the use of technology can be crucial to enhance access and bring affordability of mental healthcare services.
The shortage of human resources can be met through digital academies/institutions. Furthermore, most states have not yet implemented the Mental Health Care Act, 2017. States should be nudged and sensitized to implement the Mental Health Care Act, 2017, and form their respective statutory bodies like State Mental Health Authorities and Review Boards related to the Act.
Now, on the demand side, the lack of affordable mental health facilities is one of the primary reasons for the enormous existing treatment gap for mental ailments in India, but it is not the only reason. Many people in India still prefer going to ojhas, tantriks, and quacks to consulting a psychiatrist due to the stigma associated with mental illness. Sincere efforts must be amplified to increase awareness, help identify risk factors, and address misconceptions and fears in different regional languages. A citizen-friendly repository of information on treatment availability can reduce information asymmetry.
Awareness about mental health should find a place in the school curriculum and open dialogues/discussions can be encouraged at the higher education levels. To combat and reduce the stigma associated with mental health, more positive names, such as Wellbeing Centers, can be developed for mental health institutions. At a community & societal level, it is crucial for family members and caregivers to have the necessary knowledge, skills, and empathetic attitudes to provide effective care for their mental health. In this respect, policy interventions should be designed which encourage positive behavioural shifts.
Currently, mental health services are delivered through National Mental Health Program (NMHP) and its operational arm, the District Mental Health Program (DMHP). Besides, India recently also launched the National Tele Mental Health Program (TeleMANAS) in October 2022. But there is an urgent need to establish rigorous mechanisms for periodic review and monitoring of DMHP activities. And Tele MANAS also needs further strengthening, popularising, stabilizing, and linkage with DMHP to be more efficient and impactful. To ensure the success of DMHP/NMHP initiatives, the government must prioritise fostering stronger partnerships with mental health institutes, medical colleges, and academic institutions.
At the same time, it’s crucial to acknowledge the significance of relevant and useful local knowledge and practices. Mental healthcare can use an integrated approach to well-being. The measures like Dinacharya (daily regimen), Ritucharya (seasonal regimen), Sadvrtta (code of virtues), and adoption of Yoga for the preservation of mental health are essential strategies that may be adopted in the National Mental Health Program.
India may also undergo an emergency-like situation if this issue does not get acknowledged in policy domains. Mental illnesses are chronic and bring severe economic costs to both individuals and nations at large. Therefore, it becomes of utmost importance for the government to give due policy attention to mental health. By prioritising mental health, governments can help individuals and communities thrive, leading to stronger, healthier, and more resilient societies. It is high time for the government to prioritise mental health and take decisive and urgent action to combat this growing mental health emergency.
(The authors Dr. Badri Narayanan Gopalakrishnan is Fellow at NITI Aayog and Monika IES, is Assistant Director at NITI Aayog. Views expressed are personal.)
