Mental Health in India

• 22 Aug 2024

For Prelims: National Medical Commission, Tobacco, National Council of Educational Research and Training, Human Immunodeficiency Virus, NIMHANS, Mental health, Kiran Helpline, Manodarpan

For Mains: Mental Healthcare in India, Issues Associated with Mental Health, Initiatives by Government of India Related to Mental Health.

Source: TH

Why in News?

• The recent report by the National Task Force on Mental Health and Well-being of Medical Students-2024, released by the National Medical Commission (NMC), highlights troubling statistics about the mental health of medical students in India.

What are the Key Highlights of the Report on Mental Health of Medical Students?

• High Levels of Stress: 84% of postgraduate (PG) students experience moderate to very high levels of stress. 64% report that the workload significantly affects their mental health.
  • 27.8% of undergraduate medical students and 15.3% of postgraduate students have a diagnosed mental health disorder, indicating a widespread mental health crisis requiring immediate intervention.
  • 16.2% of undergraduate (UG) students and 31.2% of PG students have had suicidal thoughts, indicating severe mental health challenges.
• Major Stressors:
  • Medical students, particularly postgraduates, face extended working hours daily, often exceeding 60 hours a week. This leads to inadequate rest and exhaustion.
  • The need for constant availability on duty, often with insufficient breaks, significantly contributes to stress and burnout among medical students.
  • The lack of adequate mental health support systems and infrastructure within medical institutions leaves students without proper resources to manage their stress and mental well-being.
    • Around 19% of PG students expressed that they turn to substances such as tobacco, alcohol, cannabis, and other drugs to alleviate stress. This is indicative of the lack of adequate mental health support systems and the need for education on healthier coping mechanisms.
  • High expenses of medical education and insufficient stipends exacerbate financial stress for students, especially those with financially dependent families or student loans.
    • 33.9% of UG students face extreme financial stress, with 27.2% holding educational loans and struggling with repayment pressures.
    • 72.2% of PG students find their stipend insufficient, highlighting the need for a critical review of stipend policies.
  • The intense competition, fear of failure, and high academic expectations in medical training place students under immense pressure, leading to procrastination, perfectionism, and, in extreme cases, suicidal thoughts.
  • Experiences of discrimination based on gender, caste, ethnicity and geography, along with instances of ragging and harassment by seniors and faculty, contribute to the psychological distress of students.

National Medical Commission

• It is the apex regulatory body for medical education and practice in India, established in 2020 to replace the Medical Council of India (MCI).
  • It consists of four autonomous boards and a Medical Advisory Council, responsible for overseeing major screening tests (such as NEET-UG) regulating medical education and training, registration and ethics of practitioners, and assessment and rating of institutions.
• NMC has achieved the prestigious World Federation for Medical Education (WFME) recognition, ensuring global recognition of its medical degrees.

What does India's Broader Mental Health Landscape Look Like?

• High prevalence Rates: According to the National Mental Health Survey (NMHS) 2015-16, 10.6% of adults in India suffer from mental health issues.
  • The treatment gap for mental disorders varies between 70% and 92%, depending on the disorder.
  • Urban areas exhibit higher prevalence of mental health issues (13.5%) compared to rural areas (6.9%) and urban non-metro regions (4.3%).
  • The National Council of Educational Research and Training (NCERT) Mental Health and Well-being of School Students Survey found that during the pandemic, 11% of students reported feeling anxious, 14% experienced extreme emotions, and 43% experienced mood swings.
• Economic Impact: Mental health disorders contribute to significant productivity losses due to absenteeism, reduced productivity, disability, and increased healthcare costs.
  • Poverty is shown to exacerbate mental health risks, leading to heightened psychological distress due to stressful living conditions and financial instability.

What are the Policy Challenges in Addressing Mental Health?

• Policy Neglect: Mental health remains a low priority for policymakers, partly due to a lack of political will and knowledge gaps in interventions.
• Lack of Core Indicators: Mental health issues are often marginalized due to the absence or minimal inclusion of visible core indicators in international/national health metrics.
  • This absence prevents the effective allocation of resources and investment in mental health infrastructure, research, and services.
• Budget Constraints: Against an estimated need of over Rs 93,000 crore, the mental health budget was only Rs 1,000 crore in 2023, with most funds directed to tertiary institutions, leaving little for community-based initiatives.
• Legislation Shortcomings: Despite the National Mental Health Policy of 2014 and the Mental Health Act of 2017, there are significant challenges in implementation and resource allocation.
• Human Resource Planning: In India, there is a critical shortage of mental health professionals. The reliance on a few specialists, such as psychiatrists, reinforces the notion of mental health services as a luxury rather than an integral part of primary health care.
• Strategic Intervention Needed: Policymaking requires a nuanced understanding of mental health challenges, similar to the approach taken during India's fight against Human Immunodeficiency Virus (HIV)- Acquired Immuno Deficiency Syndrome (AIDS).

Lessons from India's HIV-AIDS Strategy

• India's HIV-AIDS programme was based on real-time data and surveillance. Strategies were tailored for different regions and groups based on local needs.
  • A significant portion of the budget was allocated to engaging communities and addressing stigma, a crucial step that mental health strategies must replicate.
• Involvement of parliamentarians, the media, judiciary, and other key sectors helped create widespread awareness and support.

What are the Initiatives Related to Mental Health in India?

• National Mental Health Programme (NMHP)
• Mental Healthcare Act 2017
• National Institute of Mental Health and Neurosciences (NIMHANS)
• National Tele Mental Health Programme
• NIMHANS and iGOT-Diksha Collaboration
• Ayushman Bharat – HWC Scheme
• Kiran Helpline
• Manodarpan
• MANAS Mobile App

Note:

• Sustainable Development Goal (SDG) Target 3.4, set by the United Nations, aims to reduce premature mortality from non-communicable diseases by one-third by 2030, with a particular focus on promoting mental health and well-being.

Way Forward

• Community-Based models: Evidence-based strategies like peer-led interventions and emergency care centres should be scaled up.
  • Emulate successful models like Banyan’s Home Again program in Tamil Nadu, which combines treatment, rehabilitation, and reintegration for mentally ill, homeless women.
• Support Systems: Establish dedicated counselling centres in colleges, implement mental health awareness programs, and facilitate peer support groups to support students, who are significantly affected by mental health issues.
• Increasing Mental Health Professionals: Expanding training programs and incentives to address the shortage of mental health professionals.
  • Provide professional development and culturally sensitive training for mental health professionals.
• Establish an Autonomous Agency: Like National AIDS Control Organisation (NACO) for HIV-AIDS, an independent body for mental health could help coordinate resources, involve community stakeholders, and bridge the gaps in care and support for mental health patients.
• Decentralizing Services: Establish mental health facilities in rural and remote areas to improve accessibility. Leverage collaborations and technology to enhance resource allocation and service delivery

Drishti Mains Question:

Q. Despite various initiatives to improve mental health in India, significant challenges persist. Identify the key policy challenges in addressing mental health issues and propose strategies to overcome these challenges.

UPSC Civil Services Examination, Previous Year Questions (PYQs)

Mains

Q. In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care.Discuss. (2020)