Revamping Mental Healthcare in India | 19 Aug 2024

Recently, the National Medical Commission set up a Task Force to address the mental health and wellbeing of medical students after 122 students have committed suicide in the past five years. An online survey by the Commission revealed that 27.8% of undergraduate medical students have mental health issues, and 31.3% of postgraduate students have had suicidal thoughts. This shows that mental health is a serious concern and needs a well-planned policy. 

What is Mental Health?  

• About: According to the World Health Organization (WHO), mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. 
• Good Mental Health:  Good mental health is marked by emotional stability, resilience, self-esteem, and the ability to cope with stress effectively. It also involves maintaining positive relationships and a balanced perspective on life. 
• Mental Health Conditions: Mental health conditions include mental disorders and psychosocial disabilities as well as other mental states associated with significant distress, impairment in functioning, or risk of self-harm. 
  • A mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour.   
• Common Types of Mental Disorders: 
  • Anxiety Disorders: 
    • Characterized by excessive fear and worry and related behavioral disturbances. 
    • In 2019, 301 million people were living with an anxiety disorder including 58 million children and adolescents. 
  • Depression :  
    • Characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. 
    • In 2019, 280 million people were living with depression, including 23 million children and adolescents. 
  • Bipolar Disorder :  
    • People with bipolar disorder experience alternating periods of depression and mania.  
    • During depressive episodes, they may feel persistently sad or lose interest in activities. Manic episodes are marked by elevated mood, increased energy, talkativeness, racing thoughts, and impulsive behavior.  
    • Individuals with bipolar disorder have a higher risk of suicide. 
  • Post-Traumatic Stress Disorder (PTSD) : 
    • Developed after exposure to a traumatic event, PTSD involves persistent reliving of the trauma through flashbacks or nightmares and heightened arousal. 
  • Schizophrenia :  
    • A severe mental disorder characterized by distorted thinking, perceptions, and emotions. It affects how a person thinks and behaves, often leading to a disconnect from reality. 
    • Schizophrenia affects approximately 24 million people or 1 in 300 people worldwide. 
  • Eating Disorders:  
    • Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating and preoccupation with food as well as prominent body weight and shape concerns.  
    • The symptoms or behaviours result in significant risk or damage to health, significant distress, or significant impairment of functioning 
  • Disruptive Behaviour and Dissocial Disorders:  
    • Disruptive behaviour and dissocial disorders are characterised by persistent behaviour problems such as persistently defiant or disobedient to behaviours that persistently violate the basic rights of others or major age-appropriate societal norms, rules, or laws.  
  • Neurodevelopmental Disorders:  
    • Neurodevelopmental disorders are behavioural and cognitive disorders, that arise during the developmental period and involve significant difficulties in the acquisition and execution of specific intellectual, motor, language, or social functions. 
    • Neurodevelopmental disorders include disorders of intellectual development, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) amongst others. 

How Prevalent are Mental Health Disorders in India? 

• National Mental Health Survey (2015-16): 
  • A countrywide National Institute of Mental Health & Neurosciences (Nimhans) study has revealed that at least 13.7 % of India’s general population has been projected to be suffering from a variety of mental illnesses, and 10.6% of this requires immediate intervention. 
• Suicide Rates: 
  • India has the dubious distinction of having the highest number of suicides in the world. According to a National Crime Records Bureau (NCRB) report, 1.71 lakh people died by suicide in 2022 in India. 
  • The suicide rate has increased to 12.4 per 1,00,000 in the country. 
• Depressive Disorders: 
  • India is facing a serious mental health crisis, with an estimated 56 million people suffering from depression and 38 million from anxiety disorders, according to a report by the World Health Organisation.  

What are the Key Challenges Faced by the Mental Healthcare System in India?  

• Low Policy Priority:  
  • Mental health has historically been a low priority for Indian policymakers.  
  • Despite an estimated need of over Rs 93,000 crore for mental health, the government allocated only Rs 600 crore in 2019 and Rs 1,000 crore in the latest budget, with a majority of funds going to tertiary institutions. 
• Inadequate Mental Health Infrastructure:  
  • The healthcare infrastructure dedicated to mental health is severely lacking. There are not enough mental health professionals, hospitals, or facilities to meet the growing demand. 
  • India has 0.75 Psychiatrists per 100,000 population, while the desirable number is anything above 3 Psychiatrists per 100,000. 
• High Treatment Costs:  
  • The cost of mental health services in private healthcare settings is prohibitive for many. 
  • According to the recently conducted National Mental Health Survey (NMHS), the treatment gap for any mental disorder in India was reported to be as high as 83% 
  • As many as 20%  of Indian households become poor as a result of spending money for treatment of mental illnesses. 
• Challenges in Policy Implementation:  
  • A common issue in India's policymaking is the gap between what is needed and what is feasible. 
  • The National Mental Health Policy of 2014 and the Mental Health Act of 2017 aimed to prioritize mental health, but there is a lack of clarity on implementation, resource allocation, and timelines. 
• Urban-Rural Divide:  
  • Mental health services are concentrated in urban areas, leaving rural populations with limited or no access to care. This geographical disparity exacerbates the mental health crisis in rural regions. 
• Stigma and Discrimination: 
  •  Mental health issues are often stigmatized in India, leading to social discrimination. This discourages individuals from seeking help and exacerbates their conditions. 
• Lack of Awareness and Education:  
  • There is a significant lack of awareness about mental health, leading to misconceptions and neglect. Educational initiatives are insufficient in promoting mental health literacy.

What Should be the Way Forward to Improve Mental Healthcare in India? 

• Increase Funding for Mental Health: Allocate a higher percentage of the total health budget to mental health services. Given the significant mental health challenges faced by daily wage earners and other vulnerable groups, investing more in mental health infrastructure is crucial. 
  • For the current financial year (FY 2024-25), the health budget has amounted to around 2% of the total budget and the mental health budget is approximately 1% of the total health budget 
• Expand Facilities:  
  • Develop more mental health facilities, including community health centers and emergency care units, to cover underserved areas. 
  • Enhance access to mental health services in rural and remote areas through mobile health units and telemedicine. 
• Support Economic Stability:  
  • Promote employment guarantee programs like the Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS) to provide job security and financial stability to daily wage earners. 
  • Ensure that social security measures are accessible to all, including informal workers. 
•  Ensure effective implementation of National Policies and Acts :  
  •  Ensure effective implementation of the policy, which aims to integrate mental health into general healthcare and provide quality care. 
  •  Establish robust systems for collecting and analyzing data on mental health conditions to inform policy decisions and resource allocation. 
• Training and Capacity Building :  
  • Provide specialized training for primary care doctors, nurses, and community health workers on mental health issues to improve early detection and intervention. 
  • Increase the number of mental health professionals, including psychiatrists, psychologists, and social workers, through educational programs and incentives. 
• Learning Lessons from Combating HIV-AIDS: 
  • India's success in combating HIV-AIDS offers valuable lessons for addressing mental health.  
  • Effective strategies included evidence-based interventions, community involvement, and active participation from various stakeholders.hallenges in India’s mental healthcare system 
• Collaboration and Partnerships:  
  • Collaborate with non-governmental organizations (NGOs), healthcare providers, and community organizations to expand mental health services and outreach to marginalized communities. 
  • Organizations like Banyan (Tamil Nadu), Sangath(Goa), and the Centre for Mental Health Law and Policy (Pune) have made significant contributions to mental health through innovative and evidence-based strategies. 
• Promote Awareness and Recognition:  
  • Implement proactive policies to improve mental health recognition and awareness, especially among vulnerable sections of society.  
  • This may involve conducting mental health awareness campaigns and training programs to reduce stigma and encourage early intervention.

Conclusion

To enhance mental healthcare in India, it is crucial to prioritize mental health through increased funding, integration of services into primary care, and the use of technology to expand access. While the recent task force focusing on medical student mental health is a positive development, more comprehensive measures are needed. Addressing mental health is essential for upholding the fundamental human right to health and advancing SDG 3 on ‘good health and well-being’