India, home to one of the largest populations in the world, faces unique challenges in addressing mental health issues. With a history of underfunded mental health services and significant stigma surrounding mental illness, the country has taken significant steps toward improving mental health care infrastructure and policies.
For the first time ever, the Economic Survey 2023-24 tabled by the Union Minister of Finance and Corporate Affairs Nirmala Sitharaman in Parliament on July 22, 2024, talked about mental health, its significance and implications on policy recommendations.
Acknowledging mental health as a principally impactful driver of individual and national development, the Survey notes that as per the National Mental Health Survey (NMHS) 2015-16, 10.6% adults in India suffered from mental disorders while treatment gap for mental disorders ranged between 70% and 92% for different disorders. Further, the prevalence of mental morbidity was higher in urban metro regions (13.5%) as compared to rural areas (6.9%) and urban non-metro areas (4.3%). Citing NCERT’s Mental Health and Well-being of School Students Survey, the Survey highlights an increasing prevalence of poor mental health among adolescents exacerbated by the COVID-19 pandemic, with 11% of students reported as feeling anxious, 14% as feeling extreme emotion and 43% experiencing mood swings.
The survey points out that at an aggregate economic level, mental health disorders are associated with significant productivity losses due to absenteeism, decreased productivity, disability, increased healthcare costs, etc. There is also evidence of poverty affecting the risk of mental health via stressful living conditions, financial instability, and a lack of opportunities for upward mobility, which contribute to heightened psychological distress.
Policy Recommendations on Mental Health
The Economic survey emphasizes the need for effective implementation to accelerate progress in mental healthcare, addressing existing gaps to ensure maximum impact. Key policy recommendations include:
- Re-doubling efforts to increase the number of psychiatrists, from 0.75 psychiatrists per lakh population in 2021 to the WHO norm of 3 per lakh population
- Developing comprehensive guidelines for the excellence centers’ services alongside mental healthcare professionals and users to understand their needs.
- Assessing the effectiveness of the programmes by gathering feedback from the users, professionals, and stakeholders to make necessary changes and meet the needs of a wider population.
- Nurturing peer support networks, self-help groups, and community-based rehabilitation programmes can help de-stigmatization of mental disorders and develop a sense of belonging.
- Partnering with NGOs to scale up efforts, share knowledge, and leverage resources to enhance future policies, to aid in identifying areas of improvement.
- Involving individuals with personal experience with mental health problems in decision-making, service planning, and advocacy efforts can increase the person-centricity and recovery orientation of mental healthcare services.
- Sensitization of mental health at the preschool, Anganwadi level to provide precious early identification of disorders.
- Standardization of guidelines for mental-health services across government and private sector.
- Effective pathways for integrating mental health interventions in schools including developing an age-appropriate mental health curriculum for teachers and students, encouraging early intervention and positive language in schools, promoting community-level interactions, and balancing the role of technology.
- A bottom-up, whole-of-community approach in addressing the topic of mental health and breaking the stigma.
- For public health officials, tackling mental health by acknowledging and addressing the fundamental reluctance at personal level.
Key Initiatives: Efforts by Government for a Better Tomorrow
The Government of India, through the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, conducted the National Mental Health Survey (NMHS) in 2016. According to the survey, approximately 10.6% of adults over the age of 18 suffer from mental disorders.
To address this, the District Mental Health Programme (DMHP), a key component of the National Mental Health Programme (NMHP), has been rolled out in 767 districts, with support provided to States/UTs under the National Health Mission. The DMHP aims to deliver services such as suicide prevention, workplace stress management, life skills training, and counseling for schools and colleges. Facilities at district hospitals, Community Health Centres (CHCs), and Primary Health Centres (PHCs) offer outpatient services, counselling, psycho-social interventions, continued care for severe mental disorders, drugs, outreach programs, and ambulance services. Additionally, a 10-bed in-patient facility is available at the district level. Furthermore, over 1.73 lakh Sub Health Centres (SHCs) and PHCs have been upgraded to Ayushman Arogya Mandirs, integrating mental health services into their care packages.
To further enhance mental healthcare capacity, the government has expanded the NMHP’s tertiary care component. This includes sanctioning, 25 Centres of Excellence have been sanctioned to increase the intake of students in PG departments in mental health specialities as well as to provide tertiary level treatment facilities. Additionally, 47 postgraduate departments in mental health have been strengthened across 19 government medical colleges, with mental health services also provisioned in 22 newly established AIIMS. Across India, there are 47 government-run mental hospitals, including three central mental institutions: National Institute of Mental Health and Neuro Sciences, Bengaluru, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam and Central Institute of Psychiatry, Ranchi.
In a significant initiative, the government launched the National Tele Mental Health Programme (NTMHP) on October 10, 2022, to improve access to quality mental health counselling and care. A total of 53 Tele MANAS Cells are operational across 36 states /union territories. As of October 08, 2024, more than 14.5 lakh calls have been handled on the helpline number.
Conclusion
World Mental Health Day serves as a critical reminder of the importance of mental health care in our lives and workplaces. With mental health and work being so closely linked, it is essential for governments, employers, and stakeholders to take action in creating safe, inclusive, and supportive environments where mental well-being can thrive. Global initiatives, driven by organizations like WHO and WFMH, are making progress, but there is still much work to be done in raising awareness, reducing stigma, and improving access to mental health services.
India’s recent efforts to address mental health challenges through policies, surveys, and programs are commendable. By increasing mental health resources and integrating services into primary healthcare, India is making strides toward reducing the treatment gap and addressing the country’s mental health burden. As these efforts continue, the focus must remain on creating inclusive systems that enable individuals to thrive both at work and in society. In the coming years, continued collaboration between governments, organizations, and individuals is essential to ensure that mental health care is accessible, effective, and free from stigma. This will help create a future where mental health is recognized as a fundamental right, and everyone can participate fully in both work and life.