Mental Healthcare in India

Context: In 2010, global economic losses of $2.5 trillion annually were attributed to poor mental health, stemming from diminished well-being and productivity. This will surge to $6 trillion by 2030.

What is Mental Health?

• The World Health Organization (WHO) defines mental health as 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.
• Mental health is an integral part of health; it is more than the absence of mental illnesses. It is the foundation for well-being and effective functioning of individuals.
• Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990.

Factors Affecting Mental Health

• Biological Factors:
  • Genetics: A family history of mental health disorders can increase the risk.
  • Physical Health: Chronic illnesses and neurological conditions can impact mental well-being.
• Psychological Factors:
  • Early Life Experiences: Trauma, abuse, or neglect during childhood can contribute to mental health issues.
  • Personality Traits: Certain personality characteristics may make individuals more susceptible to mental health challenges.
• Environmental Factors:
  • Socioeconomic Status: Poverty, unemployment, and financial stress can affect mental health.
  • Social Support: Strong social connections and a supportive network can buffer against mental health problems.
  • Exposure to Trauma: Experiencing violence, accidents, or natural disasters can have a profound impact.
  • Access to Healthcare: Limited access to mental healthcare services can hinder treatment.
• Lifestyle Factors:
  • Substance Abuse: Drug and alcohol abuse can exacerbate or trigger mental health disorders.
  • Diet and Exercise: A balanced diet and regular physical activity can contribute to better mental well-being.
  • Sleep: Sleep disturbances and disorders can affect mood and cognitive function.
  • Chronic Stress: Ongoing stress from work, relationships, or other sources can take a toll on mental health.
• Cultural and Societal Factors:
  • Cultural Beliefs: Cultural norms and expectations can influence how mental health issues are perceived and addressed.
  • Discrimination: Experiencing discrimination or stigma related to race, gender, sexual orientation, or other factors can impact mental health.

Status of Mental illness in India

• According to the WHO estimates:
  • The burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 100 00 population; the age-adjusted suicide rate per 100 000 population is 21.1.
    • The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
    • The age-adjusted suicide rate is the number of suicides in a country in a year, divided by the WHO standard population and multiplied with 100 000.
  • The economic loss due to mental health conditions, between 2012-2030, is estimated at USD 1.03 trillion.
• In 2017, an estimation of the burden of mental health conditions for the states across India revealed that as many as 197.3 million people required care for mental health conditions.
  • This included around 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders.
  • The situation has been exacerbated due to the Covid-19 pandemic, making it a serious concern world over.
• The NCRB recorded 1.5 lakh suicide deaths in 2020, against 1.39 lakh in 2019.
• Poor mental health amongst employees costs Indian companies a combined $14 billion a year due to absenteeism, attrition and other reasons, Deloitte estimated in a report.

Challenges of Tackling Mental Health Care

Government Initiatives for Mental Healthcare in India

• National Mental Health Programme (NMHP): The Government of India has launched the National Mental Health Programme (NMHP) in 1982, with the following objectives:
  • To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population.
  • To encourage the application of mental health knowledge in general healthcare and in social development; and
  • To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.
• The District Mental Health Program (DMHP): It was launched under NMHP in the year 1996 (in IX Five Year Plan). The DMHP was based on ‘Bellary Model’ with the following components:
  • Early detection & treatment.
  • Training: imparting short-term training to general physicians for diagnosis and treatment of common mental illnesses with limited number of drugs under guidance of specialist. The health workers are being trained in identifying mentally ill persons.
  • IEC: Public awareness generation.
  • Monitoring: the purpose is for simple Record Keeping.
• Mental HealthCare Act 2017: It was enacted to provide better mental healthcare and protect the rights of individuals with mental illness. Key provisions include:
  • Rights of Individuals: The Act guarantees the right to access mental healthcare and treatment for individuals with mental illness.
  • Advance Directives: It allows individuals to make advance directives regarding their treatment preferences.
  • Decriminalization: The Act decriminalizes suicide and prohibits the use of electroconvulsive therapy without anesthesia.
  • Mental Health Review Boards: It establishes Mental Health Review Boards to safeguard the rights of individuals with mental illness.
  • Insurance Coverage: It mandates insurance companies to provide coverage for mental health treatment.
  • Mental Health Facilities: The Act promotes the establishment of mental health services and facilities.
  • Prohibition of Inhuman Treatment: The Act prohibits the use of seclusion and chaining of mentally ill individuals.
• Kiran Helpline: The Ministry of Social Justice and Empowerment has launched a 24/7 toll-free helpline ‘Kiran’ to provide support to people facing anxiety, stress, depression, suicidal thoughts and other mental health concerns.
• MANODARPAN initiative: It is an initiative of the Ministry of Education to provide psychosocial support to students for their Mental Health and Well-being during the times of COVID-19.
• Tele Mental Health Assistance and Networking Across States (Tele-MANAS) initiative: It was launched by Ministry of Health & Family Welfare in October 2022.
  • It aims to provide free tele-mental health services all over the country round the clock, particularly catering to people in remote or under-served areas.

Way Forward

• WHO’s “World mental health report: transforming mental health for all” suggests a three-path approach for transformation:
  • Deepen the value given to mental health by individuals, communities and governments; and matching that value with commitment, engagement and investment by all stakeholders, across all sectors.
  • Reshape the physical, social and economic characteristics of environments – in homes, schools, workplaces and the wider community – to better protect mental health and prevent mental health conditions; and
  • Strengthen mental health care so that the full spectrum of mental health needs is met through a community-based network of accessible, affordable and quality services and supports.
• Promoting Mental Health Literacy: Launching awareness programs plays a pivotal role in destigmatizing mental health interventions.
  • Insufficient awareness often leads to the misjudgment or dismissal of signs that someone needs assistance, as well as stigmatization of those who seek help.
  • Furthermore, it is essential to challenge the misconception that mental health merely entails the absence of mental illness.
• Affordability Measures: Regulating the costs of counseling sessions and refining underwriting norms in insurance policies, particularly concerning outpatient expenses, disease classification, and pre-existing conditions, requires attention.
• Administrative Reforms: 
  • Bottom-Up Approach: A mental healthcare system inspired by the reproductive and child health model, beginning with services at the village level and extending to tertiary hospitals, is essential.
  • Improved Intersectoral Coordination: Enhancing coordination between mental health and social welfare departments of the government is imperative.
• Transitioning from Institutions to Communities: To promote community-based rehabilitation, India should strengthen outpatient services and establish day-care centers.

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