Mental healthcare in India

India has observed a significant increase in individuals suffering from mental health morbidities, from nearly 150 million individuals in 2016

India has observed a significant increase in individuals suffering from mental health morbidities, from nearly 150 million individuals in 2016 (National Mental Health Survey, 2016) to approximately 240 million in 2023 (Jain, 2023). The COVID-19 pandemic contributed to a significant increase in mental health issues globally. Even in India, the prevalence of mental health conditions has increased, especially in vulnerable populations and individuals with pre-existing psychiatric/psychological conditions (Roy et al., 2020; Vadivel et al., 2021). Despite these circumstances, insufficient allocation of budget towards mental health, a dearth of quality professionals and affordable institutions, and stigmatisation of mental health disorders have made seeking quality treatment or support for mental health disorders inaccessible and a luxury.

Even though there exist several policies related to mental health, such as the National Mental Health Program (1982), launched with funding for Rs. 100 million, aimed to provide accessible and affordable mental health care for ‘all’, encourage mental health knowledge, promote community participation in mental health services, and create self-help groups (Gupta & Sagar, 2018; Khandelwal et al., 2004). This program was further expanded to the District Mental Health Program (DMHP) based on the success of the Bellary District pilot project launched in 1996, aiming to have more provision of services, awareness campaigns, medications & treatments, and facility development (Singh, 2018). However, the implementation of these programs faced many hurdles in terms of resources, first the ambiguity associated with the funding and lack of trained professionals. Furthermore, this being a state initiative, there was very little involvement of the private sector (NGOs etc.). The most significant shortcoming of this initiative is that they were not successful in addressing the stigma and discrimination towards mental healthcare, which was a resisting factor for individuals seeking help. While the DMHP was successful to some extent in providing support at a district level, with NIMHANS playing an important role in training health professionals, a consequent survey conducted revealed a large treatment gap (Singh, 2018). Along with these programs in 2017, the state launched a replacement for the Mental Health Act of 1987, which aims to protect the rights of the people seeking mental healthcare and accessing treatment in the least restrictive environment, uploading their dignity. However, this had similar limitations, such as the unavailability of resources such as general hospital psychiatric units, infrastructure, trained professionals, district-level review boards, etc. (Chadda, 2019).

In addition to these programs, schemes like the Ayushman Bharat Yojana aim to provide affordable health care to the citizens, making it accessible for all (National Portal of India, 2018); however, these challenges endured by each programme are predominantly due to the insufficient budget allocation towards mental healthcare. For years, only a miniscule amount of the budget has been dedicated to the mental health sector. This underfunding is even highlighted in current years 2024–25, as approximately 1.08% of the national budget for the health and family welfare department has been allocated towards mental health institutions and programs (Ministry of Health and Welfare, 2024). India faces several barriers to mental healthcare that contribute to the treatment gap in the country; the most overt and antiquated stigmatisation and/or unawareness of mental health results in people not addressing and acknowledging that their mental health conditions eventually become severe to the extent of being fatal (Shidhaye & Kermode, 2013; Thornicroft, 2008). The inadequate budget allocation results in the scarcity of quality and affordable health professionals, and their availability across the country also adds to the barriers, increasing the treatment gap to 85%% which is not only an ordeal for the patients but also excruciating for the carers (Kar & Menon, 2024).

The lack of budgetary allocation has resulted in obstacles. In the case of the general hospitals in India, only 47 hospitals across the country are dedicated to mental health (DEPARTMENT OF HEALTH AND FAMILY WELFARE, 2021). Institutions are fully functional and are mostly set up with medical schools, have a psychiatrist, nurse (not necessarily having psychiatric training), clinical psychologist, consultants, and junior doctors. Independent general hospitals (GH) are only limited to a psychiatrist and a nurse (Chadda & Sood, 2018). India faces a shortage of mental health practitioners, 2 mental health professionals, and 3 psychiatrists per individual, which is extremely low for a population of 1.3 billion individuals (Sagar et. al., 2020). In contrast to the West, a wide range of severe psychiatric cases are handled by the general hospitals in the same range as mental health hospitals; e.g., new cases reported at AIIMS, Delhi (general hospital - 15,097) were very close to the new cases reported at NIMHANS, Bangalore (12,915). On the positive side, GH provides holistic care for the patients admitted, where they also provide psychiatric assistance to non-psychiatric cases admitted to the hospital. However, ensuring the provision of such facilities requires a multitude of resources, which these units lack; facilities lack infrastructure, equipment, and trained professionals and face negligence from the policymakers (Chadda & Sood, 2018). Most of the time, the funding provided to these hospitals is mostly concentrated towards other departments, resulting in negligence towards the psychiatric department. There are long queues outside outpatient departments of psychiatric units due to the presence of just one or two psychiatrists who are overwhelmed with patients and cannot afford to dedicate sufficient time to each person. There is also over-reliance on medications due to a lack of clinical psychologists. Furthermore, many general hospitals do not have psychiatric wards, and hence severe cases are admitted in the generic wards, which are distressing for the patients in the hospital.

Funding towards the mental health sector needs to be augmented to contribute towards mental health awareness campaigns. Many individuals perceive mental disorders as some supernatural activity on them and prefer seeking treatments from people who are not trained in the field, such as traditional healers and faith healers. Many individuals fear being discriminated against if they seek treatment from’mental hospitals’ (Kaur et al., 2023). Additionally, people also tend to go to non-medical practitioners to prevent out-of-pocket expenditure due to the perception of mental healthcare being expensive.

Considering the enormous increase of mental health issues and disorders in India, there is a need for more institutions that cater to mental healthcare. This will not only ensure available and affordable mental health care for all but also play an important role in creating further awareness and acceptance in seeking treatment for mental health conditions.

References

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Authors: Rujula Talloo, Undergraduate Student, FLAME University, & Prof. Moitrayee Das, Faculty of Psychology, FLAME University.