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The prevalence of mental health disorders in India has increased significantly in recent years. According to the National Mental Health Survey (NMHS) conducted in 2015-16, around 15% of the population requires active mental health intervention. However, the survey also highlighted a substantial treatment gap of approximately 83.
4%, indicating that many individuals do not receive the necessary care. This gap is influenced by various factors, including a lack of perceived need, societal stigma, limited awareness of available health care resources, workplace and educational stress, financial barriers, gender inequalities, and doubts about treatment effectiveness. Alarmingly, the mental health care budget for fiscal year 2024-25 accounts for only 1% of the overall health budget, which is inadequate given the gravity of the situation.
While the United States had over 1 million mental health professionals in 2023, translating to a ratio of 207.4 professionals per 100,000 individuals, India struggles with only 0.75 psychiatrists per 100,000, significantly below the recommended three.
Furthermore, a report from the Parliamentary Standing Committee on Health and Family Welfare in August 2023 revealed that India has only 2,840 accredited clinical psychologists. Before the enactment of the Mental Healthcare Act (MHA) 2017, individuals with mental health issues in India lacked legally recognised rights. The MHA emphasises the importance of community-based care and support, establishing a framework that honours the autonomy of those with mental illnesses in making treatment choices.
However, the implementation of the Act faces significant challenges, such as the ineffective establishment of Mental Health Review Boards (MHRBs) in various states. Recent government efforts, including the National Suicide Prevention Strategy launched in November 2022 and the National Tele Mental Health Programme, aim to enhance access to quality mental health counselling across the country. While the helpline provides immediate support, it is essential to ensure ongoing follow-up for individuals in distress, as continuous assistance is vital for effective mental health care and sustained outcomes.
Additionally, Ayushman Aarogya Mandirs (AAMs) are supposed to incorporate mental health services into a package of comprehensive primary health care, following specific operational protocols for mental, neurological, and substance use disorders. Nonetheless, challenges persist in the consistent implementation of these guidelines across all AAMs. Mental health services are also offered at 22 AIIMS and are included in the Pradhan Mantri Jan Arogya Yojana (PM-JAY), yet many patients remain unaware of these resources, resulting in low utilisation rates.
The treatment landscape is further complicated by a lack of standardisation in diagnostic and care practices. The prevailing stigma associated with mental health issues often prevents individuals from seeking necessary treatment, leading to a reduced demand for mental health professionals. This diminished demand contributes to fewer residency opportunities in psychiatry and may result in insufficient funding for mental health programmes, perpetuating a cycle that hinders patient care and exacerbates the prevalence of mental health disorders.
Following the completion of their MBBS, many Indian physicians typically opt for specialties like surgery, cardiology and now increasingly, radiology. It is essential to expand postgraduate medical training positions in psychiatry to address the escalating need for mental health care. Fields such as psycho-oncology remain significantly underdeveloped too.
It is essential to recognise that the effects of chronic conditions, including cancer, cardiovascular disease, diabetes, and chronic kidney disease, extend beyond physical health, profoundly impacting mental well-being as well. Mental health challenges often arise during childhood. In India, student suicide rates have alarmingly increased by 64% from 2013 to 2022.
Despite the MHA 2017 decriminalising suicide attempts for those with mental health conditions, the under-reporting of student suicides remains a significant issue. A UNICEF report reveals that one in seven young Indians aged 15-24 suffer from poor mental health, with a notable prevalence of depressive symptoms. However, only 41% of these individuals seek help.
It is essential to strengthen emotional support systems and combat the stigma associated with therapy to better assist students in navigating their challenges. The influence of social media and peer pressure exacerbates feelings of inadequacy, making it vital to incorporate mental health awareness into the educational system. Educators should create a safe and non-judgmental environment that encourages students to express their struggles.
Schools should also engage mental health counsellors and trained child psychologists to provide necessary support. By normalising conversations about mental health and fostering open communication among teachers, parents, and students, a culture can be cultivated where students feel empowered to seek help. While younger students can benefit from preventive care and awareness initiatives, older students facing issues such as bullying, substance abuse, grief and trauma require more intensive therapeutic interventions.
The ministry of education's toll-free helpline, part of the Manodarpan initiative, aims to enhance students' mental well-being, yet the effectiveness of these helplines remains a concern. Parents too must recognise that simply providing a digital device to a distressed child as a means of distraction can pose significant risks. Meaningful conversations and personal interactions are essential, especially in today's digital age.
In 2022, a Deloitte survey indicated that 80% of the Indian workforce faced considerable mental health issues and stress. Among these individuals, 39% were reluctant to seek assistance due to societal stigma. Those from lower socio-economic backgrounds experience increased stress due to unfavourable working conditions, extended hours, limited family interaction, and inadequate wages.
Additional challenges arise from factors such as disability and gender; while stress affects all genders, women disproportionately bear domestic responsibilities, often managing multiple roles. Issues like unequal pay, caregiving obligations, and gender-based violence significantly exacerbate mental health difficulties for women. Although workplaces are expected to offer support, they often intensify stress.
The MHA 2017 establishes crucial rights for individuals, including protection against discrimination, and the right to legal support. However, the actual effectiveness of employers in honouring these rights remains a pressing concern. Potential strategies for creating a supportive work environment include establishing grievance committees, implementing anonymous reporting systems, and offering therapeutic services to those in need.
India is in the early phase of acknowledging the rights of individuals with mental health conditions, and this process will necessitate ongoing reflection and a critical assessment of the impact of various legislations and policies. The goals of Viksit Bharat can only be attained with a workforce that is healthy in both the physical and mental aspects. This article is authored by Urvashi Prasad, former director, Office of Vice Chairperson, NITI Aayog, New Delhi.
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