Mental Health in India

Table of contents

Context (TH): The Economic Survey highlights the increase in mental health issues in India, emphasizing the need for a community-based approach.
WHO defines mental health as a “condition of well-being in which every person is able to reach their full potential, manage everyday pressures, engage in productive and fruitful employment, and contribute to their community.”
WHO emphasises that having a healthy mental state involves “more than just being free of mental impairments or illnesses.”
It is a fundamental human right essential for socioeconomic, communal, and personal growth.

Mental Health in India: Statistics

Mental health issues burden India with 2,443 disability-adjusted life years per 100,000 population, with an age-adjusted suicide rate of 21.1 per 100,000 people.
Age-adjusted suicide rate per 1,00,000 population is 10.9.
The economic loss due to mental health conditions between 2012-2030 is estimated at USD 1.03 trillion.
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%).

Determinants of Mental Health

Impacts of mental health issues

Diminish individual quality of life
Constrain overall productivity through absenteeism, reduced efficiency, disability.
Increased healthcare costs

Challenges in addressing the issue of mental health

Stigmatisation of mental illness leading to delay in seeking treatment and social exclusion and isolation for the ones affected.

Financial barriers to mental health treatment.
Lack of infrastructure: The average number of mental hospitals globally is 0.04 per 100,000, while it’s only 0.004 in India.
Lack of good mental health care professionals and services: India falls short in terms of the mental health workforce, with just 0.3 psychiatrists per 100,000 people (WHO).
Treatment gap for mental disorders ranged between 70 to 92 per cent for different disorders.
Limited availability of mental health education and awareness.

Mental Healthcare Act, 2017

Mental Healthcare Act, 2017 aims to provide mental health care and services to people with mental illness in India. The Act repeals the Mental Health Act, 1987.
Mental health is defined in section 2 under the act according to which “Mental illness indicates a substantial disorder of thinking, mood, perception, orientation or thought that seriously impairs behaviour, capacity to recognise reality, or ability to meet daily needs”.
The provisions of the act ensure the following rights:
- Right to access mental healthcare.
- Right to protection from cruel, inhuman and degrading treatment.
- Right to equality and non-discrimination.
- Right to information.
- Right to confidentiality.
- Right to legal aid.
- Right to make complaints about deficiencies in the provision of services. (It means one can not ask a person to go to Pakistan in case they complain about deficiencies in services!)
- Right to make an advance directive that states how he wants to be treated for the illness and who his nominated representative shall be.

Mental Health Review Commission and Board

The Mental Health Review Commission will be a quasi-judicial body that will periodically review the procedure for making advance directives and advise the government on mentally ill persons.
The Commission shall, with the concurrence of the state governments, constitute Mental Health Review Boards in the districts of a state.

Decriminalising suicide

A person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code.

Prohibiting electro-convulsive therapy

Electro-convulsive therapy is allowed only with muscle relaxants and anaesthesia.
It is prohibited for minors.

Penalties and offences

Any infringement of a provision is punishable by a six-month prison sentence and/or Rs. 10,000 fine.
Repeat offenders may face a further two years in prison and/or 50,000 to 5 lakh rupees.

Government initiatives to address issues of mental health

Tele-MANAS

The Tele Mental Health Programme aims to nationally strengthen mental health service delivery.
The Tele-MANAS is organised as a two-tier system:
1. Tier 1: State Tele-MANAS cells with trained mental health specialists for teleconsultation through a customised Interactive Voice Response system (IVRS),
2. Tier 2: District Mental Health Programme (DMHP)/Medical College resources for physical consultation and/or eSanjeevani for audio-visual consultation.

Tele-MANAS will integrate various mental health services and professionals, including the National teleconsultation service, e-Sanjeevani, Ayushman Bharat Digital Mission, etc.
Sadness, sleeplessness, stress and anxiety are the top mental health concerns shared on Tele MANAS.
Features of Tele-MANAS:
- It is a free service (Toll-free number 14416).
- It is available 24/7 in 20 languages with over 1,900 trained counsellors.
- It can link to appropriate services and nearby healthcare facilities.
Nodal Centre: National Institute of Mental Health and Neuro Sciences (NIMHANS).
International Institute of Information Technology-Bangalore (IIITB) provides technology support.

eSanjeevani

eSanjeevani was launched by the Ministry of Health and Family Welfare in 2019.
It is a web-based teleconsultation service.
eSanjeevani platform has enabled two types of telemedicine services:
1. Doctor-to-Doctor (eSanjeevani) teleconsultation, and
2. Doctor-to-Patient (eSanjeevani OPD) Tele-consultations.
Doctor-to-Patient (eSanjeevani OPD) Teleconsultation was rolled out during the COVID pandemic.
It aims to provide healthcare services to patients in their homes.

National Institute of Mental Health & Neuro Sciences (NIMHANS)

It is an Institute of National Importance under the Ministry of Health and Family Welfare.
It provides psychosocial support and training through the (iGOT)-Diksha platform.

National Mental Health Programme

Under the District Mental Health Programme of the scheme, more than 1.73 lakh Sub-Health Centres, Primary Health Centres, urban PHCs, and urban health and Wellness Centres were upgraded to Ayushman Arogya Mandirs, which provide mental health services.

Ayushman Bharat – HWC Scheme

Mental health services have been added in the package of services under Comprehensive Primary Health Care under Ayushman Bharat – HWC Scheme.
Operational guidelines on Mental, Neurological, and substance use disorders (MNS) at Health and Wellness Centres (HWC) have been released under the ambit of Ayushman Bharat.

Kiran Helpline

It is a 24/7 toll-free helpline to provide support to people facing anxiety, stress, depression, suicidal thoughts, and other psychological health concerns.

Policy Recommendations on Mental Health

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.
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
Standardization of guidelines for mental-health services across government and private sector
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.