Report on mental disorders underlines need for accessible, affordable care in India

A new report on mental health shows that one in seven people in India suffers from a mental health disorder. Experts say this underlines the importance of providing accessible and affordable mental health care.

Depression, anxiety disorders, schizophrenia, bipolar disorders, and conduct disorders are just among the few mental disorders to show a significant rise in India. This is according to the Global Burden of Disease (GBD) India Mental Disorders paper released by the Indian Council of Medical Research (ICMR). The study tracks mental disorders and their trends in all states from 1990 t0 2017.

Mental disorders in India growing

“The prevalence of adult mental disorders is higher in the southern states and that of childhood onset mental disorders is higher in the north”, said Professor Balram Bhargava, Director General, ICMR. “Further research should continue to track the changing trends of mental disorders”.

Key findings of report on mental health in India

• Mental disorders were the leading contributor in India to years lived with disability.
• Depression contributed to 33.8% of all mental disorders in 2017 followed by anxiety disorders, idiopathic developmental intellectual disability and schizophrenia.
• Significant association between prevalence of depression and suicide death rate at the state level.
• Depression, anxiety disorders, and eating disorders are significantly higher among females. Prevalence of conduct disorder, autism spectrum disorders, and ADHD is higher among boys.

“These numbers have been predicted for a while, so it doesn’t come as a surprise”, says Rajvi Mariwala, Director, Mariwala Health Initiative (MHI). MHI is working toward creating a community-based, nationwide mental health ecosystem.

The most alarming issue is that persons with mental illness who require mental health care either do not have accessible services, or those receiving services cannot access quality care that is affordable, easily available, and acceptable. It has an extreme shortage of mental health workers — as low as one mental health professional for 100,000 people. – Rajvi Mariwala, Director, Mariwala Health Initiative

The revised Mental Health Act 2017 mandates that mental disorders be covered under health insurance schemes. Only 19 states have formed a board in compliance with the regulations. Given its impact on quality of life and the economic burden, mental health care needs urgent priority. The World Health Organization estimates that India’s losses due to mental health conditions between 2012 and 2030 is over one trillion dollars.

Inadequate infrastructure to treat mental health patients

In this scenario, there is a critical need for awareness and building healthcare infrastructure. “The conversation must shift from availability of psychiatrists to immediately increasing capacity – to psychiatric nurses and psychiatric social workers and psychologists as well as trained community mental health workers”, says Rajvi. “The focus of the State has been centred on a ‘medical’ model of care with a focus on medication and institutionalisation”.

Dr Santosh K Chaturvedi, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, believes the revised Act has helped overcome some of the stigma. “The Act is more theoretical, but it has done a lot because the ancient stigmatising terminology has been changed. There is also more awareness of the rights of a person with mental illness. Facilities in institutions have been upgraded as well”.

Dr Chaturvedi says there is a need to sensitise GPs and family doctors regarding mental illness. “We have found that people with depression and anxiety tend to go to their GPs or family doctors and not necessarily a psychiatrist. What needs to be reinforced is sensitising and training these doctors to treat milder cases. Not everyone needs an expert”.

Above all, there needs to be greater political will. “We are unable to see how the new Act works on the ground due to political inertia”, points out Rajvi. Appointing State Mental Health Authorities would be crucial to understand the ground realities. “This will also help build systems of accountability and increase resources to ensure effective implementation of the Act”.

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