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1.Introduction
The World Health Organisation (WHO) defines mental health as a positive sense of well being encompassing the physical, mental, social, basic economic, and spiritual aspects of life, not just the absence of disease. Mental health is a significant global issue, and India also faces its share of challenges in this regard. However, when assessing progress in the field of mental health, it seems to have been slow. In 1954, Dr. Brock Chisholm, the inaugural Director-General of the World Health Organization (WHO), astutely stated that genuine physical health cannot exist without mental well-being.
Understanding mental health requires acknowledging its multidimensional nature. It is influenced by a combination of biological, psychological, and social factors. Genetics, brain chemistry, life experiences, and socio-cultural environment all contribute to an individual's mental well-being. It is a complex interplay of these factors that determines an individual's mental health status. The importance of mental health is not limited to the absence of mental illness. It encompasses the ability to cope with life's challenges, maintain fulfilling relationships, adapt to change, and realize one's potential. Investing in mental health is not only a matter of individual well-being but also contributes to societal productivity, economic growth, and social cohesion.
According to the National Mental Health Survey conducted in 2015-2016, it was estimated that nearly 15% of the Indian population (around 150 million individuals) was in need of active mental healthcare interventions. This survey revealed a high prevalence of mental disorders such as depression, anxiety, and substance abuse. The National Mental Health Survey also found that only about 10-12% of people with mental health disorders in India received adequate treatment. Limited availability of mental health professionals, low awareness, and stigma contribute to this treatment gap.
Mental Health is undoubtedly a vital resource for a nation's development, and its absence represents a great burden to the economic, political, and social functioning of the nation.
2.Impacts of poor mental health
2.1Economic impacts:
Reduced workforce productivity:
Poor mental health can lead to decreased work productivity and increased absenteeism in the workplace. A World Health Organization (WHO) study found that mental health issues in India lead to a 6% reduction in GDP due to decreased productivity. WHO also estimates that the economic loss to India on account of mental health disorders is about US$ 1.03 trillion.
Further, Deloitte's 2022 survey titled, “Mental health and well-being in the workplace”
examined mental well-being among Indian employees, involving nearly 4,000 participants. It revealed that workplace stress is the primary factor affecting mental health for 47% of professionals, followed by financial and COVID-19 challenges. The report estimated that "poor mental health amongst employees costs Indian employers around USD 14 billion per year due to absenteeism, presenteeism (attending work while in mental stress, hence, leading to low productivity) and attrition".
Increased healthcare costs:
Treating mental health conditions can be expensive and time consuming, and the burden of it falls both on the country and individual. The cost of treatment can strain the resources of the individual, compelling them to deplete their savings, resulting in limited resources remaining at their disposal.
Mental disorders place a considerable economic burden on those suffering from them – the NMHS (2015-16) revealed that the median out-of-pocket expenditure by families on treatment and travel to access care was Rs. 1,000-1,500 per month.
Unemployment and poverty:
The relationship between poverty and mental health is bidirectional. Poverty can contribute to the development of mental health issues, and mental health problems can further exacerbate poverty.
The World Health Organization (WHO) estimates that around 264 million people worldwide suffer from depression, which is a common mental health condition associated with unemployment. Further, according to the World Economic Forum, mental health disorders cost the global economy $1 trillion in lost productivity each year.
Social stigma and discrimination:
Stigma towards and discrimination against people with mental disorders is an important barrier to mental health service utilization in India. It contributes to delay in seeking care; impedes timely diagnosis, treatment, recovery, and rehabilitation; and ultimately reduces the opportunity for fuller participation in life and impedes political efforts to prioritize mental health policies.
A recent study conducted by The Live Love Laugh Foundation (2019) in India examined public perceptions of individuals with mental illness. The findings revealed that a significant portion of respondents believed it was necessary to maintain distance from individuals experiencing depression, with approximately 26% expressing fear. Only a minority of those surveyed (27%) demonstrated support for individuals with mental illnesses, specifically young adults with lower educational levels and from lower socioeconomic backgrounds. The prevailing belief among respondents was that lack of self-discipline and willpower were primary reasons for mental illness, while some believed that mental illness was limited to individuals deemed "mentally weak."
Addressing and overcoming social stigma requires a combination of political will and advocacy efforts aimed at promoting awareness and destigmatization.
2.2Social Impacts:
Social exclusion:
It is a distressing reality for individuals grappling with mental health conditions, as they often encounter discrimination that results in their isolation from society. This exclusionary treatment can have detrimental effects, intensifying their mental health challenges and diminishing their overall well-being and quality of life. The World Health Organization (WHO) estimates that around 25% to 40% of individuals with mental health conditions worldwide face some or the other form of stigma or discrimination.
Educational Disruption:
Mental health problems can interfere with educational attainment and academic performance. Students with mental health conditions may face difficulties in concentration, learning, and social interactions, affecting their educational outcomes and future prospects. A large body of literature has demonstrated a strong link between mental health concerns and school outcomes. children who experience mental health concerns are at an increased risk for aversive long-term academic outcomes, including increased dropout rates in both elementary and secondary schools (Breslau, Lane, Sampson, & Kessler, 2008), decreased likelihood of post-secondary enrolment (McLeod & Kaiser, 2004). Further, among students who do not complete high school in the USA, over 20% prematurely end their education because of early-onset psychiatric disorders—with mood disorders being the most common.
3.Factors contributing to poor mental health in India
3.1Inadequate funding
Mental health receives insufficient funding compared to other healthcare sectors. The National Mental Health Program (NMHP) in India has historically received minimal financial resources, leading to limited availability of mental health services, especially in rural areas. This lack of funding hampers the development of infrastructure, human resources, and research in the field of mental health. The rest of the world spends about 5% to 18% of their GDP on mental health, whereas India spends only 0.05% of its GDP.
In the budget for the Ministry of Health and Family Welfare (MoHFW) for the year 2021-2022, only a small portion of 0.81% of ₹73,931.8 crore is allocated specifically for mental health. In contrast, countries like the USA allocate 6% of their total health budget to mental health, the UK allocates 13%, and Australia allocates approximately 7%.
3.2Shortage of Mental health professionals
According to the Mental Health Atlast 2017 of the World Health Organization (WHO), India (per 100,000 population) has (0.3) psychiatrists, (0.15) mental health nurses and (0.07) psychologists, while the desirable number is anything above 3 psychiatrists and psychologists per 100,000 population. This scarcity limits access to quality mental healthcare.
3.3Stigma and discrimination
Deep-rooted societal stigma surrounding mental health remains a significant barrier. Many individuals with mental health conditions face discrimination, prejudice, and social exclusion. The stigma associated with mental illnesses often leads to delayed help-seeking and inadequate support for affected individuals.
Stigma is inversely associated with help seeking from formal healthcare services which worsens the prognosis and perpetuates the misperception of Mental health disorders as incurable.(Clement et al., 2015; Stuart, 2016) in low-and-middle income countries, over 75 percent of people that require mental healthcare do not receive any kind of intervention, compared with a “treatment gap” of only 35 %–50 % in developed countries.(Mascayano et al., 2015)
3.4Limited awareness and education
There is a lack of awareness and understanding about mental health in India. This contributes to the perpetuation of stigma, as well as misconceptions about mental illnesses. Education on mental health and well-being is inadequate in schools and communities, further hindering early recognition and intervention. Inaccurate media depictions of mental health and mental health professionals lead to misconceptions among the general population, impeding their ability to form accurate perceptions and judgments.
3.5Insufficient rural focus
While urban areas have relatively better access to mental health services, rural areas face significant challenges. There is an urban-rural divide in mental health infrastructure, awareness, availability of trained professionals and clinics. Addressing these problems requires a multi-faceted approach, including increased investment in mental health services, expansion of the mental health workforce, awareness campaigns to combat stigma and integration of mental health into primary healthcare.
4.Government Initiatives
1. Mental Health Act, 2017: The National Mental Health Survey quoted prevalence of 13.7% lifetime and 10.6% current mental morbidity. To address this mammoth problem, an aspirational law was enacted titled “Mental Healthcare Act, 2017” (MHCA 2017).
The act focuses on protecting the rights of individuals with mental illness and providing accessible mental healthcare services. Chapter 5 ensures access to various facilities and services, with provisions for compensation if services are unavailable. It also safeguards confidentiality, promotes community living, prohibits certain treatments like ECT without anesthesia, and reduces the use of Section 309 IPC (punishment for attempting suicide)
2. 24/7 toll free KIRAN Helpline under Ministry of social justice, provides support to people facing anxiety, stress, depression, suicidal thoughts and other mental health concerns. The helpline was launched as part of the Mental Health Rehabilitation Helpline initiative under the Mental Health Act of 2017.
3. Manodarpan under the Ministry of Education to provide psychosocial support to students, family members and teachers for their mental health and well-being during the times of Covid-19. The primary objective of Manodarpan is to promote mental well-being, emotional
resilience, and psychological support in the educational system. It recognizes the importance of addressing mental health issues and their impact on learning outcomes and overall development.
4. Tele Mental Health Assistance and Networking Across States (Tele-MANAS):
It is an initiative under the National Tele Mental Health Programme (NTMHP) (announced in the Union Budget 2022-23) aimed to provide free tele-mental health services all over the country.
5. National Mental health program (NMHP): The program includes activities such as awareness campaigns, training of healthcare professionals, establishment of mental health clinics, and community-based rehabilitation services. Its goal is to reduce the treatment gap for mental health disorders and ensure better mental health outcomes for individuals.
6. National Suicide Prevention Strategy: It is launched by Ministry of Health and Family Welfare in line with WHO’s South East-Asia Region Strategy for suicide prevention strategy. Its first of its kind in the country, with time-bound action plans and multi-sectoral collaborations to achieve reduction in suicide mortality by 10% by 2030.
5.Recommendations for Action
5.1Increasing mental health awareness
5.1.1 Media
Media can act as a cornerstone for action on mental health awareness. Celebrity disclosures of mental health conditions are seen as potentially positively influencing health behaviors such as help-seeking and changing public attitudes towards people with mental health conditions (Corrigan et al., 2014; Lee, 2019). In recent years, a number of well-known people globally have made such disclosures, including television and film actors, musicians, politicians and athletes. This includes internationally famous singers Lady Gaga, Adele, Serena Williams, Hollywood and Bollywood films stars such as Dwayne ‘The Rock’ Johnson and Deepika Padukone, TV stars Oprah Winfrey. Reflections of people affected by stigma have indicated that media portrayals of mental illness and celebrity disclosures can be perceived to have an impact on the general acceptance of people with mental health conditions and can reduce publicstigma (Chung et al., 2019).
On the other hand, the media may contribute to mental illness stigma through the exaggerated, inaccurate, and comical images they use to portray persons with psychiatric disorders as well as providing incorrect information about mental illness.
Henceforth, the paramount significance lies in the cultivation of a well-informed and meticulously researched media portrayal, for it is this very construct that molds the perceptions and beliefs of the multitudes at large. Creating safe spaces for individuals to freely express themselves is crucial. Moreover, journalists can form partnerships with mental health professionals to ensure reporting that is both evidence-based and sensitive. India can draw valuable lessons from established, enduring anti-stigma campaigns like 'Time to Change' in the UK, 'Opening Minds' in Canada, and 'Beyond Blue' in Australia. These initiatives have shown noteworthy progress in challenging mental health stigma and generating positive transformations. (Time-to-change, 2020)
5.1.2 Education system
Including mental health narratives in curricula is a powerful approach to destigmatize mental health, remove discrimination, enable early detection, and empower stakeholders for simple interventions. The educational system presents numerous opportunities for enhancing mental health awareness.
5.1.3 Parental Involvement
Organize workshops and awareness programs specifically designed for parents, helping them understand and support their children's mental health.
Example: Mental health professionals can collaborate with Parent-Teacher Associations (PTAs) to organize seminars and interactive sessions on parenting approaches that promote positive mental health. These workshops can provide parents with knowledge about common mental health issues, signs to look out for, and strategies to support their children's well-being.
5.1.4 Teacher Training Programs
Conduct specialized training programs for teachers to enhance their understanding of mental health issues and equip them with the skills needed to support students' well-being.
Example: National Institute of Mental Health and Neurosciences (NIMHANS) can organize workshops and training programs for teachers, focusing on mental health awareness, identification of warning signs, and implementation of effective support strategies. These programs can help teachers create a nurturing classroom environment, recognize potential mental health challenges among students, and provide appropriate support or referrals.
By incorporating mental health narratives into curricula, parental involvement, and specialized teacher training programs, the educational system in India can significantly contribute to destigmatizing mental health, removing discrimination, enabling early detection, and empowering stakeholders to address mental health concerns effectively.
5.1.5 Research and Data Collection
Encourage research studies on mental health issues in India to generate data and evidence for informed decision-making and policy development.
Example: Government agencies can collaborate with research institutions to conduct national surveys on mental health prevalence, risk factors, and barriers to access mental health services.
5.2Enhancing mental health infrastructure
Enhancing mental health infrastructure in India is crucial for providing accessible and quality mental health services to the population.
5.2.1 Increased mental health facilities
Invest in development of mental health facilities, human resource capacity building like psychiatric hospitals, outpatient clinics, community based centers etc. This would help increase the availability of mental health services in underserved areas.
5.2.2 Integrating mental health services
While most government programs remain isolated and confined to urban areas, it's absolutely necessary to integrate mental health with primary health care services so that it reaches the last mile.
5.2.3 Telepsychiatry and Digital solutions
Using technology to expand access to mental health services.
Example: The Tele Mental Health Assistance and Networking Across States (Tele-MANAS) initiative should be implemented with full vigor to increase accessibility of mental health services all over India.
5.2.4 Community based mental health care
By leveraging the strengths of communities, it facilitates access to culturally sensitive care, reduces stigma, and empowers individuals and families to navigate their mental health concerns. Further, using the existing system of Accredited Social Health Activists (ASHAs) and Aanganwadi workers can help leverage their existing community connections, reach and trust to extend mental health services.
5.3 Increasing financial aid to the mental health
The current status of mental health funding in India indicates a significant gap between the resources required and the actual allocation. According to the National Mental Health Survey conducted in 2015-2016, India's total mental health budget was less than 1% of the total health budget, significantly lower than other countries.
Example: UK allocates approximately 13% and Australia allocated about 7% of their total health budget to mental health. Further, in 2019, New Zealand introduced the Wellbeing Budget, which aimed to address mental health issues as a priority. The budget allocated a substantial amount of funding towards mental health services, including initiatives such as free counseling for young people, additional school nurses, and increased access to mental health support in primary care.
To bridge the gap it is imperative for the Indian government to increase budgetary allocations, aiming for equitable resource allocation and bringing the funding closer to the recommended global benchmark.
5.4Collaborations and Partnerships
Collaborating with global institutes and countries allows for exchange of knowledge and best practices. This can help India stay updated on the latest advancements, evidence based interventions and innovative approaches to address mental health challenges.
Further, foreign partnerships can also help in research collaborations, capacity building and enhancing skills and knowledge of mental health professionals in India, enabling them to provide better professional support to people.
6.Conclusion
As the research on mental health continues to evolve, it is essential to remain committed to ongoing research, knowledge dissemination, and evidence-based practices. By integrating research findings into policy development and healthcare delivery, we can make significant strides in improving mental health outcomes and promoting a society that values and supports mental well-being. Further, by investing in mental health promotion, prevention, and intervention, we can foster resilience, enhance individual functioning, and create supportive environments that empower individuals to lead fulfilling lives.
Ultimately, our collective efforts to address mental health challenges and promote mental well-being can contribute to a brighter future, where individuals thrive, communities flourish, and stigma surrounding mental health is eradicated.
Meet The Thought Leader
Vamsi is a mentor at GGI, and has a diverse background that includes being a former McKinsey employee and a graduate of IIT Madras. He possesses a broad skill set encompassing strategy and operations, gained from his various roles and industry exposure.
Meet The Authors (GGI Fellows)
Aarushi holds a Masters degree in Applied Psychology from Delhi University and is also a five-time national level football player. Her diverse range of interests includes immersing herself in the pages of non-fiction books, pursuing thrilling adventure sports, and photography. She is passionate about research and is continuously acquiring new skills to prepare for her future career endeavours.
If you are interested in applying to GGI's Impact Fellowship program, you can access our application link here.
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