Addressing Mental Health Problems In India: Causes, Prevalence, Initiatives, And Challenges

Context: The Parliamentary Standing Committee on Health and Family Welfare submitted its report titled ‘Mental Health Care and Its Management in Contemporary Times’. The Committee noted that Mental Health Problems in India are rising, and seeks to examine the status of infrastructure, regulatory structure, and causes behind its prevalence.

What Defines Mental Health?

The World Health Organization (WHO) defines mental health as a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well, work well, and contribute to their community.
Mental health is an integral part of health; it is more than the absence of mental illnesses. It is the foundation for the well-being and effective functioning of individuals.

What Are the Primary Factors Influencing Mental Health Problems in India?

Biological Factors:

- Genetics: A family history of mental health disorders can increase the risk.
- Physical Health: Chronic illnesses and neurological conditions can impact mental well-being.

Psychological Factors:

- Early Life Experiences: Trauma, abuse, or neglect during childhood can contribute to mental health issues.
- Personality Traits: Certain personality characteristics may make individuals more susceptible to psychological health challenges.

Environmental Factors:

- Socioeconomic Status: Poverty, unemployment, and financial stress can affect mental health.
- Social Support: Strong social connections and a supportive network can buffer against.
- Exposure to Trauma: Experiencing violence, accidents, or natural disasters can have a profound impact.
- Access to Healthcare: Limited access to psychological healthcare services can hinder treatment.

Lifestyle Factors:

- Substance Abuse: Drug and alcohol abuse can exacerbate or trigger psychological health disorders.
- Diet and Exercise: A balanced diet and regular physical activity can contribute to better mental well-being.
- Sleep: Sleep disturbances and disorders can affect mood and cognitive function.
- Chronic Stress: Ongoing stress from work, relationships, or other sources can take a toll on psychological health.

Cultural and Societal Factors:

- Cultural Beliefs: Cultural norms and expectations can influence how psychological health issues are perceived and addressed.
- Discrimination: Experiencing discrimination or stigma related to race, gender, sexual orientation, or other factors can impact psychological health.

What Are the Primary Factors Influencing Mental Health in Schools?

Mental Health in Schools

What is the Prevalence of Mental Health Problems in India?

Mental Health Problems in India: According to the WHO Estimates:
- The burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 100 00 population; the age-adjusted suicide rate per 100 000 population is 21.1.
  - The disability-adjusted life year (DALY) measures the overall disease burden, expressed as the number of years lost due to ill health, disability, or early death.
  - The age-adjusted suicide rate is the number of suicides in a country in a year, divided by the WHO standard population and multiplied by 100,000.
- The economic loss due to psychological health conditions, between 2012-2030, is estimated at USD 1.03 trillion.
In 2017, an estimation of the burden of mental health problems in India for the states across India revealed that as many as 197.3 million people required care for psychological health conditions.
- This included around 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders.
- The situation has been exacerbated due to the COVID-19 pandemic, making it a serious concern worldwide.

What is the Current Status of Mental Health in Schools?

As per the National Mental Health Survey (NMHS) Conducted in 2015-16:
- The prevalence of mental disorders among children between ages 13-17 was 7.3% in both genders.
- Further, 26.8% of girls were getting married below the legal age, while 8% of girls between ages 15-19 were already mothers or pregnant.
- The survey also found that 37% of women between ages 15-24 have experienced physical, sexual, or emotional violence by their husbands— this includes children technically of school-going age.

According to statistics from the National Crime Records Bureau (NCRB):

- Since 2011, the number of suicides among students has steadily increased from 7696 students (2011) to 13,089 students (2021).
- For those below 18, 1408 cases saw illness cited as the reason for suicide; 58% of these illnesses were related to mental health.
- Other than this, 1495 cases listed ‘love affairs’ as the cause, and 864 listed ‘failure in exams.’

Must Read: NCRB Report 2022 On Crime In India

What Are the Key Challenges Hindering the Resolution of Mental Health Problems in India?

Challenges Faced by Patients

- Stigmatization: Mental health patients often refrain from seeking medical assistance due to the pervasive stigma surrounding their conditions. This can have a deep isolating psychological impact.
- Treatment Discontinuation: Sometimes treatment including counseling can take over a year. Also, these sessions are prohibitively costly, forcing patients to withdraw.

Inadequate Resources

- Hospital beds: India has only 1.43 hospital beds available for psychological health patients per 100,000 population, compared to a median of seven in low-income countries and 50 in high-income countries.
- Shortage of doctors: Estimates from WHO in 2017 show that India has only 0.15 psychologists per lakh while the requirement is three psychiatrists per lakh.
- Inadequate training to doctors: There is a range of mental illnesses that need to be identified and treated, however, training of doctors is not commensurate with the demands of the job.
- Resources at Primary Health Cares (PHCs): The supply of medication at the PHCs level may be irregular and inadequate given the range of illnesses.
- Rehabilitation facilities: There is a dearth of rehabilitation facilities in India’s landscape of mental well-being services.

Administrative Shortfalls

- Lack of coordination: Given that psychological health involves both medical treatment and social welfare, there is an overlap between the two key ministries, yet enough intersectoral coordination may be missing.
- Underutilisation of funds: For example, less than 40% of funds allocated to states from 2015 to 2020 under the District Mental Health Program were utilized.
- Regional disparity: Due to inadequate resources in rural and remote areas, many psychological health professionals are reluctant to work in rural areas.

What Government Initiatives Are in Place for Addressing Mental Health Problems in India?

National Mental Health Program (NMHP)

- The Government of India launched the National Mental Health Program (NMHP) in 1982, with the following objectives:
- To ensure the availability and accessibility of minimum psychological health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population;
- To encourage the application of psychological health knowledge in general healthcare and in social development; and
- To promote community participation in the psychological health service development and to stimulate efforts towards self-help in the community.

The District Mental Health Program (DMHP)

- It was launched under NMHP in 1996 (in IX Five Year Plan). The DMHP was based on the ‘Bellary Model’ with the following components:
- Early detection & treatment.
- Training: imparting short-term training to general physicians for diagnosis and treatment of common mental illnesses with a limited number of drugs under the guidance of specialists. The Health workers are being trained in identifying mentally ill persons.
- IEC: Public awareness generation.
- Monitoring: the purpose is for simple Record Keeping.
Mental Health Care Act 2017
- It was enacted to provide better mental health care and protect the rights of individuals with mental illness. Key provisions include:
- Rights of Individuals: The Act guarantees the right to access psychological healthcare and treatment for individuals with mental illness.
- Advance Directives: It allows individuals to make advance directives regarding their treatment preferences.
- Decriminalization: The Act decriminalizes suicide and prohibits the use of electroconvulsive therapy without anesthesia.
- Psychological Health Review Boards: It establishes psychological health Review Boards to safeguard the rights of individuals with mental illness.
- Insurance Coverage: It mandates insurance companies to provide coverage for psychological health treatment.
- Psychological Health Facilities: The Act promotes the establishment of psychological health services and facilities.
- Prohibition of Inhuman Treatment: The Act prohibits the use of seclusion and chaining of mentally ill individuals.
Tele Mental Health Assistance and Networking Across States (Tele-MANAS) initiative:
- It was launched by the Ministry of Health & Family Welfare in October 2022.
- It aims to provide free tele-mental health services all over the country round the clock, particularly catering to people in remote or under-served areas.

What Government Programs Focus on Enhancing Mental Health Specifically Among School Children?

School Health Program (2018): Launched under the Ayushman Bharat scheme, this program has a broad focus, including screening children’s health, conducting classroom activities on health and wellness, and organizing thematic school assemblies.
- The program promotes activities like meditation and yoga, bullying prevention, internet safety and media literacy, prevention of substance abuse, and violence and psychological health awareness.
- Coordination committees at the block, district, State, and national levels have been tasked with the implementation of the program.
Teacher and Counselor Training: In 2022, the Union Health Ministry issued a handbook for schools to train teachers, and counselors to identify, detect, and intervene in cases of psychological health issues.
Manodarpan Portal: Launched during the COVID-19 pandemic, it provides guidelines, FAQs, posters, and videos for support to students facing psychosocial issues, loneliness, and withdrawal behavior.
NCERT Counseling Services: The National Council of Educational Research and Training (NCERT) offers free counseling services for children, employing 270 counselors across regions to address mental health issues among students through live interactive sessions.
Kiran Helpline: The Ministry of Social Justice and Empowerment has launched a 24/7 toll-free helpline ‘Kiran’ to provide support to people facing anxiety, stress, depression, suicidal thoughts, and other psychological health concerns.

What Are the Predominant Issues Undermining the Effectiveness of India’s School Mental Health Programs?

Inadequate Manpower: As per the World Mental Health Atlas (2017), India had 0.29 psychiatrists per lakh population (plp) and zero child plp.
- Among other professionals, there were 0.8 mental health nurses plp and 0.07 psychologists plp.
- In total, there were only 25,312 psychological health professionals in India, with only 49 child psychiatrists, as of 2017.
Lack of Nationwide Structure: Despite a school health Program under the NMHP, there is no comprehensive, uniform SMHP to deal with the psychological health and well-being of all school children uniformly across the nation.
Exclusion of Key Stakeholders: Such as non-governmental organizations (NGOs), private hospitals, psychological health research facilities, and pharmaceutical companies in implementing a nationwide SMHP.
Insufficient Funding: As per the World Mental Health Atlas (2017), the Indian government spends only 1.3% of its health expenditure on psychological health.

What Measures Can Bolster the Overall Mental Health Landscape in India?

WHO’s “World Mental Health Report: Transforming Mental Health for All” suggests a three-path approach for transformation:
- Deepen the value given to psychological health by individuals, communities, and governments; and matching that value with commitment, engagement, and investment by all stakeholders, across all sectors.
- Reshape the physical, social, and economic characteristics of environments – in homes, schools, workplaces, and the wider community – to better protect psychological health and prevent psychological health conditions; and
- Strengthen psychological healthcare so that the full spectrum of psychological health needs is met through a community-based network of accessible, affordable, and quality services and supports.
Promoting Psychological Health Literacy: Launching awareness programs plays a pivotal role in destigmatizing psychological health interventions.
- Insufficient awareness often leads to the misjudgment or dismissal of signs that someone needs assistance, as well as stigmatization of those who seek help.
- Furthermore, it is essential to challenge the misconception that psychological health merely entails the absence of mental illness.
Affordability Measures: Regulating the costs of counseling sessions and refining underwriting norms in insurance policies, particularly concerning outpatient expenses, disease classification, and pre-existing conditions, requires attention.
Administrative Reforms:
- Bottom-Up Approach: A psychological health care system inspired by the reproductive and child health model, beginning with services at the village level and extending to tertiary hospitals, is essential.
- Improved Intersectoral Coordination: Enhancing coordination between the psychological health and social welfare departments of the government is imperative.
Transitioning from Institutions to Communities: To promote community-based rehabilitation, India should strengthen outpatient services and establish daycare centres.

How Can the Mental Health Ecosystem for School Children in India be notably improved?

UNICEF’s Framework: As per the United Nations International Children’s Emergency Fund (UNICEF), any mental health Program in schools must include five pillars of support:
- an enabling learning environment,
- access to early intervention and psychological health services,
- teachers’ well-being,
- targeted mental health Programs using educational workforce in national, state, and local levels, and
- meaningful collaboration between school, family, and community.
NITI Aayog is planning to set up a comprehensive school healthcare Program: The Program will cover students in both government and private schools via policy intervention to existing health promotion and disease prevention measures under the Ayushman Bharat scheme.

What Key Recommendations Did the Parliamentary Standing Committee Propose for Enhancing the Mental Health Ecosystem in India?

Rapidly undertake the subsequent round of the psychological health survey to assess the pandemic’s impact and address increased risks promptly.
Initiate mental health education and counseling programs targeting children and adolescents, focusing on urban areas and vulnerable populations.
Implement a 24×7 helpline for distressed students and enhance surveillance systems to understand and mitigate suicide causes.
Strategically increase psychological health professionals, particularly psychiatrists, and expand MD Psychiatry course capacities to bridge the critical gap.
Strengthen primary and secondary psychological health services by integrating community-based care, emphasizing accessibility, early intervention, and holistic support.
Urgently fill vacancies in state-level Mental Health Authorities and establish mental Health Review Boards to ensure compliance with the Mental Healthcare Act, 2017.

Do You think that Social Media is one of the Reasons for Rising Mental Health issues? If Yes, What Are the Reasons For It?

Yes, social media is considered one of the factors contributing to rising mental health issues. Several reasons contribute to this phenomenon:

Social Comparison: Social media often presents an idealized version of people’s lives, creating a constant comparison culture. Users may feel inadequate when comparing their lives to the seemingly perfect lives of others, leading to feelings of low self-esteem and anxiety.
Cyberbullying: The anonymity and distance provided by social media can lead to cyberbullying, which can have severe consequences on the psychological health of victims. The constant threat of online harassment can contribute to anxiety, depression, and other psychological health issues.
Fear of Missing Out (FOMO): Social media platforms often showcase social events, achievements, and experiences. The fear of missing out on these activities can lead to feelings of isolation and inadequacy among those who are not part of such events.
Negative Impact on Body Image: Social media is filled with images promoting certain beauty standards. Exposure to such images can negatively impact body image and contribute to the development of eating disorders and body dysmorphia.
Addiction and Social Isolation: Excessive use of social media can lead to addiction, with individuals spending significant amounts of time online. This can contribute to social isolation, as real-world interactions are replaced by online engagements.

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Addressing Mental Health Problems in India: Causes, Prevalence, Initiatives, and Challenges

What Defines Mental Health?

What Are the Primary Factors Influencing Mental Health Problems in India?

Biological Factors:

Psychological Factors:

Environmental Factors:

Lifestyle Factors:

Cultural and Societal Factors:

What Are the Primary Factors Influencing Mental Health in Schools?

What is the Prevalence of Mental Health Problems in India?

Mental Health Problems in India: According to the WHO Estimates:

What is the Current Status of Mental Health in Schools?

As per the National Mental Health Survey (NMHS) Conducted in 2015-16:

According to statistics from the National Crime Records Bureau (NCRB):

What Are the Key Challenges Hindering the Resolution of Mental Health Problems in India?

Challenges Faced by Patients

Inadequate Resources

Administrative Shortfalls

What Government Initiatives Are in Place for Addressing Mental Health Problems in India?

National Mental Health Program (NMHP)

The District Mental Health Program (DMHP)

Mental Health Care Act 2017

Tele Mental Health Assistance and Networking Across States (Tele-MANAS) initiative:

What Government Programs Focus on Enhancing Mental Health Specifically Among School Children?

What Are the Predominant Issues Undermining the Effectiveness of India’s School Mental Health Programs?