Prevalence of Mental Illnesses in India
Substance use disorders form the major chunk of the mental health burden of the country. The situation is aggravated by systemic factors and inequities along socioeconomic and regional lines. Despite the heavy caseload, the access to care for mental health issues is sporadic and skewed in favour of urban, high-income groups. Lack of awareness, the stigma around mental illnesses, prohibitive treatment costs and scarcity of healthcare facilities prevent 70-90% of mental health patients from receiving care.
The policy landscape in India reflects an emphasis on mental health. However, government initiatives are scattered and the lack of sufficient resource allocations and governance has led to a considerable gap in implementation. Private stakeholders, a crucial component in service delivery, are also seen to work in silos. Consequently, the democratisation of mental health care has emerged as an area for urgent action. Solutions under development seek to provide sustainable and comprehensive mental health care at the last mile. The strengthening of the primary health care system is an essential pathway to enable mental healthcare access to all. In particular, innovations that harness technology are being seen as key to enhancing the efficiency and reach of mental healthcare.
The current solution ecosystem indicates that models that have successfully integrated mental health with primary healthcare, operate within all levers of the continuum of care (CoC) and health-system pillars (HSP), and provide sustainable and comprehensive mental healthcare. Emerging process innovations have demonstrated effective delivery of care at a primary care level with the potential to scale and make it sustainable over time. In addition, product innovations harnessing technology, such as predictive analytics, self-care and telemental health applications, complement processes and present an opportunity to enhance efficiency and reach of mental health services to the last mile.
Challenges to Universal Access
Several challenges need to be overcome to achieve universal access to care. Mental health is allocated a meagre 0.7% of the entire health budget, which affects infrastructure development, resource management and training of mental health professionals. The inconsistent implementation and monitoring of existing initiatives such as the District Mental Health Programme form an additional impediment. Structural disparities further expose marginalised groups such as women, LGBTQIA+, and underprivileged castes to mental health risks. Migration due to climate change, man-made disasters and urbanisation add to the quantum of vulnerable populations. Proposed solutions, many of which are heavily reliant on technology, also need to navigate the ethics of tech-enabled care delivery, consent, and data privacy. Mental health treatment continues to demand high out-of-pocket expenditure, which calls for regulatory measures to include mental illnesses under insurance coverage.
Recommendations for Action
A multi-stakeholder approach is necessary to disrupt the prevalent siloed functioning for common mental health challenges. The alignment of mental health paradigms is an important starting point, which would enable the conceptualisation of mental health around common principles. Establishing a common nomenclature and defining universal concepts are essential to ensure consistency in service delivery at scale. Businesses and social enterprises have a crucial role to play in steering conversations with an inclusive orientation. Governments should undertake infrastructure-strengthening and capacity-building measures to provide a robust foundation for implementing solutions. Implementing organisations should ensure that solutions account for systemic inequities and also serve marginalised communities in low-resource settings. Philanthropy is particularly equipped to channel resources towards these areas of priority, thus ensuring the necessary support for democratising access to mental health for the larger population.
Authors: Yashasvi Murali and Disha Kouli with support from Anshika Singh, Suraksha Jain and Karthika Kumar
Data Analysis: Devlina Bhattacharjee, Arnab Mukherjee, Pragati Keswani, Veda Kulkarni, Manmath Agarwal and Gopinadh Lakkoju
Technical review: Lakshmi Sethuraman