Even though India’s Mental Healthcare Act 2017 is one of the most progressive legislations on mental health globally—it entitles people with mental illnesses to access comprehensive medical and social care from public health apart from safeguarding their other rights—on ground, mental health doesn’t seem a priority at all. Data from WHO show that, in 2014, India had just 0.3 psychiatrists per 100,000 population compared with Brazil’s 3.49, China’s 1.71 and the US’s 12.4. Psychologists working in the mental health space were fewer still—0.07 per 100,000 compared with Brazil’s 3.22 and the US’s 29.62. The findings of the just released report of the Lancet Commission on Mental Health bring India’s problem into even starker relief. In a country where nearly 7% of the population suffers from mental-health afflictions, 80% of those with mental or substance-use disorders don’t undergo any treatment for this. In terms of healthcare costs, lost productivity, etc, Lancet estimates a massive economic toll exacted by mental illness from the global economy—of nearly $16 trillion by 2030. By 2020, estimates are, 20% of the Indian population will be suffering from some form of mental illness or the other. This means India’s share—thanks to the sheer number of those will mental illness—will be much larger than many comparator economies. In 2016, the Economist Intelligence Unit had estimated that, by 2030, mental illness could knock off $11 trillion from the Chinese and Indian GDP taken together.
Writing in The Indian Express, Vikram Patel and Shekhar Saxena—lead editors of the Lancet Commission report—say, for many mental health indicators, India’s showing is on a par with some of the worst globally. Suicide is now the leading cause of death amongst the youth while WHO data shows that every 6th Indian suffers from depression, making it the most depressed country in the world. The policy response has been sporadic and inadequate. As a result, thousands of mentally ill persons are left without recourse—living under conditions of extreme insecurity, with under-nutrition and violations of their human rights rife. To treat such appalling neglect, the government needs to start with making mental health services a key part of universal health coverage. The Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana envisaging 1.5 lakh health and wellness centres across the country, where mental health will be a focus area, is a step towards this. Realising the vision, however, will require substantial investment in increasing the strength of mental healthcare professionals and building treatment facilities. Patel/Saxena recommend “more efficient use of existing resources”—in 2012-2013, for instance, only 42% of the budget for the National Mental Health Programme was used—by redistribution of healthcare spend where, instead of huge funding for large hospitals, the grant for mental health at district hospitals and community-based local services are increased. There is also a case to recognise emerging mental health concerns, such as digital-mediated isolation faster and develop the right public health response to it. The policy foundation for mental healthcare in the country is, no doubt, robust; it is implementation that will be key to avoiding the losses from neglected mental health that Lancet projects.