Addressing

mental
health in
India
Addressing mental health in India
ISBN 978-92-9021-017-7
© World Health Organization
2022
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Printed in India
Addressing
mental
health in
India
Prepared for the Ministerial Roundtable of the 75th
Session of the WHO Regional Committee for South-East
Asia
6th September 2022
2 Addressing mental health in India

28 States and 8 Union Territories,

750 Districts
1.37 billion (2019)
Population

69.7 (2019)
Life-expectancy

2120 (2019)
Gross National Income per capita, Atlas method (current
US$)

67 (2019)
UHC coverage index

Govt health expenditure

3.01 (2019)
As a % of GDP

63.75 (2019)
Gross National Income per capita, Atlas method (current
US$)

For each 100,000 population

92.8 (2019)
Doctors

232.9 (2019)
Nurses and midwives

58.1 (2016)
Community health workers

289.4 (2017)
Source: World Bank https://data.worldbank.org/ - accessed on 10th June 2022
Hospital beds
World Health Organization 3

The burden of mental

health problems
Prevalence

The overall weighted prevalence of mental morbidity for those over 18 years of age was 10.6%
and 13.7% for lifetime prevalence.

Lifetime prevalence (by ICD 10 classification)

• Schizophrenia and psychotic disorders (F20–F29) 1.4%

• Depressive disorders (F32–F33) 5.1%

Current prevalence (by ICD-10 classification)

• Epilepsy (Generalized Tonic-Clonic Seizures) 0.3%

• Schizophrenia and psychotic disorders (F20–F29) 0.4%

• Depressive disorders (F32–F33) 2.7%

• Bipolar (affective) disorder (F30–F31) 0.3%

• Neurotic and stress-related disorders (F40–F48) 3.5%

• Alcohol use disorder (F10) 4.6%

• Other substance use disorders (F11–F19 except F17) 0.6%

Intellectual Disability (ID) screener positivity rate: 0.6%

The National Suicide incidence rate per 100,000 was 10.6 (male 14.3, female 7.2)

Source: National Mental Health Survey of India, 2015-16: Prevalence, Pattern and Outcomes. National Institute of Mental Health and
Neuro Sciences 2016

• The prevalence of mental health conditions (1.14%) compared males (0.66%), those
was higher among males (13.9%) than living in urban metros (1.71%) and those
females (7.5%). However, mood disorders between the ages of 40–49 years.
were higher among women. Males in the
• The prevalence of mental health disorders
age group of 30–49 years were the most
affected by mental illnesses. in the age group of 13–17 years was
7.3% and similar among boys and girls.
• Residents of urban metros had a greater Depressive disorders were the commonest
prevalence of mental disorders and persons conditions. Nearly 9.8 million young Indians
from lower income quintiles had a greater aged between 13 and 17 years were in
prevalence of one or more mental disorders. need of active interventions. The prevalence
was significantly higher (13.5%) in urban
• Of those over 18 years, 0.9% was at high metros compared to rural areas (6.9%) in
risk and 0.7% at moderate risk of this age group.
suicide. The highest-risk groups
were females
4 Addressing mental health in India

Treatment gap
• The treatment gap for all types of mental health problems ranged from 28% to 83%. It
was 85.2% for common mental disorders, 75.5% for psychoses, 70.4% for bipolar
affective disorders and 86.3% for alcohol use disorder.

• The median duration for seeking care from the time of onset of symptoms differed from
2.5 months for depressive disorder to 12 months for epilepsy. A government facility was
the commonest source of care.

Source: National Mental Health Survey of India, 2015-16: Prevalence, Pattern and Outcomes.
National Institute of Mental Health and Neuro Sciences 2016.

Mental health
policies, programmes
and laws
• The National Mental Health Policy • The Mental Healthcare Act 2017, has
(NMHP) 2014 calls for universal access provisions for mental health care and
to quality services, equitable distribution, services for persons with mental illness
community participation, a rights-based and for protecting, promoting and fulfilling
approach, intersectoral coordination, use the rights of such persons during delivery
of appropriate technology, and a holistic of mental health care and services. The
approach to mental health. It is fully national rules for implementation of the
implemented, and its principles have been Act have been endorsed. Further, states
incorporated in the NMHP/DMHP (National are in the process of developing their own
and District Mental Health Programmes), rules, drawing from the national rules.
and Mental, Neurological and Substance It safeguards the rights of persons with
Use (MNS) package at health and wellness mental illnesses, decriminalizes suicide
centres (HWCs) operating at the primary and regulates electroconvulsive therapy.
care level. Elements of mental health promotion can
be included as appropriate.
World Health Organization 5

Prevention and
promotion:
organization and
coverage
• To generate awareness of mental illnesses, age for 4 D’s – Defects at birth,
information, education and communication Diseases, Deficiencies and Development
(IEC) activities are already an integral delays, spanning 32 common health
part of the NMHP. Posters and videos to conditions for early detection and free
generate awareness of mental health, treatment and management. These
and advisories for promotion of mental include surgeries
well-being are periodically released on at the tertiary level. Mental health and
the Ministry of Health and Family Welfare neurological conditions are identified (1).
(MoHFW) website and social media Children diagnosed with identified
handles. selected health conditions are provided
• At district level, funds up to INR 400 000 early intervention services and follow-up
per annum are provided to each district for care at the district level.
IEC and awareness generation activities • Preventing bullying: the School Health
in communities, schools and workplaces, Programme under Ayushman Bharat – a
with community involvement. Under the joint initiative of the MoHFW and Ministry of
District Mental Health Programme (DMHP), Human Resource and Development – takes
various IEC activities such as messages to care of this aspect. Prevention of bullying
generate awareness in local newspapers is included under school health promotion
and the radio, street plays, wall paintings, activities (2).
etc. are undertaken by the states/Union • The Ministry of Human Resource, in
Territories (UTs). Since public health is a collaboration with Ministry of Health, is
state subject, details of specific activities implementing the School Health Programme
may be requested from the states. under Ayushman Bharat.
• Early childhood and good parenting: • The Ministry of Social Justice and
the Rashtriya Bal Swasthya Karyakram Empowerment has schemes to address
(RBSK), under the National Health Mission, alcohol and other psychotropic substance
screens children from birth to 18 years of addiction.

1.Rashtriya Bal Swasthya Karyakram (RBSK). In: Ministry of Health and Family Welfare, Government of India [website]
(https://rbsk. gov.in/RBSKLive/, accessed 20 August 2022).
2.Operational guidelines on school health programme under Ayushman Bharat. New Delhi: MoHFW and Ministry of Human
Resource and Development; 2018 (https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/AH/guidelines/
Operational_guidelines_ on_School_Health_Programme_under_Ayushman_Bharat.pdf, accessed 20 August 2022).
6 Addressing mental health in India

Mental health
services:
organization and
coverage
• The Mental Health Division, Ministry of
Health and Family Welfare (MoHFW) at
the national level, Mental Health Division
of the MoHFWs of state governments
at the state level and the District Mental
Health Programme (DMHP) govern mental
health services. However, on occasion,
the responsible officers are entrusted with
responsibilities to run multiple programmes,
thus they are not able to give focused
attention to mental health.
• The DMHP component of the NMHP has
been sanctioned for implementation in
704 out of 750 districts for which support
is provided to all states/UTs through the
National Health Mission.
• Facilities made available under the DMHP
include outpatient services, assessment,
counselling/psychosocial interventions,
awareness generation, continuing care
and support to persons with severe mental
disorders, drugs, outreach services at the
community health centre (CHC) and
primary
World Health Organization 7

health centre (PHC) levels, ambulance CHC level, where they are dispensed by the
services, etc. In addition to the above Medical Officer.
services ,there is provision for a 10-bedded • Half-way homes and community
inpatient mental health treatment facility at rehabilitation centres have been established
the district level. by certain states in collaboration with
• To increase the availability adequately nongovernmental organizations (NGOs).
trained mental health workforce at all • The Drug De-Addiction Programme under
healthcare levels, tailor made courses have the MoHFW provides treatment facilities
been initiated through a digital academy. in selected Central Government hospitals/
• The government is also taking steps to institutions.
strengthen mental health and neurological • To provide psychosocial support and
care services at the primary level. Mental mental health services during emergencies,
health services are provided to the primary a 24 x 7 toll free helpline (toll-free number:
level through the DMHP through outreach 080–4611 0007) has been established to
services at the community health centre provide psychosocial support and mental
and primary care level. Operational health services during emergencies. People
guidelines on mental, neurological and from any part of the country can call up at
substance use disorders (MNS) at HWCs this number and avail psychosocial support
have been released under Ayushman and mental health services from mental
Bharat, which define the roles of multiple health professionals.
cadres of primary health workers, including
• Human resources is a major challenge,
accredited social health activists (ASHAs).
although the government provides grants
Primary health-care workers are being
to education and training institutions
trained in line with these guidelines to
to produce qualified mental health
provide mental health services to all
sections of the society at the primary level. professionals.

• DMHP guidelines makes provisions for

medications to be made available at the

The District Mental Health Programme (DMHP)

component of the NMHP has been sanctioned
for implementation in 704 out of 750 districts
for which support is provided to all states / UTs
through the National Health Mission.
8 Addressing mental health in India

Services
through
different sectors
• The National Trust, a statutory and school readiness scheme), early
body of the Ministry of Social Justice interventions, including therapies to
and Empowerment, was set up affected persons, and training and support
under the to family members are carried out (3).
“National Trust for the Welfare of Persons
• The Ministry of Social Justice and
with Autism, Cerebral Palsy, Mental
Empowerment has schemes to address
Retardation and Multiple Disabilities” Act
alcohol and other psychotropic substance
(Act 44 of 1999), based on the principles
addiction.
of the United Nations Convention on
the Rights of Persons with Disabilities • The Ministry of Education is implementing
(UNCRPD). It works to provide the Ayushman Bharat School Health and
opportunities for capacity development of Wellness Programme in collaboration with
persons with disability and their families. the MoHFW.
Under the Disha scheme (early intervention

3 https://www.thenationaltrust.gov.in/content/innerpage/introduction.php
World Health Organization 9

Mental health
information
system and
research
• The country has a high capacity for interventional research, with
centres of excellence situated in different parts of the country.
• To strengthen mental health programmes and develop data-
driven programmes, the MoHFW, Government of India
commissioned the National Institute of Mental Health and Neuro
Sciences (NIMHANS) to conduct the National Mental Health
Survey, which was completed in 2015–2016. Planning for the
second version of the survey is now under way at the national
level.
• Components of alcohol and tobacco use are covered in the
National Family Health Survey.
10 Addressing mental health in India

Analysis
Issues (approximately 7.2 million individuals)
need help for their cannabis use
requiring problems

urgent attention
• Due the large population of the country,
• 2.1% of the country’s
population (22.6 million) uses
the numbers affected by mental health
opioids which include opium,
conditions are significant. The National
heroin and different
Mental Health Survey 2015–2016 (4)
pharmaceutical opioids. About 0.55% of
showed that 150 million people in India
Indians are estimated to need help for
needed intervention for mental disorders.
their opioid use problems. At the national
However, less than 30 million are seeking
level, the most common opioid used
care at present.
is heroin, (current use 1.14%) followed
• Except for epilepsy, all the other mental by pharmaceutical opioids (current use
disorders had a treatment gap of more than 0.96%) and opium (current use 0.52%).
60% with the highest treatment gap being The overall prevalence of current use of
for alcohol use disorders (86%). opioids is 2.06% .

• One in 20 persons in the country suffers What needs to

from depression, out of which 3 9 % suffer
from severe depression. Three out of four be sustained and
persons with severe mental disorders have
disabilities affecting their work, family,
supported
education and other aspects of life. • The NMHP is being implemented in all
• Of the population over 18 years, 0.9 % is at states and UTs in India, with the objective
high risk of suicide. of ensuring the availability and accessibility
of minimum mental health care for all, with
• According to the Magnitude of Substance a special focus on the most vulnerable and
Use in India (2019) (5): underprivileged sections of the population.
• 14.6% of people about (160 • The DMHP is currently being
million) were current alcohol users implemented in 704 of the 750 districts in
between 10 and 75 year of age. About the country to facilitate early detection and
5.2% of Indians are estimated to be treatment and to generate public
affected by harmful or dependent alcohol awareness.
use. • To ensure the availability of health-care
services at the community level, the
• About 2.8% of Indians (31 million) Government of India, under its Ayushman
reported using cannabis products within Bharat initiative, included the “Mental
the previous year and about 0.66%

4.National Mental health Survey of India, 2015–16. Bengaluru: NIMHANS; 2016

(http://www.indianmhs.nimhans.ac.in/Docs/Summary. pdf, accessed 20 August 2022).
5.Magnitude of substance use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India, NDDTC,
AIIMS; 2019 (https://www.aiims.edu/images/pdf/Departments_Centers/NDDTC/Magnitude_Substance_Use_India_
REPORT.pdf, accessed 20 August 2022).
World Health Organization 11

health, Neurological and Substance use

disorders” (MNS) package at HWCs. The Areas needing
government has a target of operationalizing
150 000 HWCs by the end of 2022. further investment
• These initiatives are ensuring the availability • Strengthening the capacities of
of trained human resources by building the community mental health workforce to
capacities of non-specialist cadres with a address issues related mental health.
capsule of in-service training, which is in
• Availability of medicines, addressing
line with the WHO mental health Global
disabilities and other essentials
Action Programme (mhGAP). Priority is also
for treatment of mental health and
given to ensure the availability of medicines
substance use disorders.
and other essential equipment for diagnosis
and treatment of mental health conditions. • Effective implementation of the Mental
Healthcare Act 2017, which ensures
• Recently, the government has announced
the rights of the people with mental
the launch of telemedicine services to be
health conditions
implemented through NIMHANS as the
nodal centre. Preparations are ongoing.

Challenges and possible

solutions
• There is a lack of awareness among people that mental health, neurological
and substance use disorders are conditions that require interventions. This is a
major challenge at the community level. Such conditions are usually considered
as punishment for sinful actions or curses by evil spirits. The stigma associated
with mental health and substance use disorders further dissuades people from
accessing services. The NMHP/DMHP and services at HWCs have a major
component of community awareness, generating demand for the available
mental health services.

• Although a comprehensive mental health law and policy and treatment

guidelines are available, their implementation needs strengthening to ensure the
effectiveness of these policies, laws and guidelines at the ground level.
12 Addressing mental health in India

SWOT
Strengths
Strong central- and district-level organization Prevalence data are available at the state
is available for mental health preventive and level.
curative services.

A comprehensive mental health policy and An established community and primary care
law and guidelines are in place. system is in place.

Opportunities
Mental health has been There is a plan to implement High-quality technical
given high importance the Mental health, expertise is available within
during the pandemic. Neurological and Substance the country.
use disorders (MNS) package
at 150 000 HWCs by the end
of 2022.
World Health Organization 13

Weaknesses
Administrators are entrusted with other Human resource constraints related to
programmes in addition to mental health. clinical, primary care and field staff need
to be addressed.

Threats
Stigma and lack of mental health literacy are The current high treatment gap could
widespread. escalate.

Conditions for mental health professionals in There is a large number of substance users
the government sector are not attractive. who may develop mental disorders.
14 Addressing mental health in India

Notes
World Health Organization 15
16 Addressing mental health in India

Notes
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