Mental health must anchor public health

Why in the News

Mental health has been placed at the centre of India’s public health agenda as a determinant of every other health goal rather than as a separate specialty. India’s Viksit Bharat 2047 vision carries a Healthcare for All pillar built on strengthening Ayushman Bharat, expanding primary healthcare, reducing out of pocket expenditure and promoting preventive care. Mental health cuts across all four and decides whether they succeed. The case for prioritising it rests on a treatment gap that has not closed even as delivery infrastructure has expanded across districts. The tension is between an architecture that now reaches most of the country and an outcome in which more than four out of five people needing care still receive none.

How wide is the gap between mental illness and mental healthcare?

1. Prevalence: Mental illness affects one in seven Indians, with nearly 200 million people living with a diagnosable mental health condition.
2. A rising share of total disease burden: The contribution of mental disorders to India’s total disease burden has doubled over the past three decades.
3. The treatment gap: The national treatment gap stands at 84.5%, so more than four out of five people who need care do not receive it.
4. Specialist density: India has 0.3 psychiatrists per 1,00,000 population.
5. The shortage runs across the whole care team: Clinical psychologists, psychiatric social workers and psychiatric nurses are all in significant short supply, the result of decades of insufficient attention to the field.

Why does neglecting mental health weaken physical health programmes?

1. The risk runs both ways: Mental disorders significantly raise the risk of chronic disease, and chronic disease in turn raises the risk of mental illness.
2. Most primary care patients are already affected: More than 60% of people attending primary care facilities have a diagnosable mental disorder.
3. Specific comorbidities are worse: Rates of anxiety and depression are substantially higher among people living with diabetes, hypertension, tuberculosis and HIV/AIDS.
4. The cost falls on disease control programmes: Ignoring mental health undermines efforts to control non communicable diseases and to reduce healthcare expenditure.

What is the economic case for universal screening?

1. The study: A 2025 modelling study by researchers from the Postgraduate Institute of Medical Education and Research (PGIMER) and the National Institute of Mental Health and Neurosciences (NIMHANS) examined integrating universal depression screening into India’s primary healthcare system.
2. The estimated saving: It put net savings at ₹291 billion to ₹482 billion annually.
3. The scale relative to the economy: That is equivalent to as much as 0.32% of GDP.
4. The framing that follows: On those numbers mental health is a human capital investment and an economic growth strategy, not a social welfare issue alone.

What delivery foundation already exists?

1. Primary care conversion: More than 1.73 lakh sub centres and primary health centres have been converted into Ayushman Bharat Arogya Mandirs.
2. Mental health sits inside the service package: Mental healthcare is included among the essential service packages those centres are meant to deliver.
3. District coverage: The District Mental Health Programme now covers more than 90% of districts.
4. A national tele service: Tele-MANAS (Tele Mental Health Assistance and Networking Across States), launched in 2022, has expanded across all States and Union Territories.

What three priorities does scaling this foundation require?

1. Make frontline workers the backbone of community mental healthcare: India’s one million Accredited Social Health Activists (ASHAs) form the world’s largest community health workforce, and with training and supervision they can identify, support and refer individuals with common mental disorders. Validated screening tools, digital learning platforms and performance linked incentives are the levers that would scale the model. Eg. Evidence from Madhya Pradesh and other States shows ASHAs already performing that role.
2. Invest systematically in community based care: Trained community workers bridge the gap between awareness and treatment, particularly in rural and underserved populations, and these approaches improve access while reducing costs. Eg. Zimbabwe’s Friendship Bench, Atmiyata in India and programmes run by The Live Love Laugh Foundation all operate on this model.
3. Complete the promise of financial protection: Extending outpatient mental health benefits under the Pradhan Mantri Jan Arogya Yojana would cover the continuous care that mental illness actually needs. Strengthening implementation of insurance parity under the Mental Healthcare Act, 2017 would make that care affordable for people currently going without it.

Challenges to integrating mental health into primary care

1. Stigma stops care seeking before any service is reached: A diagnosis treated as a family reputational risk rather than as an illness keeps the patient out of the system entirely. Eg. Tele-MANAS was built as an anonymous telephone service precisely because anonymity lowers a barrier that in person help seeking raises.
   The Fix: Fund sustained district level anti stigma communication through the same channels that already carry immunisation and tuberculosis messaging.
2. District coverage is counted in districts, not in staff: Sanctioned psychiatrist, psychologist and psychiatric social worker posts at district level frequently remain vacant, so a covered district may still have no functioning team. Eg. District hospitals must recruit specialists against private practice pay, which is why the posts stay open.
   The Fix: Allow districts to contract trained mid level providers against unfilled specialist posts rather than carry the vacancy.
3. The rights framework depends on authorities that were slow to appear: The Mental Healthcare Act, 2017 requires every State to constitute a State Mental Health Authority and to register mental health establishments, and several States were late in doing so. Eg. The Act’s advance directive and nominated representative provisions cannot be exercised without a functioning State authority.
   The Fix: Tie a State’s central mental health funding to a constituted and staffed State Mental Health Authority.
4. Psychotropic medicines are not reliably stocked below district level: Treatment breaks when a patient stabilised at a district hospital cannot refill medication at the primary health centre. Eg. Antipsychotics and mood stabilisers sit outside the routine stock lists many sub district facilities actually maintain.
   The Fix: Place the core psychotropic list on the essential drug list procured for every Ayushman Bharat Arogya Mandir.
5. Suicide prevention has no single accountable owner: Prevention needs police, education, agriculture and health departments to act together, and none of them is answerable for the outcome. Eg. The National Suicide Prevention Strategy, released in 2022, set a target of reducing suicide mortality by 10% by 2030 and relies on voluntary departmental convergence.
   The Fix: Give the strategy a named nodal authority in each State reporting against annual targets.

Conclusion

Mental health is not a missing programme in India. It is a programme that exists at scale and does not reach people. The binding constraint is who delivers care at the point a person first presents, and that is a workforce question before it is a financing question. Closing the gap therefore turns on whether frontline and community workers are trained, supervised and paid to do the work, and on whether the payment system follows the patient out of the hospital. Until those two move together, coverage will keep expanding without treatment expanding with it.

Back2Basics

1. What it is: Tele-MANAS is a national round the clock tele mental health service providing free counselling and psychiatric support by telephone, run under the Ministry of Health and Family Welfare.
2. Origin: It was announced in the Union Budget for 2022-23 as the National Tele Mental Health Programme and launched in October 2022.
3. How it is organised: It works in two tiers, with State level cells staffed by trained counsellors and a second tier of specialists and district programme resources for escalation.
4. Nodal institution: NIMHANS is the nodal centre for the programme, with technical support from the International Institute of Information Technology, Bangalore.

Matching Previous Year Question

“[2024] With reference to the ‘Pradhan Mantri Surakshit Matritva Abhiyan’, consider the following statements: 1. This scheme guarantees a minimum package of antenatal care services to women in their second and third trimesters of pregnancy and six months post-delivery health care service in any government health facility. 2. Under this scheme, private sector health care providers of certain specialities can volunteer to provide services at nearby government health facilities. Which of the statements given above is/are correct? (a) 1 only (b) 2 only (c) Both 1 and 2 (d) Neither 1 nor 2 ANSWER: (b)”