Subject: Health

Why in the News?

The Economic Survey flagged rising digital addiction and screen-related mental health disorders, particularly among children and adolescents. The Union Budget announced strengthening of mental health infrastructure, including establishment of a second campus of NIMHANS in North India and upgradation of premier institutions in Ranchi and Tezpur. Despite increased allocation from ₹683 crore (2020-21) to ₹1,898 crore (2024-25), mental health spending remains about 2% of total health outlay.

What is the Scale of India’s Mental Health Burden?

1. Suicide Burden: Accounts for nearly one-third of global suicides; depression and addiction contribute significantly to disease burden.
2. Economic Impact: Mental health conditions impose an estimated economic loss of $1.03 trillion between 2012 and 2030.
3. Treatment Gap: 70-92% of individuals with mental disorders lack proper treatment due to low awareness, stigma, and workforce shortages.
4. Human Resource Deficit: 0.75 psychiatrists per 1,00,000 population against the recommended 3 per 1,00,000.
5. Adolescent Vulnerability: Rising digital addiction and screen-related disorders flagged in the Economic Survey.

What Institutional Measures Have Been Announced?

1. National institute of mental health and Neuro Sciences (NIMHANS) Expansion: Establishes second campus of National Institute of Mental Health and Neurosciences in North India.
2. Institutional Upgradation: Upgrades premier institutions in Ranchi and Tezpur to improve regional access.
3. Centre of Excellence Expansion: Sanctions over 20 Centres of Excellence to train postgraduate students in mental health.
4. Advanced Treatment Infrastructure: Establishes 47 PG departments in mental health.
5. Primary Healthcare Integration: Integrates mental health services under Ayushman Arogya Mandirs and Health and Wellness Centres.
6. Tele-MANAS Helpline: Provides 24×7 free mental health support via toll-free number 14416 and 1-800-891-4416; operational across 36 States/UTs and supported by 23 specialised mentoring institutes.

How Has Budgetary Allocation Evolved?

1. Allocation Increase: Raises allocation from ₹683 crore (2020-21) to ₹1,898 crore (2024-25).
2. Relative Share: Maintains mental health share at approximately 1% of total health budget and about 2% of national health outlay.
3. Historical Underfunding: Reflects long-standing low fiscal prioritisation despite rising burden.

Where Do Structural Gaps Persist?

1. Low Budgetary Share: Limits impact due to marginal share within overall health expenditure.
2. Underutilisation of Funds: Prevents full utilisation of allocated funds at national level.
3. Institution-Centric Focus: Directs significant funds towards tertiary institutions such as NIMHANS and Centres of Excellence.
4. Limited Community-Based Models: Weakens early intervention and preventive mental health services.
5. Capacity Constraints: Maintains shortage of trained professionals, with only 9% gap reduction in access to mental healthcare.

What Approach is Required Going Forward?

1. Affordable Access: Ensures continuity of care and long-term treatment.
2. Preventive Focus: Reduces years lived with disability through early detection.
3. Human Resource Strengthening: Expands trained workforce capacity.
4. Community Integration: Integrates mental well-being into school curricula and workplace policies.
5. Whole-of-Community Model: Mainstreams mental health beyond hospital-centric systems.

Conclusion

India’s mental health crisis reflects a structural mismatch between the scale of the burden and the scale of response. Rising suicides, a 70-92% treatment gap, severe psychiatrist shortages, and mental health spending hovering around 1-2% of the health budget indicate systemic under-prioritisation despite recent institutional expansion.

Strengthening tertiary institutions alone cannot address a crisis rooted in access, stigma, affordability, and preventive failure. A shift towards community-based care, workforce expansion, full utilisation of allocated funds, and integration of mental well-being into schools and workplaces is essential to convert policy intent into measurable public health outcomes.

PYQ Relevance

[UPSC 2023] Explain why suicide among young women is increasing in Indian Society. 

Linkage: UPSC frequently frames GS-I Society questions around emerging social vulnerabilities reflected in current data trends. The article highlights India accounting for nearly one-third of global suicides and flags rising mental health distress, making youth and gender-specific suicide patterns directly relevant to contemporary exam themes.

Why in the News?

Antimicrobial resistance (AMR) has become a serious global public health threat as the development of new antibiotics has not kept pace with the rapid rise in drug resistance. Unlike earlier decades, when ineffective antibiotics were regularly replaced by new ones, no truly new antibiotic classes have emerged in recent years. India is among the worst affected, with very high antibiotic use and an estimated 2.74 lakh deaths linked to AMR in 2019.

Why is antimicrobial resistance a growing public health crisis?

1. Rising mortality burden: AMR-attributable deaths in India were estimated at 2.74 lakh in 2019, reflecting a large and growing health burden.
2. Treatment failure: Common infections are increasingly difficult to treat, increasing complications, hospital stays, and mortality.
3. Systemic impact: AMR undermines surgery, chemotherapy, organ transplants, and neonatal care by increasing infection risk.
4. Global spread: Resistant pathogens spread rapidly through travel, trade, food chains, and the environment.

Why is India disproportionately affected by AMR?

1. High infectious disease load: India continues to face a high burden of communicable diseases requiring antibiotic use.
2. Extensive antibiotic consumption: India is among the world’s largest consumers of antibiotics, both in human and animal health.
3. Healthcare pressures: Overcrowded hospitals and limited diagnostic capacity encourage empirical and broad-spectrum antibiotic use.
4. Survival advantage of pathogens: Drug-resistant bacteria survive treatment and transmit resistance genes to other bacteria.

How does antibiotic misuse accelerate resistance?

1. Inappropriate prescribing: Antibiotics are frequently used for viral infections such as colds, coughs, and diarrhoea.
2. Empirical treatment: Lack of timely diagnostics leads to blind antibiotic use without pathogen identification.
3. Prophylactic use: Antibiotics are prescribed preventively, even where clinical benefit is uncertain.
4. Seasonal misuse: Antibiotics are used for seasonal viral illnesses due to patient demand and prescribing habits.

What is happening to the global antibiotic pipeline?

1. Limited innovation: Very few new antibiotic classes have been developed in the past three decades.
2. R&D stagnation: Most recent approvals involve modifications of existing drugs rather than new mechanisms of action.
3. Commercial disincentives: Antibiotics offer low returns compared to chronic disease drugs, discouraging private investment.
4. Effectiveness erosion: Even newly introduced antibiotics lose effectiveness rapidly due to resistance.

Why is antibiotic stewardship more effective than blanket bans?

1. Behavioural regulation: Stewardship programs guide rational prescribing rather than eliminating access.
2. Evidence from India: The Indian Council of Medical Research (ICMR) launched a national antibiotic stewardship programme in 2015.
3. Measured impact: Prescription awareness improved, but full behavioural internalisation remains limited.
4. Sustainability challenge: Stewardship requires continuous monitoring, training, and institutional commitment.

How do livestock and agriculture worsen the AMR problem?

1. Non-therapeutic use: Antibiotics are used in animals for growth promotion and disease prevention.
2. Shared drug classes: Many antibiotics critical for humans are also used in animals.
3. Environmental spread: Antibiotic residues enter soil and water through animal waste and food chains.
4. Resistance transfer: Resistance genes move between human, animal, and environmental bacteria.

Why is data collection on AMR inadequate?

1. Limited surveillance: ICMR’s AMR surveillance network covers only 25 tertiary hospitals.
2. Urban bias: Most data originates from large hospitals, missing community-level resistance patterns.
3. Underestimation risk: Resistance prevalence is likely higher than reported due to incomplete coverage.
4. Policy constraint: Inadequate data limits targeted interventions and resource allocation.

Why can’t new antibiotics alone solve AMR?

1. Rapid resistance development: Resistance emerges even against newly introduced drugs.
2. Finite effectiveness window: Antibiotics lose usefulness within a few years of widespread use.
3. Overreliance risk: Dependence on drug discovery ignores behavioural and systemic drivers.
4. Adjunct necessity: Stewardship, infection prevention, and diagnostics remain central.

Conclusion

The antibiotic pipeline crisis reflects a structural mismatch between rising resistance and declining innovation. India’s experience demonstrates that stewardship, surveillance, and behavioural regulation are as critical as drug discovery. Without systemic correction, modern medicine risks returning to a pre-antibiotic era.

PYQ Relevance

[UPSC 2024] Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved.

Linkage: This question directly maps to GS Paper III (Science & Technology-Public Health), aligning with UPSC’s repeated focus on antimicrobial resistance as a governance and regulatory challenge. It links with PYQs on antibiotic overuse, emerging health challenges, and technology-policy gaps, reflecting UPSC’s trend of testing systemic failures rather than medical details.

Introduction

Mental health systems globally and in India continue to prioritise biomedical treatment and functional integration. They often overlook lived experiences of distress, social exclusion, and structural vulnerability. There is a need for a fundamental shift: from care as a technical service to care as disability justice, grounded in dignity, equity, and relational accountability.

Reframing Mental Health Care Beyond Treatment

1. Dignity-Centred Care: Positions dignity, rather than cure or productivity, as the primary objective of mental health systems.
2. Disability Justice Lens: Recognises mental illness as shaped by intersecting social, economic, and political structures.
3. Relational Accountability: Frames care as embedded in relationships, not limited to institutional or clinical settings.

Limits of Dominant Psychosocial Disability Models

1. Productivity Bias: Prioritises economic functionality and independence as markers of recovery.
2. Reductionist Integration: Treats community inclusion as an end-state without addressing exclusionary social norms.
3. Invisible Chronic Distress: Marginalises individuals whose suffering does not conform to biomedical recovery trajectories.

Structural Determinants of Mental Distress

1. Material Deprivation: Highlights housing insecurity, income precarity, and food scarcity as persistent stressors.
2. Social Abandonment: Identifies shame, rejection, and relational breakdown as under-recognised drivers of distress.
3. Political and Cultural Loss: Notes erosion of cultural meaning, safety nets, and social identity as contributory factors.

Multiplicity of Explanations for Mental Illness

1. Biological Factors: Includes neurotransmitter alterations and inflammatory markers.
2. Psychological Factors: Covers trauma, grief, and interpersonal loss.
3. Socio-Structural Factors: Integrates caste, gender, class, and institutional neglect into causation analysis.
4. Intersectionality: Emphasises overlapping vulnerabilities rather than single-cause explanations.

Care as Relational and Material Practice

1. Everyday Care Practices: Includes shelter, nutrition, social connection, and safety as therapeutic.
2. Non-Linear Recovery: Rejects uniform timelines and outcome metrics.
3. Shared Responsibility: Frames care as a collective moral obligation rather than individual compliance.

Justice-Oriented Mental Health Engagement

1. Recognition of Harm: Acknowledges that distress often arises from unjust social arrangements.
2. Ethical Accountability: Asks what society owes to those it has marginalised.
3. Transformative Focus: Shifts emphasis from symptom management to social repair.

Implications for Education, Research, and Practice

1. Curricular Reorientation: Calls for training that values lived experience and contextual care.
2. Practice Diversity: Recognises non-specialist and community-based care providers.
3. Interdisciplinary Learning: Supports integration of social theory, ethics, and practice.
4. Systemic Support: Emphasises that professional competence requires institutional backing, not credentials alone.

Conclusion

Mental health care must be reimagined as an ethical, relational, and justice-oriented practice rather than a narrowly clinical intervention. By centering dignity and disability justice, the article calls for a paradigm shift that recognises suffering as socially produced and care as a shared societal responsibility.

Mental Health in India About 10.6% of Indian adults, roughly 11 out of every 100 adults, were living with a diagnosable mental health disorder, according to a 2015-16 National Mental Health Survey (NMHS) conducted by the National Institute of Mental Health and Neurosciences (NIMHANS). The survey also revealed: 15% of India’s adult population experiences mental health issues requiring intervention The lifetime prevalence of mental disorders was 13.7%, indicating that around 14 out of every 100 people in India have experienced a mental disorder at some point in their lives Mental health disorders are more prevalent in urban areas (13.5%), compared to rural areas (6.9%).

PYQ Relevance

[UPSC 2024] In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest measures through which the State can enhance the reach of public healthcare at the grassroots level.

Linkage: The article directly links to GS-II (Social Justice, Health) by highlighting the limitations of market-centric and outcome-driven public healthcare in addressing mental health and disability. It also enriches GS-IV by framing mental health care as an ethical obligation grounded in dignity, compassion, and justice rather than mere service delivery.