[Premium] Mental Healthcare in India – Key Issues and Analysis

Recently, the Supreme Court of India was moved by the plight of the chained mentally ill patients in a “faith-healing asylum” at Badaun, Uttar Pradesh and ordered the Uttar Pradesh government to take urgent measures to address the horrible situation. Chaining of such patients amounts to violation of the Mental Health Care Act of 2017 and the right to life guaranteed under Article 21 of the Constitution. Notably, 14% of India is in need of active mental health interventions. This issue calls for a relook at the status of mental health and healthcare in India.

What is Mental Health and Mental Illness?

  • Mental Health is defined by WHO as “a state of well-being in which every individual realizes his/her own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his/her community”.
  • Mental Health is defined by Mental Health Act, 2017 as “a substantial disorder of thinking, mood, perception, orientation, or memory that grossly impairs judgement, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs”.

What is the status of Mental Health and healthcare in India?

  • According to the 2011 Census, there was 15 lakh mentally retarded and 7.2 lakh mentally ill people in India.
  • According to National Mental Health Survey (2015-16), around 13% of the population suffer from minor to major mental disorders and the prevalence of depressive disorders in India accounts for 2.7% of the total population.
  • According to WHO report 2017, the prevalence of depressive disorders in India is about 4.5% of the population. Furthermore, 38 million people suffer from anxiety disorders.
  • Budgetary allocation: India’s expenditure for mental health is only 0.06% of the total budget compared to 0.44% of Bangladesh.
  • Infrastructure and human resource:
    • There are only 43 government-run mental hospitals across all India to provide services to more than 70 million people living with mental disorders.
    • There are only 0.30 psychiatrists (compared to 1.7 of China), 0.17 nurses and 0.05 psychologists per 1 lakh mentally ill patients in the country.

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What are the initiatives taken by the government?

National Mental Health Programme (NMHP), 1982: It was launched for detection, management, and treatment of mental illness.

District Mental Health Program (DMHP), 1996:

  • It was launched under NMHP.
  • The primary components are counselling in schools and colleges, workplace stress management, life skills training, suicide prevention services and IEC (Information, Education, and Communication) campaigns for creating awareness and remove the stigma associated with Mental illness.

Mental Health Act, 1987:

  • It replaced the Lunacy Act of 1912.
  • The Act was enforced in 1993.
  • It aimed at the regulation and administration of mental health care in institutional settings.
  • It also included provisions for the treatment of mentally ill patients in general hospitals and provisions for discharge from institutions.

National Mental Health Policy, 2014:

It aims at promoting mental health, prevent mental illness, enable recovery from mental illness, encourage destigmatization and desegregation, and make sure of socio-economic inclusion of mentally ill people.

Rights of Persons with Disabilities Act, 2017:

It refers to mental illness as a disability and aims at increasing the rights and entitlements for the disabled and grant efficient mechanism for guaranteeing their empowerment and inclusion in the society.

Mental Healthcare Act, 2017:

  • It aims at ensuring the rights of the person with mental illness to get the necessary care and to live a life with dignity.
  • Key features are as follows:
  • Rights of persons with Mental Illness
    • Right to Access Healthcare – Every person shall have the right to access mental health care and treatment from mental health services run or funded by the government.
    • It also ensures free treatment to persons who are homeless or under the poverty line.
    • It also requires insurance policies to place mental health treatment at par with physical health.
    • Right to live with dignity – Every person with mental illness shall have the right to live with dignity.
    • Right to confidentiality – A person with mental illness shall have the right to confidentiality with respect to mental health, mental healthcare, treatment, and physical healthcare.
  • Advance Directive – The Act endows the mentally ill person with the right to make an advance directive that mentions how he/she wants to be treated for the illness and who his/her nominated representative shall be.
  • Authorities – It requires the government to establish the Central Mental Health Authority at the national level and State Mental Health Authority at the state level.
  • Mental health treatment
    • A mentally ill adult person shall not be subjected to electroconvulsive therapy without the proper administration of muscle relaxants and anesthesia. Also, electro-convulsive therapy should not be used on minors.
    • Sterilisation shall not be performed on such persons.
    • They shall not be chained in any manner or under any circumstances.
    • They shall not be subjected to seclusion or solitary confinement.
  • Decriminalization of suicide:
    • Suicide was a punishable offence under IPC Section 309 until the enactment of Mental Health Care Act, 2017.
    • The Act decriminalised suicide by mentioning that whoever attempts suicide will be assumed to be under intense stress, and shall not be punished for it.

India’s international commitments

  • Sustainable Development Goals (SDGs): SDG 3: Good health and wellbeing.
    • Target 3.4 – By 2030, reduce by 1/3 premature mortality from Non-communicable diseases by means of prevention and treatment and improve mental health and well-being.
    • Target 3.5 – wants countries to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.
  • UN Convention on Rights of Persons with Disabilities
    • It recognizes mental illness as a disability and wants commitments from signatory countries to encourage human rights and fundamental freedoms by all persons with disabilities and promote and respect their inherent dignity.
    • Mental Healthcare Act, 2017 has been created based on this convention.

What are the issues or challenges with mental healthcare in India?

Issues with Mental Healthcare Act, 2017

  • It ignores the prevention of mental issues and the promotion of mental well-being and acknowledges mental illness as a clinical problem which can be treated only by medicines and clinical procedures.
  • It does not provide clear guidelines for creating the Advance Directive. Doctors are of the view that they are the best option when it comes to taking decisions on treatment since patients or their nominated representatives may have less knowledge regarding the mental health/illness.
  • It provides a narrow and limited definition of mental health professionals by not including psychotherapists, counsellors and psychoanalysts.
  • Moreover, considering the infrastructural and human resource constraints, the enforcement of the act poses a big challenge.

Treatment gap

  • Treatment gap refers to the difference between those suffering from mental illnesses and those utilising medical/psychiatric care.
  • According to a study, around 92% of the people who need mental health care and treatment do not have access to any form of mental health care.

Mental Healthcare Resources

  • Mental healthcare resources in India are insufficient with bad infrastructure and meagre number of healthcare professionals.
  • Furthermore, there is a high rural-urban disparity with the majority of the mental health institutions being located in urban areas.

Social stigma

  • The mixture of superstition, social stigma, discrimination and dependence on ‘faith healers’ is a primary concern.
  • Lack of illiteracy and awareness further aggravates the mental health issues by contributing to social stigma and affects treatment and social inclusion of patients.

Economic Burden

  • The mental illness causes a serious economic burden.
  • There are both direct (cost of long-term treatment) and indirect (the inability of patient and caregiver to work, social isolation and mental stress) that contribute considerably to the economic burden.

Human rights violation

  • Many mental asylums have been alleged to be violating human rights.
  • This is particularly true when it comes to home-based treatment and places of traditional or faith healing.
  • Furthermore, poor infrastructure like closed structures, poor maintenance, unsanitary toilets, and sleeping areas etc. violate basic human rights such as the right to live with dignity (Article 21).
  • Case studies
    • In 2001, 28 patients who were chained at a home for mentally-ill people died after a fire that engulfed the home in Erwadi village in the Ramanathapuram District (Tamil Nadu).
    • The recent case of chaining of mentally ill patients in a faith-based asylum in Badaun UP.

What are the initiatives taken by civil society?

Atmiyata Project:

  • It is a community-led project seeks to increase community awareness and enabling access to both mental health and social care.
  • Community volunteers are trained to provide psychological counselling, social care, and referral services to mentally ill persons.

The Live, Love, Laugh Foundation (TLLLF), by actor Deepika Padukone:

  • The foundation has worked together with Association of People with Disability (APD) to improve rural mental healthcare, in Davangere district, Karnataka.
  • It has also launched various other projects including ‘You are not Alone’ (school awareness programme), ‘Together against Depression’ (a doctor’s awareness programme) and ‘Dobara Pucho’ (a public awareness programme on mental health).


It is a South-Asian Mental Health Outreach Program of ASHA international which seeks to create awareness about mental health and emotional wellbeing, increase access to care and link people with community supports and wellness resources.

What is the way forward?

  • WHO recognizes mental healthcare system in Thiruvananthapuram, Kerala as a best practice.
    • Since 1999, Thiruvananthapuram District has integrated mental health services into primary healthcare.
    • Trained medical practitioners diagnose and treat mental disorders as part of their general primary care duties.
    • Furthermore, a multidisciplinary district mental health team provides direct management of difficult cases and in-service training and support of primary care workers.
    • Free, timely and sufficient availability of psychotropic medications in the clinics has decreased the economic burden of patients.
  • The government should allocate appropriate budget to resolve the present infrastructural gaps in the mental healthcare facilities.
  • A proper survey should be conducted to assess shortages in mental health professionals and operational challenges for effective implementation of mental health programmes.
  • There is an urgent requirement of easily accessible diagnostic test and affordable treatment to provide better primary mental health care.
  • Also, the government should enable insurance covers for mental illness in order to the associated economic burden.
  • Early interventions should also be carried out
    • Create living conditions and environment that support healthy mental growth.
    • Encourage society to respect and protect basic, civil, political, and cultural rights.
    • Early childhood interventions such as preschool psychosocial activities, nutritional and psycho-social help.
    • Ensure socio-economic empowerment and safety of women = reduce the burden of mental disorders in women.
  • Create public awareness about the commonness of mental disorders, understanding mental disorders as illnesses, treatment and the importance of acceptance by the family and the community.
  • Finally, all the stakeholders (government, medical fraternity, civil society, educational institutions, family, peer group and community) are the need of the hour to resolve the growing issue of mental health in India.
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