Editorial: Mental health — acknowledge the elephant in the room

Strengthening the health infrastructure to address the needs of mentally ill people must get top priority from the central and State governments

It’s an elephant in the room that we often tend to ignore. In a society full of social stigmas and taboos, mental health disorders are often mocked, with some even denying their existence. Depression, for instance, is an invisible stalker who pulls the victim into a black hole of loneliness. The social stigma surrounding mental disorders often forces patients to suffer in silence. The situation in India is particularly alarming because it is a taboo to talk about mental health problems, and support systems are woefully inadequate. Recent studies indicate that 15 per cent of Indian adults require intervention for mental health issues. More alarmingly, between 70 per cent and 92 per cent of people with mental disorders do not receive proper treatment, primarily due to a lack of awareness, pervasive stigma, shortage of professionals, and infrastructure limitations. The reported overall treatment gap for mental disorders is roughly 84.5 per cent. According to the World Health Organization (WHO), over 90 million Indians, accounting for 7.5 per cent of the population, suffer from mental health issues. In a 2021 UNICEF survey, around 14 per cent of 15 to 24-year-olds in India reported frequently feeling depressed. The major reasons that prevent many patients from seeking medical treatment are high healthcare costs, social stigma and lack of awareness about available therapies. The woefully inadequate infrastructure and shortage of specialists are other major obstacles. When it comes to mental healthcare personnel, India has 9,000 psychiatrists, or less than one doctor for every 1,00,000 people, while the WHO norms say there should be three for every 1,00,000 people.

A comprehensive approach involving multiple sectors, including healthcare, education, and social services, is needed to tackle the problem effectively. Efforts to increase public awareness about mental health, reduce stigma, and promote help-seeking behaviour are crucial, while increasing access to affordable and quality mental health services is essential to bridge the treatment gap. High suicide rates, particularly among young adults, underscore the severity of mental health issues in India. At present, India faces challenges due to inadequate mental health infrastructure, severe shortage of trained professionals, and inaccessibility of services. While addressing these structural and financial lacunae, it is also important for society not to stigmatise the victims but provide a community support structure so that they are not left to wage a lone battle. The proportional contribution of mental health to the total disease burden has almost doubled since 1990. Strengthening the health infrastructure to address the needs of mentally ill people must get top priority from the central and State governments. Unfortunately, only about 1.05 per cent of the country’s health budget is allocated to mental health, which greatly hampers service expansion and innovation. Poverty, gender inequalities, and cultural beliefs intensify the difficulty of recognising and treating mental health conditions. While tele-mental health programmes like Tele-MANAS have improved the reach, limited digital infrastructure in rural areas is a major hindrance.

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