India is grappling with a significant mental health crisis, contributing nearly 15% of the global burden of mental health disorders. From 1990 to 2017, the country saw a troubling doubling of its mental health burden, with an estimated 200 million individuals requiring care by 2017—yet more than 80% of these people lacked access to necessary treatment.
Despite the Mental Health Care Act of 2017, which recognizes mental health care as a right, India’s current system falls short of adequately addressing this pressing issue. PATH, a non-profit organization, has been actively working to strengthen the healthcare workforce and support public health systems in addressing this gap through comprehensive mental health services.
The Challenges Hindering Mental Health Care
Mental health issues in India remain highly stigmatized, with many still viewing them as signs of personal weakness or attributing them to supernatural causes. This stigma prevents individuals from seeking help, further compounded by a widespread lack of awareness about mental health conditions, making it difficult for people to recognize symptoms and seek appropriate care.
The country’s mental health services are traditionally specialized, concentrated in tertiary care facilities, and severely limited in rural and underserved areas. With only 0.3 psychiatrists, fewer than 0.01 child psychiatrists, and 0.07 psychologists per 100,000 people—far below global recommendations—the scarcity of mental health professionals exacerbates the problem. Regional disparities add another layer, with rural areas, especially in northern states, facing even greater shortages.
The private mental health sector is expensive and mainly concentrated in urban centers, leading to fragmented care. In addition, the prevailing focus on a biomedical approach often overlooks the essential role of psychosocial interventions, and the country has been slow to develop reliable self-care tools for mental health.
Integrating Mental Health Care into Primary Health
One promising solution to India’s mental health crisis is integrating mental health services into primary care. By incorporating mental health care into community-based health systems, the country could close the treatment gap, making services more accessible and cost-effective. This approach facilitates early intervention, promotes adherence to treatment, and encourages patients to remain active in their communities, all while improving overall health outcomes.
Primary care integration also reduces stigma by de-linking mental health services from specialist care, making these services more acceptable to the public. This concept has gained recognition in India, especially with the government’s Ayushman Bharat initiative. Through this initiative, sub-centers and primary health centers have been transformed into Health and Wellness Centers (AAMs), which offer mental health services as part of a broader package of essential services.
A comprehensive model at these centers links services through both backward and forward connections, ensuring a seamless care continuum for patients.
PATH’s Contributions to Mental Health Care
PATH has been working to improve mental health care in India since 2021, with a focus on raising mental health awareness, particularly among youth. Through the Stakeholder-Led Advancement of Mental Health of Young People (SAMYP) project, funded by Fondation Botnar, PATH conducted in-depth analysis and consultations to understand the mental health needs of young people aged 15-24.
Using these insights, SAMYP created resources to enhance mental health literacy and encourage self-care and help-seeking behaviors among young people.
In 2023, PATH expanded its work, aiming to reimagine comprehensive primary health care for youth by integrating mental health services in urban health centers in three cities in Manipur. These services create adolescent-friendly hubs to provide affordable, responsive, and high-quality care.
PATH has also worked with the Asian Development Bank to develop digital tools for managing noncommunicable diseases (NCDs) and mental health in primary care settings. Their efforts led to the creation of an open-source digital directory that helps healthcare providers incorporate patient-centered technologies into their practices.
Looking forward, PATH launched the ASPIRE project in 2024 in collaboration with the Government of Karnataka and the Indira Foundation. This three-year initiative will focus on providing mental health literacy and self-care tools for youth in Chikkaballapura district, while empowering primary health care workers to screen and offer first-line counseling and referrals.
The Path to Progress
India’s mental health system needs comprehensive reform, particularly in the following areas:
Empowering Primary Care Providers: Ensuring that primary health care providers are equipped with the skills and knowledge to identify mental health issues early and provide first-line care, including counseling, diagnosis, treatment, and follow-up.
Strengthening Health Systems: Building a robust mental health information system and ensuring the regular supply of essential medications at the primary care level.
Addressing Help-Seeking Barriers: Identifying and addressing factors that discourage individuals from seeking mental health care, particularly in rural and underserved areas.
Integrating Care for Comorbid Conditions: Prioritizing the integration of mental health care with physical health care, as mental health conditions often co-occur with chronic physical health issues.
For India, addressing the mental health crisis requires a system-wide commitment to the belief that “there is no health without mental health.” This vision demands action at all levels—empowering healthcare providers, addressing stigma, and ensuring equitable access to mental health resources, particularly for the country’s most vulnerable populations.
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