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International Journal of Culture and Mental Health
ISSN: 1754-2863 (Print) 1754-2871 (Online) Journal homepage: http://www.tandfonline.com/loi/rccm20
Burden of mental illness: a review in an Indian
context
Sahithya B. R. & R. P. Reddy
To cite this article: Sahithya B. R. & R. P. Reddy (2018): Burden of mental illness: a
review in an Indian context, International Journal of Culture and Mental Health, DOI:
10.1080/17542863.2018.1442869
To link to this article: https://doi.org/10.1080/17542863.2018.1442869
Published online: 08 Mar 2018.
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Burden of mental illness: a review in an Indian context
Sahithya B. R.
a
and R. P. Reddy
b
a
Department of Psychiatry, St. John’s National Academy of Health Sciences, Bangalore, India;
b
Department of Clinical
Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
ABSTRACT
Mental disorders pose a major challenge to the community due to early
onset, chronic progressively deteriorating course, frequent relapses and
disability. They are associated with tremendous distress both for the
patient and the caregiver, and can produce significant disability,
especially when not treated in a timely manner. This review aims to
discuss the burden of mental illness in terms of economic cost, family
burden, disability and unemployment in India. After a conceptual
overview of burden, barriers to mental health and treatment gaps are
discussed. Finally, progress made in the area of mental health, recent
government initiatives and future directions to address the growing
problems associated with mental disorders are discussed.
ARTICLE HISTORY
Received 20 November 2017
Accepted 16 February 2018
KEYWORDS
Burden; mental disorders;
economic cost; disability;
barriers to mental health;
mental health policy
1. Introduction to India
India is a diverse country with a range of languages, religions and cultures. It is the second most
populated country in the world, with approximately one-sixth of the world’s population, and is pro-
jected to be the world’s most populated country by 2024 (United Nations, 2017). The Eighth Sche-
dule of the Constitution of India, as of 2007, listed 22 official languages. The overall literacy rate is
74.04%, with male literacy being 82.14% and that of females being 65.46% (Registrar General of
India, 2011). In addition, a large proportion of the population lives in rural areas, with agriculture
being the main occupation. There were about 363 million people, (i.e. 29.5% of India’s population)
living below the poverty line in 2011–2012 (Planning commission, Government of India, 2014).
Thus, the varying levels of education, socioeconomic status, gender differences and urban rural
divide make India a diverse nation. Such diversity, however, presents with unique challenges in
the context of managing mental health. The interconnections between sociocultural factors and
mental health not only influence the illness manifestations and psychopathology, but also the burden
of mental illness.
2. Mental disorders
Mental disorders are common in general populations across the world, and represent a wide spec-
trum of illness, which ranges from mild anxiety states to severe forms of behavioural and thought
abnormalities such as those seen in schizophrenia. Mental disorders are associated with high levels
of stigma, disability and discrimination, which significantly contribute to the burden of disease
(Trani et al., 2015). Mental illness causes misery to both the patient and their families, and leads
to loss of quality of life, economic loss and social dysfunction (Pompili et al., 2014).
© 2018 Informa UK Limited, trading as Taylor & Francis Group
CONTACT Sahithya B.R. sahithyabr@gmail.com Department of Psychiatry, St. John’s National Academy of Health Sciences,
Bangalore, Karnataka, India
INTERNATIONAL JOURNAL OF CULTURE AND MENTAL HEALTH, 2018
https://doi.org/10.1080/17542863.2018.1442869
The exact causes of mental health problems are unknown and there is no consensus on single
factor involved in most mental disorders. Generally, a bio-psycho-social approach is used to under-
stand the etiology of mental illness. In developing countries like India, the social determinants of
health, such as poverty, unemployment, illiteracy, low living standards and related factors, have
been associated with mental illness (Lund et al., 2010). Many mental disorders begin in child-
hood-adolescence, and may have significant adverse effects on subsequent role transitions (Kessler
et al., 2009)
There is no general consensus on the exact prevalence of mental disorders across India. Several
epidemiological studies have attempted to determine the prevalence of mental disorders. However,
most of these surveys are plagued by a host of methodological problems, including lack of focus on
common mental disorders and unclear timeframes for estimating prevalence (Sagar et al., 2017).
Therefore there is no national-level consensus available for India. Various meta-analysis of epide-
miological studies have estimated the prevalence at between 5.82% (Reddy & Chandrashekar,
1998) and 7.3% (Ganguli, 2000). Math, Chandrashekar and Bhugra (2007) critically evaluated the
prevalence rate of mental disorders as reported in Indian epidemiological studies and found that
these discrepancies were not specific to India alone, but were also witnessed in international studies.
A recent National Mental Health Survey of India (Gururaj et al., 2016) reported a lifetime prevalence
rate of mental disorders to be 13.7%, and that nearly 150 million Indians were in need of active inter-
vention. Despite having high rate of mental disorders, it is believed that the estimates of prevalence
reported by Indian epidemiological studies are much lower than the accurate reflections in the popu-
lation. Such inaccuracies may result from systematic underreporting due to stigma, unreliable infor-
mants, use of low sensitivity screening instruments and poor sampling methods (Math et al., 2007).
3. Burden of mental disorders
Burden not only refers to estimates of prevalence or costs associated with the disorder, but also of
disability, stigma and impact of living with a patient in terms of quality of life or health of family
members. Mental illness affects almost all areas of day-to-day functioning, resulting in greater dis-
ability and increased burden on caregivers (Swain & Behura, 2016). It also results in lower pro-
ductivity and earning potential, as well as a number of antisocial behaviours, crime, homelessness,
domestic violence, alcohol and drug use. Persons with mental disorders account for nearly a quarter
of the total caseload in primary care settings, highlighting the burden at peripheral levels as well
(Gururaj et al., 2016). In addition to their health impact, mental disorders cause a significant econ-
omic burden due to reduced productivity and economic output, as well as due to the link between
mental disorders and costly, potentially fatal conditions such as cancer, cardiovascular diseases, dia-
betes, HIV, obesity and so on (Mnookin, 2016). In addition, death by suicide, which is frequently
caused by mental disorders, also has an enormous impact on the family and society. Suicide
death rates in India are among the highest in the world, and at ages 15–29 years, suicide is the second
leading cause of death in both sexes after transport accidents (Patel et al., 2012).
According to the World Health Organization (WHO 2001), the burden of mental disorders is well
beyond the treatment capacities of developed and developing countries, and the social and economic
costs associated with this growing burden will not be reduced by the treatment of mental disorders
alone. The burden of mental illness is on the rise in India (Patel et al., 2011). Earlier, joint family
systems used to support many of the ill effects of disease, and persons with mental illness were man-
aged and cared for within the family. Unfortunately, this support system appears to be gradually
diminishing. Young people are migrating to urban areas because of urbanization and industrializ-
ation, resulting in increased isolation. Mental disorders are on the rise due to the stress and strains
of life, unemployment, disturbed sex ratios, poverty and poor quality of life. In addition, as mental
disorders are associated with widespread social stigma and discrimination, families do not easily dis-
close the disease until the illness becomes unmanageable (Luthra, 2017).
2SAHITHYA B. R. AND R. P. REDDY
3.1. Economic cost
Giving an exact estimate of the economic costs of mental illness is not an easy task as indirect costs of
mental disorders are higher than direct costs (Bloom et al., 2011). Direct costs include costs of con-
sultation, medication, hospitalization, diagnostics, residential care, community services, rehabilita-
tion and so on, while indirect costs include those costs incurred due to illness, such as the
reduced supply of labour, reduced educational attainment, expenses for social support and costs
associated with consequences like chronic disability, homelessness, crime, suicide, caregiver burden,
early mortality, substance abuse and so on. Mental health costs stand highest in terms of burden;
they account for more than half of the projected total economic burden from non-communicable
diseases and are responsible for 35% of the global lost output (Bloom et al., 2011). According to
recent global health estimates by the WHO (2015), mental disorders account for 30% of the non-
fatal disease burden worldwide and 10% of overall disease burden, including death and disability.
Bloom et al. (2011) estimated that the global cost of mental illness in 2010 was US$ 2.5 trillion,
and that 54% of that burden was borne by low- and middle-income countries. They projected
that by 2030 this figure would go up by about 240%, to $6 trillion, and the proportion of burden
borne by low- and middle-income countries will reach up to 58%. India alone stands to lose US
$1.03 trillion before 2030 due to mental health conditions (Bloom et al., 2014).
In India, Math and Srinivasaraju (2010) attempted to estimate the treatment costs of mental ill-
nesses. By taking the prevalence rate of mental illness as 200/1000 population, and calculating indi-
vidual cost of Rs. 500 per month, they estimated the approximate total cost required per month to be
Rs.10,000 crores (US$ 100 billion). However, they did not account for hospitalization or indirect
costs. The recent National Mental Health Survey of India (Gururaj et al., 2016) reported a higher
burden in terms of economic cost involved in care of a person with mental illness, mainly as out-
of-pocket expenditure. The researchers found that the families had to spend nearly Rs. 1000–1500
a month, mainly for treatment and travel to access care, which is nearly three times more than
what had been reported by previous researchers. However, they did not include hidden and intan-
gible costs, which are difficult to monetize, but add to the burden, often driving families into econ-
omic crisis.
3.2. Disability and unemployment
Disability is the restriction or inability to perform an activity within a range that is considered nor-
mal (WHO, 1980). Mental disorders are one of the largest contributors to disability worldwide,
accounting for 25% of total disability (WHO, 2001). Five of the ten leading causes of disability
are in the category of mental illnesses: major depression, alcohol dependence, schizophrenia, bipolar
affective disorder and obsessive-compulsive disorder (WHO, 2001). Mental and neurological con-
ditions account for 33% of all years lived with disability (YLDs), with neuropsychiatric disorders
alone accounting for 13% of the total disability-adjusted life-years (DALYs) lost due to all diseases
and injuries (WHO, 2002). However, disability associated with mental disorders appears to be sig-
nificantly underestimated, and recent estimates of disease burden for mental illness show that the
global burden of mental disorders account for 32.4% of YLDs and 13.0% of DALYs (Vigo, Thorni-
croft, & Atun, 2016).
In addition, people with long-term mental health problems have more chronic health conditions,
tend to develop chronic health conditions at a younger age and die sooner following diagnosis than
others (WHO, 2011). People with mental disorders have higher mortality rates. Those with schizo-
phrenia and major depression have an increased risk of mortality (1.6 and 1.4 times, respectively),
which is greater than that of the general population because of physical health problems associated
with mental disorders (Funk, 2012).
Disability is caused not only because of the nature of symptoms or comorbid physical conditions,
but also due to the side-effects of some of the medication used in treatment. The side-effects include
INTERNATIONAL JOURNAL OF CULTURE AND MENTAL HEALTH 3
drowsiness, dizziness, headache, confusion and so on, which create difficulties at work or in school.
Disability may also be due to the irregular nature of the illness, which creates problems in establish-
ing or maintaining consistent work or school patterns, thereby interrupting education or training.
Mental health problems also affect one’s efficiency at work due to decreased concentration, activity
and performance, or absenteeism, which might result in unemployment. In many developed
countries 35–45% of absenteeism is because of mental health problems (WHO, 2003). Disability
leave for mental disorders is almost twice the cost of a leave due to physical illness, and individuals
with mental illness are less likely to be employed (Dewa & McDaid, 2011). In fact, unemployment
rates are as high as 70–90% for people with severe mental illnesses (Marwaha & Johnson, 2004).
There are very few Indian studies that have looked into the employment status of persons with
mental illness. Sometimes, a person is looked after within the joint family systems or given minor
role in family business or agricultural activities. However, this is not always the case, especially in
urban setups. The latest census (Registrar General of India, 2011) recorded self-reported disabilities,
which included mental illness. This is probably the first study of its kind to investigate the employ-
ment status of persons with mental illness in India. This study indicated that 78.62% of persons with
mental illness were not employed, and only 13.15% were currently employed. Such a high rate of
unemployment among persons with mental illness calls for immediate attention to create healthy,
special job opportunities, reservations and several other rehabilitative measures exclusively for
this vulnerable group (Ramasubramanian, Mohandoss, & Namasivayam, 2016).
3.3. Family burden
Family members are often the primary caregivers of people with mental disorders, who provide
emotional and physical support to the patient and bear the financial expenses associated with treat-
ment and care. Families may experience an array of stress ranging from the objective burden (e.g.
healthcare costs) to the subjective burden (e.g. fear, anxiety, mental and physical stress and fatigue).
The burden faced by families of persons with mental illness is higher than that bourne by families
of persons with physical illness, and it affects family leisure, family routines and interactions, as well
as mental health of other family members (e.g. Gautam & Nijhawan, 1984). In addition to the econ-
omic costs, symptoms and treatment, the patients and their family suffer from emotional strain due
to discrimination, social isolation, stigma, disability, poverty, poor quality of life and failure in many
aspects of life (Yerramilli & Bipeta, 2012). Such families make a number of adjustments and com-
promises, which prevents them from leading a satisfactory life or achieving their full potential (Gal-
lagher & Mechanic, 1996). They experience significant stresses and various psychological strains
while providing care to their ill relatives (Senthil, 2017).
The demands of being involved in the care of persons with serious mental illness have a tremen-
dous impact on the caregiver’s health as well (Math et al., 2007). Families perceive patient’s care as a
full-time job. They describe their burden as being very sad, drained and lonely (Marsh et al., 1996).
Quite often, jobs are lost or given up, and in any given quarter of the year family members of affected
individuals miss about 10–20 working days taking care of persons with mental illness (Gururaj et al.,
2016). Caregivers may also experience anger towards the patient or other family members for lack of
support, involvement or even ignorance of the patient. They may often experience, what Lefley (as
cited in Pratt, Gill, Barrett, & Roberts, 2013, p. 412) called the ‘Dilema of Functional Expectancy’,
which refers to frustration when persons with mental illness do not meet normal role expectations.
4. Barriers to mental health in India
While the burden of mental illness is in catastrophic proportions, the resources available to tackle it
are insufficient. The treatment gap, as measured by the absolute difference between the true preva-
lence of a disorder and the treated proportion of individuals affected by the disorder, is very high
(Thirunavukarasu, 2011). Nearly two-thirds of persons with known mental disorders never seek
4SAHITHYA B. R. AND R. P. REDDY
help from health professionals, and are at risk for harmful practices such as visiting faith healers and
delaying treatment until the condition deteriorates (Luthra, 2017). A survey of an urban community
in southern India found that one-third of people with schizophrenia had never accessed any treat-
ment resources despite the availability of treatment (Padmavathi, Rajkumar, & Srinivasan, 1998).
Even after they were offered treatment in a follow-up study, one-third of them remained untreated
(Srinivasan, Rajkumar, & Padmavathi, 2001). They found that unemployed status of male patients,
living in a joint family setting and families initially unaware of the psychiatric nature of the problem
were the leading factors that related to failure to seek treatment. The latest national mental health
survey (Gururaj et al., 2016) also reported that nearly 80% of persons suffering from mental dis-
orders had not received any treatment despite the presence of illness for more than 12 months.
Another large epidemiological survey also reported that there was a huge treatment gap of 90%,
and only 5 out of 100 individuals with common mental disorders had received any treatment
over the past year (Sagar et al., 2017).
One of the major reasons attributed to such a wide treatment gap is the problem of inadequate
resources and non-availability of mental health services. Funding allocation to mental health services
continues to be inadequate in India. Although the federal budget allocates 4.6% of the gross domestic
product to health, which works out to per capita sum of US$0.22, mental health receives only 0.06%
of the general health budget (Rathod et al., 2017). In addition, existing mental health services are
lacking in India. There is an alarming deficit of 77% for psychiatrists, 97% for clinical psychologists
and 90% for psychiatric social workers (PSWs) (Agarwal, Salhan, Shrivastava, & Goel, 2004). It is
estimated that in India, there is only one psychiatrist for every 10 lakh (1 million) of population,
and this proportion is less in rural settings. The median number of psychiatrists in India is only
0.2 per 100,000 population compared to a global median of 1.2 per 100,000 population. Similarly,
the figures for psychologists, PSWs and nurses working for mental health are 0.03, 0.03 and 0.05
per 100,000 population compared to a global median of 0.60, 0.40 and 2.00 per 100,000 population,
respectively (WHO, 2005). As against an estimated requirement of 11,500 psychiatrists, 17,250 clini-
cal psychologists, 23,000 PSWs and 3000 psychiatric nurses, only approximately 3000 psychiatrists,
500 clinical psychologists, 400 PSWs and 900 psychiatric nurses are available (Goel, Agarwal, Ichh-
pujani, & Shrivastava, 2003).
There is a shortage of training centres as well, which are unable to keep up with the demand for
mental health professionals. The existing training infrastructure in the country produces approxi-
mately 320 psychiatrists, 50 clinical psychologists, 25 PSWs and 185 psychiatric nurses per year
(Sinha & Kaur, 2011). In addition, the undergraduate medical curriculum assigns only 1.4% of lec-
ture time and 3.8–4.1% of internship time to psychiatry (Thirunavukarasu & Thirunavukarasu,
2010). Hence, the general practitioners and the non-psychiatrist specialists do not have the necessary
training and are unprepared to competently deal with mental health problems in their practice.
To add to the conundrum, the state of the mental hospitals is also not satisfactory. The existing
facilities in the country fall short of the required norms, with number of psychiatric beds to be about
0.2 per 1,00,000 population (Mohandas, 2009). In addition, the majority of large psychiatric facilities
are run by the government sector and are centred in a few urban areas. The psychiatric services are
not yet integrated into the primary healthcare system, which has led to a scarcity of such facilities for
a large proportion of people with mental illness. Hence, a significant population in India is in dire
need of psychiatric services as they are living in rural places and cannot access mental healthcare
easily, or they cannot afford such care. Moreover, there is very little emphasis on rehabilitation in
psychiatry, and shortage of manpower, increased workload and lack of rehabilitation skills have
resulted in inadequate rehabilitation facilities (Chavan & Das, 2015).
Adding to the woes is the lack of structured administration to dispense available services effec-
tively. Regardless of various government initiatives to address the problem associated with mental
illness, the number of persons getting these benefits is very low because of many barriers such as
stigmatization and discrimination (Chandrashekar, Kumar, Prashanth, & Kasthuri, 2010). Mental
health programmes and activities in India are fragmented, disorganized and have a low priority
INTERNATIONAL JOURNAL OF CULTURE AND MENTAL HEALTH 5
during implementation as they suffer from administrative, technical and resource constraints and,
thus, result in limited reach (Gururaj et al., 2016). A huge proportion of people do not seek help
because of lack of knowledge about symptoms of mental illness, myths and stigma related to it,
and lack of awareness of available treatment and its potential benefits (Sinha & Kaur, 2011).
Other major barriers in seeking help include low literacy, religious beliefs and discrimination associ-
ated with mental illness (Kumar, 2011). Despite there being an availability of welfare measures such
as pensions, legal aid and travel concessions for people with disabilities through the Persons with
Disabilities Act (PWD Act, 1995), the effective coverage of such welfare measures, however, still
remains uncertain.
5. Initiatives to tackle the burden of mental illness in India
The problem posed by mental illness has not been ignored, and active steps have been taken by the
government of India to bridge the treatment gap. In recent years, mental health has been receiving
significant attention by the policy makers, and attempts are being made to improve services and
increase manpower through various schemes and budget revisions. This was first attempted through
the launch of the National Mental Health Program (NMHP) (Director General of Health Services,
1982). The main objectives of the NMHP were to ensure the availability and accessibility of mini-
mum mental healthcare for all, to encourage the application of mental health knowledge in general
healthcare and social development, and to promote community participation in mental health ser-
vice. There have been several revisions to the NMHP over the last few decades since its conceptual-
ization. Keeping up with the global trend of community care of mental illness, the NMHP was
decentralized through the District Mental Health Program (DMHP). By the end of 11th plan
(2007–2012) the DMHP had expanded and was implemented in 200 districts all over India. It intro-
duced various schemes to establish a number of centres of excellence in the field of mental health by
upgrading/strengthening existing mental hospitals/institutes, and made provisions to increase
human resources. There has been a substantial increase in the budget allocation for DMHP, from
Rs. 280 million in the ninth 5-year plan to Rs. 1390 million in the tenth 5-year plan period. However,
it constituted to only 2% of public health expenditure (Sinha & Kaur, 2011).
Currently, we are into the twelfth 5-year plan (NMHP, 2012), and a budget of Rs. 10,000 million
has been allocated. There are dedicated manpower development schemes in addition to continuing
with the community care approach adopted under the DMHP. Under the scheme, 11 centres of
excellence in mental health, 120 post-graduate departments in mental health specialties, the upgrad-
ing of psychiatric wings of medical colleges and modernization of state-run mental hospitals will be
supported. These schemes are aimed at increasing post graduate training capacity in the mental
health specialties of psychiatry, clinical psychology, PSW and psychiatric nursing. Manpower Devel-
opment schemes are expected to deliver 104 psychiatrists, 416 clinical psychologists, 416 PSWs and
820 psychiatric nurses every year once these institutions and departments are established.
A significant policy change in recent years involved training in undergraduate medical pro-
grammes to sensitize medical students to mental health problems. Until 2008, psychiatry was not
mandatory for the successful completion of house internship. In 2008 the Medical Council of
India (1997) made it mandatory for interns to rotate exclusively through psychiatry for two
weeks. In 2011 teaching hours in psychiatry increased from 20 to 40 hours, and the clinical posting
was increased from 2 to 4 weeks. Another major development in the area of mental health was the
introduction of the Mental Health Care Bill (2013). The bill states clearly the rights of persons with
mental illness to access good quality mental healthcare and treatment, protection from inhuman and
degrading treatment, free legal services, access to medical records and the right to complain; de-
criminalization of suicide; and the abolition of direct electroconvulsive therapies. The bill also man-
dated that the insurance companies should endeavour to make provisions for medical insurance for
treatment of mental illness on the same basis as is available for the treatment of physical illness.
6SAHITHYA B. R. AND R. P. REDDY
Additionally, for the first time, the Government of India took steps to include mental health in the
public health programme the National Mental Health Policy (2014), with the vision of promoting
mental health, preventing mental illnesses, enabling recovery and the socioeconomic inclusion of
persons affected by mental illness, by providing accessible, affordable and quality health and social
care to all persons in their lifespan. It was formulated based on the resolution made at the 65th World
Health Assembly (2012), which emphasized the need for a comprehensive, coordinated global
response, considering the ramifications of the burden of mental disorders. The aim was to reduce
the stress, disability, morbidity and premature mortality associated with mental health problems.
The ‘Rights of Persons with Disabilities’bill (Ministry of Social Justice and Empowerment, 2014)
was also passed, which made provision for a 5% reservation of posts in all government establish-
ments for persons with disability, out of which 1% will be reserved for those with autism, intellectual
disability and mental illness combined.
6. Future directions and conclusion
The challenge that India faces in trying to meet population needs for quality mental healthcare are
huge and require urgent and impactful interventions. Recent developments display the seriousness
with which our lawmakers view the mental health challenge. Future prospects for mental health look
bright in India as the government is becoming increasingly aware and concerned about mental
health problems. Issues like stigma, non-governmental organization participation, research, train-
ing and preventitive and promotive mental health services are being taken up in earnest. Not only
has there been an increase in expenditure towards mental healthcare, there has been a growing pol-
itical commitment to mental health, which can be seen through various revisions of the mental
health programme, the introduction of a national mental health policy and the mental healthcare
bill. However, despite such aggressive strategies, mental health status in India is far from satisfactory.
There has been both appreciation and criticism of India’s mental health initiatives. Where policies
are concerned, India is on a par with its Western counterparts; however, it lags behind in implemen-
tation. Despite progressive thinking and aims, the funding continues to be in deficit and progress has
been slow. Thus, the huge burden of mental disorders calls for the attention of politicians, policy
makers, mental health professionals and society at large to improve the availability, accessibility
and quality of mental healthcare, with an emphasis on prevention and promotion. Usually several
factors interact where mental health is concerned, hence reforms at various levels of healthcare sys-
tem are required, and these involve reforming policy and legislation, addressing barriers to financing,
affordability and service delivery, as well as addressing human resource barriers and filling gaps in
data and research (Mnookin, 2016).
The effective care of individuals with mental illness requires a comprehensive mental health sys-
tem involving governance, healthcare institutions and community settings. This involves building a
multi-sectorial consensus backed by a strong political will to enact holistic mental health plans. All
policies and programmes in health, and all related sectors of welfare, education, employment and
other programmes, should include and integrate a mental health agenda in their policies, plans
and programmes. Establishing a number of centres in rural areas and increasing the number of men-
tal health professionals in general hospitals can address the accessibility and availability of mental
health services. The emphasis should also be on the modernization and upgrading of government
run mental hospitals, as well as on training in mental health for improving service delivery.
The integration of mental healthcare into the primary healthcare system can increase easy acces-
sibility and early intervention. Most hospitals do not screen for mental illness unless specifically
asked by the patient or family members. However, routine screening for mental disorders can
lead to early detection and intervention, which can lead to a better prognosis. In addition, interven-
tions should not be seen as being isolated from one another; rather, they should be incorporated into
different delivery platforms, such as primary care and community health. Although insurance pol-
icies have recently begun to cover mental healthcare, there are several challenges that are likely to
INTERNATIONAL JOURNAL OF CULTURE AND MENTAL HEALTH 7
hinder universal coverage of mental healthcare, and this needs to be addressed immediately to make
treatments more affordable.
There is also an urgent need to establish a well supported rehabilitation centre that aims at main-
streaming people recovering from mental illness. Mental disorders are interconnected with poverty,
unemployment, stigma and other social stressors, and there is a need for social workers who can help
the recovering individual integrate with society by addressing the needs of employment, skills train-
ing and accommodation. This requires establishing centres such as vocational training centres, day-
care centres, hostels, half-way homes and support groups, at both the district and state levels.
Use of available human resources can meet the current shortage of mental health professionals.
Available professionals such as nurses, teachers, anganwadi (rural mother and child care centre)
workers and so on are underutilized where mental health is concerned. Mental health in work places
and educational institutions can aim at health promotion, early detection and awareness. Pro-
grammes such as school-based interventions, workplace interventions and interventions related to
conflicts and natural disasters have been successfully utilized in Western countries, and the same
approach can be utilized in India to enhance mental wellbeing.
Advocacy for mental health by actively engaging communities through various programmes,
media and social media is critical to promoting awareness and acceptance. Educating people
about nature of mental illness may prevent stigma, shame and secrecy, and put an end to
magico-religious treatments. Anti-stigma campaigns can be used as powerful tools to fight social iso-
lation and discrimination in areas such as employment, education and housing.
There is also a need to promote research in the area of mental health. While research is rigorous in
areas of psychopathology and treatment, there is a dearth of studies that focus on issues related to
burden, disability and economic cost in India. It is well known that those individuals who receive
treatment are better able to study or work productively, and that even though mental disorders gen-
erate a large economic and social cost, treating or preventing them can also generate substantial
health and economic gains (Mnookin, 2016). However, there are not many long-term epidemiolo-
gical studies that answer questions related to the costs and benefits of investing in mental health.
Such research can help convince policy makers that investing in mental health is good investment,
and their funding to address mental health issues will provide a good return in terms of improved
health and restored productivity.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributors
Sahithya B. R. is a Clinical Psychologist, with an M.Phil (Clinical Psychology Degree), currently pursuing full-time
PhD in the department of psychiatry in St. John’s Medical College, Bangalore India.
R. P. Reddy is a Clinical Psychologist, (MPhil, PhD, PDF), currently working as assistant professor in the department
of clinical psychology in NIMHANS, Bangalore, India.
ORCID
Sahithya B. R. http://orcid.org/0000-0002-9234-1552
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