India needs to talk about mental illness

At least 13.7 percent of India’s general population has various mental disorders; 10.6 percent of them require immediate interventions. While nearly 10 percent of the population has common mental disorders, 1.9 percent of the population suffers from severe mental disorders. These are some of the findings of a National Mental Health Survey held recently and conducted by the National Institute of Mental Health and Neurosciences (NIMHANS).

That is not all. The prevalence of mental morbidity is very high in urban centers, where there is a higher prevalence of schizophrenia, mood disorders, and neurotic or stress-related disorders. This disturbing scenario could be due to fast-paced lifestyles, stress, complexities of living, a breakdown of support systems, and economic instability challenges. In 2014, concerned over the growing problem of mental health in India, the Union Ministry of Health and Family Welfare appointed NIMHANS to study mental health status in the country.

After a pilot feasibility study in Kolar district, Karnataka using a sample size of 3,190 individuals, the team, which comprised senior professors from NIMHANS, G. Gururaj, Mathew Varghese, Vivek Benegal, and Girish N., began the survey in Punjab, Uttar Pradesh, Tamil Nadu, Kerala, Jharkhand, West Bengal, Rajasthan, Gujarat, Madhya Pradesh, Chhattisgarh, Assam, and Manipur Extra Update.

The study covered all important aspects of mental illness, including substance abuse, alcohol use disorder, tobacco use disorder, severe mental illness, depression, anxiety, phobia, and post-traumatic stress disorder, among others — and had a sample size of 34,802 individuals. Primary data collection was done through computer-generated random selection by a team of researchers and local teams of co-investigators and field workers in the 12 States.

While the overall current prevalence estimate of mental disorders was 10.6 percent in the total surveyed population, significant variations in overall morbidity ranged from 5.8 percent in Assam to 14.1 percent in Manipur. Assam, Uttar Pradesh, and Gujarat reported prevalence rates of less than 10 percent. In eight of the 12 States, the prevalence varied between 10.7 percent and 14.1 percent.

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Treatment gaps and impact

A major concern in the findings, which were recently submitted to the Union Health Ministry, is that despite three out of four persons experiencing severe mental disorders, there are huge gaps in treatment.

Apart from epilepsy, the treatment gap for all mental health disorders is more than 60 percent. Mental disorders’ economic burden is so huge that affected families spend nearly Rs.1,000-Rs.1,500 a month mainly for treatment and access to care.

Due to the stigma associated with mental disorders, nearly 80 percent of those with mental disorders had not received any treatment despite being ill for over 12 months, the study says. Poor implementation of schemes under the National Mental Health Programme is largely responsible.

Dr. Gururaj says that there is also a lack of mental health specialists, pointing out that mental disorders are a low priority in the public health agenda. The health information system itself does not prioritize mental health.

Recommending that mental health financing needs to be streamlined, he says there is a need to constitute a national commission on mental health comprising professionals from mental health, public health, social sciences, and the judiciary to oversee, facilitate support, and monitor and review mental health policies.

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Prevalence of mental disorders in different States

Manipur: 14.1 %
Madhya Pradesh: 13.9 %
Punjab: 13.4 %
West Bengal: 13 %
Tamil Nadu: 11.8 %
Chhattisgarh: 11.7 %
Kerala: 11.4 %
Jharkhand: 11.1 %
Rajasthan: 10.7 %
Gujarat: 7.4 %
Uttar Pradesh: 6.1%
Assam: 5.8 %

Key findings

Common mental disorders such as depression, anxiety, and substance use are as high as 10 percent of the total population. Almost 1 in 20 suffer from depression; it is higher in females in 40-49 years. 22.4 percent of the population above 18 years suffers from substance use disorder

The highest was contributed by tobacco and alcohol use disorder. Nearly 1.9 percent of the population is affected by severe mental disorders. These are detected more often among males in urban areas. While the prevalence of mental illness is higher among males (13.9 percent) as compared to females (7.5 percent), certain specific mental illnesses like mood disorders (depression, neurotic disorders, phobic anxiety disorders, etc.) are more prevalent in females. Neurosis. Stress-related diseases are also seen to be more common in women. Prevalence in teenagers aged between 13 and 17 years is 7.3 percent.