Abstract
An estimated 197.3 million people have mental disorders in India, and majority of the population have either no or limited access to mental health services. Thus, the country has a huge burden of mental disorders, and there is a significant treatment gap. Public mental health measures have become a developmental priority so that sustainable gains may be made in this regard. The National Mental Health Program (NMHP) was launched in 1982 as a major step forward for mental health services in India, but it has only been able to partially achieve the desired mental health outcomes. Despite efforts to energize and scale up the program from time to time, progress with development of community-based mental health services and achievement of the desired outcomes in India has been slow. Public health measures, along with integration of mental health services in primary healthcare systems, offer the most sustainable and effective model given the limited mental health resources. The main barriers to this integration include already overburdened primary health centres (PHCs), which face the following challenges: limited staff; multiple tasks; a high patient load; multiple, concurrent programs; lack of training, supervision, and referral services; and non-availability of psychotropic medications in the primary healthcare system. Thus, there is an urgent need for a fresh look at implementation of the NMHP, with a focus on achieving sustainable improvements in a timely manner.
Highlights
Estimates made by the World Health Organization (WHO) suggest that mental and behavioral disorders account for around 12% of the global burden of disorders.[1]
It has been suggested that this may be an underestimation, considering the interconnectedness between mental illness and other socioeconomic conditions, especially in low- and middle-income countries (LMICs), which account for almost three quarters of the global burden of mental and behavioral disorders.[2,3]
Integration with Primary Care Currently, integration of community mental health services with primary healthcare is the most viable method to provide mental health services in most LMICs, including India, but significant shortcomings still exist in terms of achieving this goal.[38]
Summary
Estimates made by the World Health Organization (WHO) suggest that mental and behavioral disorders account for around 12% of the global burden of disorders.[1]. Integration with Primary Care Currently, integration of community mental health services with primary healthcare is the most viable method to provide mental health services in most LMICs, including India, but significant shortcomings still exist in terms of achieving this goal.[38] The main barriers to integration include the following: already overburdened PHCs with limited staff; multiple tasks; patient load; multiple concurrent programs; lack of training, supervision and referral services; and non-availability of psychotropic drugs in the primary healthcare system.[32] In this context, alternative mechanisms for program delivery, like the National Health Mission (which subsumed the National Rural Health Mission and National Urban Health Mission in India), should be considered. Attention needs to be focused on a systemic approach in order to debate the relevance of research questions, with the involvement of all stakeholders at appropriate levels (including policymakers, practitioners, advocacy groups and the community at large), and to generate resources and funds for this.[42,43,44]
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