FE Mental Health Series | India’s troubled minds! How land of 140 crore faces severe shortage of mental health experts – News Healthcare

Mental health involves emotional, psychological, and social well-being. Mental health plays a crucial role in how we think, feel, and act, and it also helps in determining how we handle stress, relate to others, and make choices.

However, the status of mental health continues to deteriorate globally. A 2023 study published in The Lancet Psychiatry journal revealed that one out of every two people in the world will develop a mental health disorder in their lifetime. According to the study, the most common mental illnesses were mood disorders, such as major depression or anxiety, and that the risk of certain mental disorders differed by sex.

According to public health experts, mental health illnesses continue to be a major burden due to a lack of enough treatment options. Although there have been several prevention and treatment interventions, accessibility to these facilities continues to be a major challenge.

What is the status of mental health in India?

In India, the prevalence of mental health disorders has increased steadily in recent years. According to a 2023 study published in Cureus Journal, India is grappling with a high burden of mental health disorders, including depression, anxiety disorders, bipolar disorder, schizophrenia, and substance use disorders.

The study also revealed that “access to mental healthcare remains a significant concern, with considerable gaps in access to and quality of treatment and limited availability of mental health professionals, especially in rural areas.”

Prakriti Poddar, a Seattle-based wellbeing expert and Global Head, Mental Health at Roundglass Living app highlighted that the National Mental Health Survey (2015-16) indicates that nearly 15 percent of the population requires active intervention for one or more mental health issues.

“The stigma around mental illness, lack of awareness and infrastructure, discrimination, workplace and academic stress, physical healthcare challenges, gender inequalities, and poverty are all contributing to a heavy burden of mental illness in the Indian population. The National Mental Health Survey (2015-16) indicates that while, nearly 150 million Indians need mental health care services, less than 30 million are seeking care,” Poddar told Financial Express.com.

These challenges can be addressed by adopting a wholistic approach to mental health, which includes a greater emphasis and investment in preventive healthcare and improving access to mental health resources, Poddar said.

According to Poddar, the stigma surrounding mental illness often stems from misconceptions, fear, and a lack of awareness.

“If we compare India’s mental health challenges with those of the US, we find that in the US too a large part of the population is grappling with mental health issues – more than 1 in 5 US adults and over 1 in 5 youths (ages 13-18) live with a mental illness says the Centres for Disease Control. However, there’s more openness and an active dialogue around mental health challenges in the US with celebrities including actors, politicians and sportspersons courageously coming out to talk openly about their personal struggles with mental health,” she told Financial Express.com.

It is noteworthy that there has been several interventions by the government to improve the status of mental health in India. “The National Mental Health Policy introduced in 2014 and the Mental Healthcare Act of 2017 outline strategies to improve mental health services and safeguard individuals’ rights. The National Mental Health Program aims to deliver basic mental healthcare at the grassroots level and integrate mental health with general health services. Despite the initiatives, the government spending on mental health remains low,” Dr. Vishal Arora, Chief of Business Transformation & Operational Excellence, Artemis Hospitals told Financial Express.com.

Dr. Arora also India faces a significant and growing burden of mental health problems. The issues are magnified by challenges like shortage of professionals, social stigma, inadequate funding, and limited access to care.

“The government has introduced policies and programs to address these issues, however, much more needs to be done to ensure universal access to quality mental healthcare in the country,” he added.

Does India have enough mental health professionals?

There were more than 1 million mental health professionals working in the United States in 2023, Poddar revealed. The country has 207.4 mental health professionals for 100,000 people. In comparison, India has 0.75 psychiatrists for 100,000 people. However, the guidelines suggest that there should be at least three psychiatrists per one lakh population.

According to a report submitted by the Parliamentary Standing Committee on Health and Family Welfare in August 2023, there are 2,840 accredited clinical psychologists in India.

“In the current situation, the mental health status in India is poor and it is a grave situation across the country. One of the key reasons for this status is that there are so many taboos attached to it. If we talk about figures, around 20 to 25 percent of the individuals in India have some mental issues and this has seen an increase post-COVID. Also, the ratio of psychiatrists to patients in India is one psychiatrist for more than 1 lakh people. Psychologists are more in numbers, but the situation is not that good,” Dr. Vishesh Kasliwal, Founder and CEO Medyseva told Financial Express.com.

Meanwhile, Dr. Arora also highlighted that there is a severe shortage of mental health professionals in India. The country has only 0.75 psychiatrists, 0.07 psychologists and 0.07 social workers per 100,000 people. In developed countries, this number is around 6.6 psychiatrists per 100,000 people.

He also revealed that India is currently short of around 27,000 psychiatrists to reach the recommended ratio of 3 per 100,000 population.

“Every year somewhere between 700 and 1000 new mental healthcare professionals are trained in India. This is far below the required number to address the shortage. The availability of psychologists in India is also severely lacking, with only about 0.07 psychologists per 100,000 population. The required number of clinical psychologists in India is estimated to be around 20,000,” Dr. Arora told Financial Express.com.

As of July 2023, only 3372 clinical psychologists were available in the country, causing an acute shortfall. The number of psychiatric social workers in the country is estimated to be around 1500 against an estimated requirement of around 35,000, he revealed.

India faces a massive shortage of both psychiatrists and psychologists compared to the recommended standards and the actual mental health needs of the population.

This shortage is a key challenge in providing adequate and accessible mental healthcare services across the country, he said.

“In the financial year 2024-25, the mental healthcare budget is only 1 percent of the total healthcare budget. This is very low considering the size and seriousness of the problem. The treatment gap for mental disorders in India ranges from 70-92 percent, meaning a vast majority of those affected do not receive the care they need. The cost of mental health treatment can be prohibitive for many Indians, preventing timely and adequate care,” he revealed.

In contrast, the situation is generally better in developed countries, which have higher ratios of mental health professionals, greater public awareness, and more
robust mental healthcare systems and funding, he said. However, mental health challenges persist globally, with the COVID-19 pandemic worsening the burden of conditions like anxiety and depression worldwide, he added.

According to Poddar, there are various reasons for the shortage of mental health professionals, such as fewer post-graduate seats for psychiatry and even fewer super specialization courses in this discipline.

“At the undergraduate level too, there’s not enough focus on this mental health and only a few mandatory psychiatry exams. The existing stigma around mental health leads to fewer patients seeking medical treatment and impacts the demand for mental health professionals. Low demand for mental health professionals translates to fewer seats in medical colleges for disciplines like psychiatry and also, perhaps, to low allocation of budget and funds for promoting mental healthcare in the country. So, it becomes a vicious circle which contributes to patients not getting timely care and spiking the prevalence of mental illness in the population, she told Financial Express.com.

Despite growing awareness about mental healthcare, social stigma surrounding mental health conditions persists, particularly in India, she said.

“Patients are still hesitant to seek professional medical help, resulting in underutilization of mental healthcare services which in turn impacts the number of medical professionals as well. As a result, the treatment landscape remains non-standardized with varying approaches to diagnosis and treatment,” Poddar added.

Dr. Kasliwal revealed that Indians after completing their MBBS are drawn towards more traditional outlets like surgeons, cardiologists, etc. “One of the reasons for the shortage of mental health professionals is that not many doctors are drawn towards being a psychiatrist as they feel it is a challenge and they feel it is not right from a work perspective as well,” he said.

The number of patients with mental illness is relatively high however the struggle is to get them to the doctor’s clinic, he pointed out. “We are seeing a gradual rise in the number of doctors graduating as psychiatrists but at the same time we are seeing an ever-increasing rise in the number of patients due to which the number or health professionals is still looking low,” he told Financial Express.com.

Last year, On the occasion of World Mental Health Day last year, Niti Aayog member (health) Dr V K Paul said that postgraduate medical seats in psychiatry need to be increased to achieve the required manpower.

In 2022, the government launched Tele-Manas, a tele-mental health helpline and till date the platform has provided counseling to more than 905225 through 51 tele Manas Cells. More than 1,000 calls are being received on this helpline every day.

What are the challenges that mental health professionals are facing in India?

Professionals in the field are overstretched and often work under challenging conditions, facing issues like patient overload, insufficient infrastructure, and ongoing stigma.

According to Dr K Madan Gopal, Advisor, Public Health Administration, NHSRC, a premier think tank for Ministry of Health and Family Welfare, these challenges complicate treatment delivery and can lead to professional burnout.

“In comparison to Western countries where mental health services are more integrated and accessible, India struggles with a significant gap in mental health literacy and service availability, particularly in rural areas. Stigma continues to be a formidable barrier, delaying or preventing effective treatment and social acceptance,” Dr. Gopal told Financial Express.com.

Dr. Arora highlighted that some of the key challenges that mental health professionals are facing in India include:

• Inadequate Infrastructure and Resources: There is a shortage of psychiatric hospitals, outpatient clinics, and community-based mental health services, particularly in rural areas.
• The lack of appropriate infrastructure and resources hinders the delivery of comprehensive mental healthcare services.
• Stigma and Lack of Awareness: Stigma surrounding mental health issues in India discourages individuals from pursuing careers in mental health professions.
• Limited Integration with Primary Healthcare: Mental health services are not adequately integrated into primary healthcare systems in India.
• Financial Barriers: The limited budgetary affects the development of infrastructure, training programs, and recruitment of mental health professionals. This lack of funding hampers efforts to address the shortage of mental health professionals effectively.

“The key challenges faced by mental health professionals in India include the severe shortage of personnel, uneven distribution of services, inadequate infrastructure and resources, stigma and lack of awareness, limited integration with primary care, and insufficient funding, all of which contribute to the significant treatment gap for mental health issues in the country,” he told Financial Express.com.

The existing stigma around seeking treatment for mental health illnesses in India makes it hard for psychiatrists to build up a successful practice in India. According to Dr. Kasliwal, acceptance of the illness is the main challenge faced in India and it is still considered a big taboo to talk or share about the illness.

“‘He is Crazy’ is a statement we all hear if anyone has visited a psychiatrist or consulted a psychologist. To avoid being labelled ‘Crazy’ or ‘Mad’ people do not want to take their children, themselves or any of their family members to see the doctor,” he told Financial Express.com.

“In the rural areas, mental illness is unspeakable and people think that the person is possessed by a demon or they think someone has done some blackmagic. To understand that it is a health problem and is treatable, will lessen the challenges faced by doctors and patients alike,” Dr. Kasliwal revealed.

The way forward

To improve the status of mental health in India, there is a need to implement a multi-faceted approach in which the role of all the stakeholders, especially civil society, is equally essential.

“We need appropriate legislation and advocacy to increase the number of mental health professionals in India,” Poddar said. According to Poddar, steps like increasing the number of seats in the psychiatry discipline, introducing more courses and exams at the undergrad level and more super-specialization courses, and increasing the budget for mental healthcare in India, and integrating mental health services into primary healthcare and increasing awareness at the grassroots level can play a crucial role.

“…focusing more on preventive healthcare measures and improving access to mental health resources, leveraging AI-enabled tech tools, like mental health apps, to improve outcomes of mainstream treatment modalities, increasing the number of psychiatric nurses, psychologists, and other mental health professionals,” Poddar told Financial Express.com.

This can be achieved by expanding training programs that attract more individuals to the field and provide them with the necessary skills and knowledge to practice effectively. Integrate modern medicine and traditional healing systems for a more wholistic approach to mental health, she said.

“Psychometric Analysis at every stage be it when you are entering a school, there or when you are entering college, even when one joins the corporate workforce. It should become a mandate. With the help of the analysis, we will get to know if someone is suffering from mental illness and the treatment can start at an early stage. So, when these kinds of policies and regulations come into play, the holistic approach will change, the total approach will change and there will be much better results,” Dr. Kasliwal revealed.

He also emphasised on the need for Public-Private Partnership (PPP) to provide better solutions to the patients.

“I feel that the private and government agencies should work together in amalgamation. So, I believe that if it can be done together maximum number of mental health patients can be reached to provide a viable solution to their illness. In a population of 140-150 crores, more than 40% may have mental health problems,” he said.

According to Dr. Arora, the implementation of the Mental Healthcare Act, 2017 is a positive step, as it aims to protect the rights of individuals with mental illness and improve access to mental healthcare services. However, more needs to be done to ensure effective enforcement of this legislation.

“The government needs to take concrete steps to increase the number of mental health professionals, such as psychiatrists, psychologists, and psychiatric social workers, to address the severe shortage. This could involve expanding training programs, improving incentives, and ensuring equitable distribution of these professionals across the country. Mental health services should be better integrated into the primary healthcare system, enabling early detection, timely intervention, and continuity of care. This would help address the treatment gap and improve access to mental healthcare, especially in rural and underserved areas,” he told Financial Express.com.

The allocation of the national healthcare budget to mental health needs to be significantly increased from the current 0.16 percent to ensure adequate funding for infrastructure, training, and service delivery, he added.

He also highlighted that collective efforts from the government and the healthcare industry are required to tackle the stigma surrounding mental health issues and raise public awareness about the importance of mental well-being.

Moreover, steps like prioritising mental health in the National Health Agenda, empowering and supporting mental health professionals, strengthening Community-Based Mental Health Services, enhancing Mental Health Literacy and Education, Investing in comprehensive mental health literacy programs, promoting Intersectoral Collaboration and Partnerships, ensuring Monitoring and evaluation of Mental Health Initiatives can play a pivotal role in addressing the existing challenges, Dr. Arora maintained.

“By addressing these additional aspects, India can work towards building a more comprehensive, equitable, and responsive mental healthcare system that caters to the diverse needs of its population and promotes overall mental well-being,” he told Financial Express.com. 

DISCLAIMER: If you or someone you know is struggling with their mental health or in distress contact the Vandrevala Foundation’s helpline (+91-9999666555) which is available in 11 languages including English and can be accessed via telephone or WhatsApp 24×7. You can also contact Fortis Hospital’s National Helpline number 91-8376804102 which is available 24×7. You can also contact the Government Mental Health Rehabilitation Helpline ‘KIRAN’ at 18005990019 which is available 24×7.