Treatment coverage for major depressive disorder (MDD) remains low worldwide despite it being the leading cause of disability. According to research conducted by the Institute for Health Metrics and Evaluation at the University of Washington, only 33% of people diagnosed with MDD in high-income countries and a scant 8% in low- and lower-middle-income countries took advantage of mental health services.
The study, published in please journal—a nonprofit open access science, technology, and medicine publisher—on February 15, aims to provide a comprehensive review of estimates of MDD treatment coverage and gaps by location and type of treatment between 2000 and 2019.
Nearly 75% of MDD patients worldwide live in low- and lower-middle-income countries, according to the study, The Global Gap in Treatment Coverage for Major Depressive Disorder in 84 Countries Between 2000 and 2019: a systematic review and a Bayesian meta-regression analysis’, it showed.
The study was based on a meta-regression analysis of data from 149 studies, 342 data points, and 84 countries between 2000 and 2021 on MDD treatment. While global health financing has historically prioritized malaria, HIV/AIDS, and tuberculosis, which are some of the leading causes of disability and mortality in many low- and middle-income countries, global health financing mental is still far from adequate, found .
In 2019, development assistance for health (DAH) for noncommunicable diseases (including mental disorders) for Sustainable Development Goal 3 targets was $700 million for 135 low-income countries and medium, which represents less than 2% of the total estimated DAH in 2019. 2019 of $40.6 billion. “Therefore,” the study said, “it is important to align funding priorities with epidemiological changes in countries that are likely to be accompanied by an increase in the burden of noncommunicable diseases, including mental disorders.”
Previous analysis had shown that scaling up effective treatment for depression and anxiety disorders leads to an additional 43 million years of healthy life and a net present economic value of $310 billion between 2016 and 2030, the researchers said.
In conclusion, the study said: “Ultimately, our findings emphasize the need for governments and policymakers to reconsider the availability of appropriate care for MDD and treatment facilitators as they respond to the heavy burden imposed by this disorder.”
MENTAL HEALTH EPIDEMIC IN INDIA
Mental illnesses, including depression, anxiety, schizophrenia and neuropsychotic disorders, contribute 18.5% to the global burden of disease. India bears a disproportionate component of this burden with 56 million cases of depression, 43 million anxiety disorders and a large number of people committing suicide daily. The World Health Organization estimates the economic loss due to mental health conditions in India between 2012 and 2030 at Rs 75.84 lakh crore.
While developed countries allocate between 5% and 18% of their annual healthcare budget for mental health, India spends roughly 0.05%. In a rare occurrence, deteriorating mental health among Indians found a mention in Union Finance Minister Nirmala Sitharaman’s 2022-2023 budget speech. “The pandemic has accentuated mental health problems in people of all ages,” she said in announcing the launch of a National Tele Mental Health Program to “improve access to quality mental health care and counseling services.”
The program will include a network of 23 mental health telecenters of excellence. “The National Institute of Mental Health and Neurosciences (NIMHANS) will be the hub and the Indian Institute of Information Technology in Bangalore will provide technology support,” Sitharaman said.
In addition, an open platform for the National Digital Health Ecosystem will be deployed. “It will consist of digital records of health providers and health establishments; a unique health identity; framework of consent and universal access to health facilities,” said the minister.
The National Mental Health Program (NMHP) was launched in 1982. A District Mental Health Program under NMHP was launched under the Ninth Five Year Plan in 1996. It is supposed to provide mental health services in 692 districts. In addition to NMHP, the Center also funds two NIMHANS Bengaluru institutes and the Lokpriya Gopinath Bordoloi Regional Mental Health Institute in Tezpur, Assam.
The budget increased the allocation for NIMHANS from around Rs 500 crore to Rs 560 crore and Lokpriya Gopinath Bordoloi Regional Institute of Mental Health from Rs 57 crore to Rs 70 crore compared to last fiscal year.
Unfortunately, the grant for NMHP remained unchanged at Rs 40 crore. The allocation of funds to mental health care services still represents only 0.81% of the total outlay of Rs 71,269 crore to the Ministry of Health and Family Welfare.
Despite the low allocation for NMHP, funds have been underutilized even during the pandemic. In 2021, the Parliamentary Standing Committee on Health and Family Welfare noted underspending of funds. “The Committee is of the opinion that a consistent under-use over the years under this heading clearly points to the ministry’s inability to understand the magnitude of the mental health burden in the country.”
Despite studies highlighting “the high prevalence of mental illness in the country,” “substantial progress has not been made in facilitating a robust mechanism for the delivery of mental health services,” the Committee added.
In its analysis of the 2021-2022 budget, the Mental Health Observatory of India mentioned that different population groups have faced varying levels of emotional distress which, in some cases, may have been made worse by psychosocial and economic factors, including loss of employment, depleted savings, and financial insecurity have affected large sectors of the population, particularly those working in the informal sector. “The lack of social interaction has implications for children’s social and emotional development,” he said.
