The mental health issues, particularly in youth and old age people, are increasing by leaps and bounds during the last few decades in India. The rising and alarming trend of suicides among teenagers and youngsters is just one example. According to the National Crime Records Bureau, over 40,000 student suicides have been reported in India in the past five years. Though several other factors are also responsible for suicides, mental health disorders are the most prominent among them. The National Mental Health Survey (2016) reported that one in 10 adolescents has a mental health disorder. In fact, with over 250 million people under the age of 20, this crisis calls for immediate action.1 In December 2019, a study conducted by the India State-level Disease Burden Initiative, published in The Lancet Psychiatry, found that 197.3 million Indians (one in every seven) were suffering from mental disorders in 2017. The study throws light on the prevalence of mental disorders in Indian States between 1990 and 2017. Out of 197.3 million in 2017, 45.7 million cases suffered with depressive disorders and 44.9 million with anxiety disorders. Among the disorders with the highest prevalence, idiopathic developmental intellectual disability affects most Indians, at 4.5 per cent, followed by depressive disorders (3.3%), anxiety disorders (3.3%) and conduct disorders (0.8%). Tamil Nadu topped the list in case of depressive disorders (4.796 per 100,000), followed by Andhra Pradesh (4.563), Telangana (4.356), Odisha (4.159) and Kerala (3.897). In case of anxiety disorders, the prevalence is highest in Kerala (4,035), followed by Manipur (3,760), West Bengal (3,480), Himachal Pradesh (3,471) and Andhra Pradesh (3,462). For conduct disorders, Jharkhand and Bihar have the highest prevalence, at 983 and 974 per 100,000 people. Bihar and Uttar Pradesh, at 6,339 and 5,503 per lakh, respectively, have the highest prevalence of idiopathic developmental intellectual disability.2

The Lonely Elders

Because of changed social discourse, the elderly are forced to live alone in their houses. Their progenies remain outside the city, the state and sometimes, even the country, due to compulsions of lucrative jobs. Therefore, they are left alone or with their spouse only to fend for themselves. This solitary confinement causes mental stress of different kinds. According to a 2018 report of the World Health Organization (WHO), 15% of adults aged 60 and over suffer from a mental disorder, the most common being depression and dementia which affect approximately 5% and 7% of the world's older population, respectively. Anxiety disorders affect 3.8% of the older population. Older adults are also vulnerable to abuse (physical, verbal, psychological, financial and sexual), abandonment, and neglect. WHO states that 1 in 6 older people experience abuse. Further, some 50 million people worldwide live with dementia, and 60% of them live in low- and middle-income countries.

A survey carried out by IVH SeniorCare among 1,000 senior citizens whose children were abroad showed that loneliness was not uncommon among India's older adults. Around 39% of the respondents missed spending time with loved ones and seven out of every ten respondents felt their social interactions were either poor or needed to improve.3 Loneliness and not being able to use their time fruitfully, combined with diseases such as diabetes, hypertension and cancer also make an adverse impact on the psyche of old people. Generally, mental health deterioration has a direct impact on the physical health of a person.

Mental Disorders

There are different kinds of mental disorders which may be summarised as such: 4

1. Common mental disorders which include depression, anxiety disorders and substance use disorders, affect nearly 10% of the Indian population.
2. Depressive disorders are further classified as Major Depressive Disorders, Bipolar Disorders, Dysthymia and Anxiety disorders. Severe mental disorders include schizophrenia, alcohol abuse disorders, and non-affective psychoses.
3. People with mental disorders account for nearly one-fourth of the total caseload in primary care settings.
4. In spite of the presence of illness for more than twelve months, nearly eighty percent of people suffering from mental disorders had not received any treatment.

The Mental Health Care Act, 2017

This Act is said to be a major initiative to redress the prevalence of mental disorders and substantially improve the mental health of the people. According to Vikram Patel, the Pershing Square Professor of Global Health at Harvard Medical School, “India's Mental Health Care Act, 2017 is one of the most progressive legislations on mental health globally, and should be read as a bill of rights for people with mental disorders. Fundamentally, the Act enshrines equality for mentally ill people with those who have physical health problems in all matters related to healthcare.”5 It has conceptually shifted the focus of mental health legislation from treating the people with mental disorders as second-class citizens and providing affordable care, aligned with the preferences and needs of the affected person, through the primary care system funded by the government. From this perspective, the said Act is a “historical intervention” that can prove to be a game-changer if implemented properly and in the right spirit. In this regard, two specific features are noteworthy: first, the Act adopts a rights-based approach in as much as it places obligations on mental health services and prescribes procedures ensuring that mental health professionals offer treatment according to the person's will and preferences. The law envisages a provision for the right to make advance directives, that implies that a person may state how he wishes to be treated or not in the event that he has a mental illness and can't make decisions for himself at that time. In addition to that, the law recognizes an entire array of rights relating to confidentiality, access to medical records, protection from cruel treatment and non-discrimination based on social markers, including sexual orientation. These rights are meant to be protected at a time when a person is undergoing mental healthcare and treatment as an admitted patient or otherwise. Any violation or laxity in providing services can be brought into the knowledge of the Mental Health Review Boards. Any kind of non-compliance with the provisions contained in the said Act is punishable and the penalties can be imposed accordingly.

Further, the said Act is the first of its kind that mandates universal mental healthcare for all citizens. Prior to it, no law in India had recognized a right to healthcare as a universal right. Access to mental healthcare encompasses affordability, quality, and non-discrimination. ‘It offers a decentralized model, placing obligations on the central and state governments to put infrastructure, resources and budgets in place to bridge the deficit in mental health services and facilities. This includes integration of mental healthcare at the primary, secondary and tertiary levels, setting up community-based rehabilitative facilities, offering free mental healthcare to below poverty line families, and providing free essential medicines, among other things.’ Not only this but also, the Act places an obligation on insurance firms to provide health insurance to persons with mental illness on the same basis as other physical illnesses.6

The Status of Mental Health Insurance in India

In the aftermath of the Mental Healthcare Act of 2017, the central government for the first time, made medical insurance for the treatment of mental illnesses available, as in cases of physical illnesses. In this regard, the Insurance Regulatory and Development Authority of India (IRDAI) had issued a directive that asked insurance companies to make provisions to cover mental illnesses in their policies along with physical illnesses. According to the National Mental Health Survey, 2016, an estimated 150 million people require mental health interventions.7

However, the mental health insurance policies pay only for hospitalization. But such policies don't cover the outpatients who pay counselling fees to a psychiatrist. Only a small fraction of the mental health patients need hospitalization. This is a big lacuna which needs to be fulfilled at the earliest. That would encourage people to seek help from mental health practitioners and also reduce the stigma attached to it.

The Current Scenario

1. In India, a grossly inadequate professional resource base exists even today. It is evident from its ratio of 0.3 psychiatrists for 100,000 people, compared to China's 1.7. There are also massive deficiencies in the availability of trained clinical psychologists (0.07) and 0.12 nurses per 1,00,000 people, and psychiatric social workers. The budgetary provisions regarding the funding of the National Mental Health Programme seem to be insufficient.
2. The mental health services at the primary and district levels still need to be strengthened to increase coverage of the people in the vicinity of their dwelling places.
3. According to the National Mental Health Survey, 2016, it was estimated that over 85% of people with common mental disorders, such as depressive anxiety disorders and 73.6% of people with severe mental disorders, such as psychosis or bipolar disorder, do not receive any mental healthcare and treatment.8
4. The National Mental Health Survey, 2016, published by NIMHANS, showed that 13.7% of Indians are likely to have a mental illness during their lifetime. The survey also highlighted the huge treatment gap for mental illness, ranging from 28 to 83%. Stigma, discrimination and violation of rights are everyday occurrences for persons with mental illness and their families.9
5. To address the challenge of mental illnesses, the Government of India is implementing the National Mental Health Programme (NMHP) in the country. Under this programme, the District Mental Health Programme (DMHP) has been approved for 692 districts of the country for the early detection and management of mental disorders and illnesses. In order to tackle the problem of shortage of qualified mental health professionals in the country, manpower development schemes are being implemented for the establishment of Centre of Excellence and the strengthening/establishment of Post Graduate Departments in mental health specialities.10

The problem of growing mental health issues in India is gaining momentum every year. This phenomenon is most prevalent among the youth and the old people. While the youth are facing various challenges ranging from employment and other issues, the elderly people face loneliness and the feeling of being left out in society. All these circumstances result in different kinds of mental issues, ranging from depression to the development of suicidal tendencies. The mental health problems are further aggravated due to the absence of adequate medical care and attention. In this regard, the Government of India has enacted the Mental Health Care Act, 2017 which has been termed as epoch-making in the neglected realm of mental health care in India. But the desired results can only be achieved through the effective implementation of the said Act by the official machinery. The main thrust area is the availability of properly trained medical staff, including the doctors, nurses and other paramedical staff, to deal with people facing mental disorders. There is a dearth of trained clinical psychologists and psychiatrists, especially in rural areas, for basic consultation purposes. Moreover, the availability of government funds is also not sufficient to achieve the desired results. Medical insurance for people having some kind of mental disorder does not cover consultations with psychiatrists and counsellors. There is a need to redress the situation. Seeing the increasing trend of mental disorders cases every year, effective and more concrete measures are urgently required at the government level.

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References:

1. Gaurav Gogoi, The Adolescent At Home, The Indian Express, Apr 19, 2025.
2. Telling Numbers, Mental disorders among 20 cr Indians: breakup among states, The Indian Express, Dec 25, 2019.
3. Malathy.Iyer@timesgroup.com, Are lonely elders predisposed to mental illness? Doctor says late onset of psychosis on the rise, The Times of India, Oct 12, 2018.
4. Soumitra Pathare and Arjun Kapoor, New law can be game-changer, Hindustan Times, Sep 11,2018.
5. Vikram Patel, ‘New law is the most progressive globally', Hindustan Times, Sep 14, 2018.
6. Soumitra Pathare and Arjun Kapoor, New law can be a game-changer, Hindustan Times, Sep 11, 2018.
7. Editorial, Hindustan Times, Aug 22, 2018.
8. Soumitra Pathare and Arjun Kapoor, New law can be a game-changer, Hindustan Times, Sep 11, 2018.
9. JP Nadda, A life of dignity: New mental health care law is imminent and it will help fill a yawning treatment gap, The Times of India, Nov 24, 2016.
10. India 2024, Publications Division, Ministry of Information and Broadcasting, Government of India, 280.