Mental Health Care in INdia
Mental Health Care in INdia
Mental Health Care in INdia
REFERENCE NOTE .
No. 33/RN/Ref./December/2013
For the use of Members of Parliament
The reference material is for personal use of the Members in the discharge of their Parliamentary duties, and is not for
publication. This Service is not to be quoted as the source of the information as it is based on the sources indicated at the
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contained in the note/collection.
INTRODUCTION
Mental health is an integral and essential component of health. The World Health
Organization (WHO) defines mental health as a state of well-being in which an
individual realizes his or her own abilities, can cope with the normal stresses of life, can
work productively and is able to make a contribution to his or her community. In this
positive sense, mental health is the foundation for individual well-being and the effective
functioning of a community1.
Mental and behavior problems are increasing part of the health problems the
world over. The burden of illness resulting from psychiatric and behavioural disorders is
enormous. Psychiatric symptoms are common in general population in both sides of
the globe. These symptoms viz. worry, tiredness, and sleepless nights affect more than
half of the adults at some time, while as many as one person in seven experiences
some form of diagnosable neurotic disorder.
INTERNATIONAL SCENARIO
Prevalence of mental disorders as per World Health Report (2001) is around
10% and it is predicted that burden of disorders is likely to increase by 15% by 2020. At
the international level, mental health is receiving increasing importance as reflected by
the WHO focus on mental health as the theme for the World Health Day (4th October
2001), World Health Assembly (15th May 2001) and the World Health Report 2001 with
Mental Health as the focus22.
In 2008, the WHO Mental Health Gap Action Programme (mhGAP) was
launched which aims at scaling up services for mental, neurological and substance use
disorders for countries especially with low and middle income.
1
2
-2Taken together, mental, neurological and substance use disorders accounting for
13% of the total global burden of disease in the year 2004. Depression alone accounts
for 4.3% of the global burden of disease and is among the largest single causes of
disability worldwide (11% of all years lived with disability globally), particularly for
women. The gap between the need for treatment and its provision is large all over the
world. WHOs Mental Health Atlas 2011 provides data that demonstrate the scarcity of
resources within countries to meet mental health needs3.
The Director General, World Health Organization launched the Mental Health
Action Plan 2013-2020 on 7 October 2013. The action plan recognizes the essential
role of mental health in achieving health for all people. It aims to achieve equity through
universal health coverage and stresses the importance of prevention. The four major
objectives of the Action Plan are to:
Provide comprehensive, integrated and responsive mental health and social care
services in community-based settings.
World Mental Health Day. The day is celebrated at the initiative of the World
Federation of Mental Health and WHO supports this initiative through raising awareness
on mental health issues. The theme of the day in 2013 was Mental Health and Older
Adults.
On 10 December 2013 the Human Rights Day, WHO launched the MiNDbank. It
is a new online platform which brings together key international resources and national
policies, strategies, laws and service standards for mental health, substance abuse,
general health, disability, human rights and development. MiNDbank will facilitate
Sixty-sixth World Health Assembly, Comprehensive Mental Health Action Plan 2013-2020.
-3debate, dialogue, advocacy and research in order to promote national reform in line with
international human rights and best practice standards.
INDIAN SCENARIO
According to various community based surveys, prevalence of mental disorders
in India is 6-7% for common mental disorders and 1-2% for severe mental disorders. In
India the rate of psychiatric disorders in children aged between 4 to 16 years is about
12% and nearly one-third of the population is less than 14 years of age. With such a
magnitude of mental disorders it becomes necessary to promote mental health services
for the well being of general population, in addition to provide treatment for mental
illnesses. Treatment gap for severe mental disorders is approximately 50% and in case
of Common Mental Disorders it is over 90%4.
As per the National Survey of Mental Health Resources carried out by the
Directorate General of Health Services, Ministry of Health and Family Welfare during
May and July, 2002, the details of number of patients with mental disorders and
proportionate availability of psychiatrist, psychiatric nurses and social workers,
clinical psychologist and mental hospitals and beds in the Country, State/UT wise
is given in Annexure-I.
As per the same survey, the ideal required number of mental health
professionals has been calculated and the details of present requirement and
availability of mental health professionals in the country are given in Annexure-II5.
In India the Government has been implementing several programmes to address
mental disorder as explained below:
-4to encourage mental health knowledge and skills and to promote community
participation in mental health service development and to stimulate self-help in the
community.
The strategies of National Mental Health Programme were - integration of mental
health with primary health care through the NMHP; provision of tertiary care institutions
for treatment of mental disorders; to eradicating stigmatization of mentally ill patients
and protecting their rights through regulatory institutions like the Central Mental Health
Authority, and State Mental Health Authority.
Gradually the approach of mental health care services has shifted from hospital
based care (institutional) to community based mental healthcare, as majority of mental
disorders do not require hospitalization and can be managed at community level. The
National Mental Health Programme Division conducts nationwide mass media
campaign through audio-video and print media6.
6
7
-6period. 11 Mental Health Institutes have been funded for developing as Centres of
Excellence in Mental Health.
District Mental Health Programme in an enlarged and more effective form covering
the entire country.
Ibid
-7
Strengthening the Central and State Mental Health Authorities with a permanent
secretariat. Appointment of medical officers at state headquarters in order to make
their monitoring role more effective;
Research and training in the field of community mental health, substance abuse and
child/ adolescent psychiatric clinics9.
District Mental Health Programme with added components of Life Skills Education
and Counseling in Schools and Colleges, Suicide Prevention Services etc.
Health Programme. Year wise financial allocation for the NMHP and expenditure
incurred is as given in the table below
Financial Year
2009-10
2010-11
2011-12
Expenditure(Rs. Crore)
55
101
130
52.27
113.66
50.34
10
OTHER INITIATIVES
The Ministry of Social Justice and Empowerment, under its Central Sector
Deendayal Disabled Rehabilitation Scheme (DDRS) has provided financial assistance
to Non-Governmental Organizations (NGOs), for providing various services to persons
with disabilities including special schools, half way homes etc. for mentally retarded
persons. The National Trust for the Welfare of Persons with Autism, Cerebral Palsy,
Mental Retardation and Multiple Disabilities implements various other schemes for the
rehabilitation of such persons. The State-wise details of funds released under DDRS
by the Ministry of Social Justice and Empowerment for the rehabilitation of the
mentally retarded persons during the last three years is given at Annexure-V.
11
Ibid
The Central and State Mental Health Authorities will continue as regulatory
agencies.
-9
All persons have the right to access mental health care and treatment from
mental health services run or funded by the Government. Such services should
be affordable, of good quality and available without discrimination.
Any person with or without mental illness can make an Advance Directive stating
how he/she wishes to be treated for a future mental illness and also how he
does not wish to be treated.
A person with mental illness had the right to live in, be part of and not segregated
from society .The Government has an obligation to provide for half way homes,
community caring centres etc.
Provision for Mental Health Review Commission (MHRC). The MHRC is a quasijudicial body to provide an independent oversight to the functioning of mental
health facilities and protect the rights of persons with mental illness in these
facilities. It thus meets the need for an independent review mechanism as
required under the Convention on the Rights of Persons with Disabilities
(CRPD)12.
CONCLUSION
Problems relating to mental health would be managed with sensitivity at the
community level, through better training of community workers and primary care teams,
and through education of care givers. However, to address the huge burden of mental
disorders and shortage of qualified professionals in the field of mental health, the
Government is implementing the National Mental Health Programme since 1982 .
Further there are 3 centrally run mental health institutes, 43 Government run mental
hospitals and institutions and 381 medical colleges both Government and Private
across the country equipped to treat the patients suffering from mental illness. The
Mental Health Care Bill 2013 would bring about a paradigm shift in the area of mental
health. The National Institute of Mental Health and Neuro Sciences (NIMHANS),
Bangalore which has become an institution of national importance would mentor and
support child and adolescent mental health services 13.
12
Departmentally Related Parliamentary Standing Committee on Health & Family Welfare, SeventyFourth Report on The Mental Health Care Bill, 2013, pp. 10-12.
13
Press Information Bureau, Ministry of Health and Family Welfare, 25 September, 2013.
-10-
ANNEXURE - 1
Number of Patients with mental disorder and proportionate availability of
Psychiatrist, Psychiatric Nurses and Social Workers etc.
S.No
State
(1)
Population
(2)
Existing facilities
Hospital beds
(5)
Major
mental
disorders
Minor
mental
disorders
Govt.
sector
Pvt.
secto
r
Manpower resources
(6)
Available
Ideal req.
Deficit
Available
Ideal req.
Deficit
Available
Ideal req.
Deficit
Psychiatric nurses
Deficit
Ideal req.
Clinical psychologists
Available
Density/
Sq Km (3)
Psychiatrists
iii
356265
75727541
1091117
iv
43
275
13
v
3562
757275
10911
vi
18810
3766375
54555
vii
10
1020
10
viii
210
-
ix
1
180
1
x
4
757
10
xi
3
577
9
xii
8
-
xiii
6
865
15
xiv
6
857
15
xv
3
-
xvi
8
1154
20
xvii
8
1151
20
xviii
Nil
-
xix
3
123
1
xx
3
123
1
26638407
82878796
900914
20795956
158059,
220451
340
880
7903
154
1411,
449
266384
828787
9009
207959
3785
1331720
4143935
45045
1049795
18925
500
57
10
10
3
-
29
28
31
15
1
266
828
9
207
4
237
800
+22
192
3
5
13
14
1
-
450
1214
14
304
6
445
1201
303
6
1
NA
10
2
1
564
1656
18
414
8
563
**
8
412
7
1
NA
1
4
50
**
6
2
1
49
**
5
2
+3
ii
A&N
Andhra Pradesh
Arunachal
Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Daman & Diu,
Dadra & Nagar
Haveli
Delhi
13782976
9294
137829
689145
329
113
155
137
+18
43
207
164
13
274
261
32
+140
10
11
12
13
14
15
16
17
18
19
20
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
J&K
Karnataka
Kerala
Lakshadweep
MP
Maharashtra
1343998
50596992
21082989
6077248
26909428
10069917
52733958
31838619
60595
60388118
96752247
363
258
477
109
338
99
275
819
1894
196
314
13439
505969
210829
60772
269094
100699
527339
318386
605
603881
967522
77195
2529845
1054145
303860
1345470
503495
2636695
1591930
3025
3019405
4837610
210
853
89
14
1173
120
1341
1937
592
6073
326
98
3
145
1113
1539
NA
652
26
97
39
8
50
4
198
238
12
486
14
505
210
61
270
100
527
318
1
603
967
+12
408
171
53
220
96
329
80
1
591
481
2
12
2
2
15
1
69
42
33
21
753
315
90
405
150
762
477
2
905
484
19
741
313
88
390
149
693
435
2
905
451
3
12
10
1
56
40
44
28
1010
420
122
540
200
1052
636
4
1206
1934
25
998
420
122
530
199
996
596
4
1206
1890
172
**
2
1
NA
175
14
1
117
21
118
19
6
135
12
245
348
1
60
672
19
118
18
6
**
12
70
334
1
59
555
i
1
2
3
4
5
6
7
8
-1121
22
23
24
25
26
27
28
29
30
31
32
33
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttaranchal
Uttar Pradesh
2388634
2306069
891058
1988636
36706920
973829
24289296
56473122
540493
62110839
3191168
8479562
166052859
107
103
93
120
236
2029
482
165
78
478
304
159
689
23886
23060
8910
19886
367069
9738
242892
564731
5404
621108
31911
84795
1660528
119430
115300
44550
99430
1835345
48690
1114460
2823655
27020
3105540
159555
423975
8302640
10
70
14
25
118
44
580
627
20
1800
16
1750
20
267
110
12
NA
275
6
5
4
5
19
15
89
75
2
262
9
6
115
24
23
9
20
367
10
242
565
5
621
31
84
1660
18
18
5
15
348
+5
153
490
3
359
22
78
1545
1
1
5
1
18
12
7
20
36
35
13
30
550
5
363
798
7
910
45
126
2490
35
35
12
30
545
14
345
786
7
903
45
126
2470
2
1
1
13
21
4
21
35
48
46
18
40
734
20
484
1130
10
1242
62
168
3320
46
46
17
40
733
7
463
1126
10
1221
62
168
3285
2
2
1
20
10
-
1
7
2
3
11
7
85
74
3
180
2
202
1
5
2
11
-(+13)
75
74
3
180
2
202
34
West Bengal
Grand Total
80221171
904
802211
10270165
4011055
51251625
1471
20893
210
5096
83
2219
802
9696
719
7477
28
343
1204
13259
1176
12926
290
1604
19064
1604
17118
4400*
**
(6527)
1604
4036
+4258
**
Note
*figures unreliable: Nurses with some psychiatric training but without a Diploma in Psychiatric Nursing (DPN) appear to have been
included.
** Figures unreliable
Column 2.The population figures have been taken from the Census of India-2001 as published in Provisional Population Totals (Registrar
General Census Commissioner, India).
Column 3.Population density per square kilometre together with geographical terrain is a useful input in planning deployment of mental
health resources.
Column 4.Case-load in respect to major mental disorders has been calculated at the rate of 1% of the population and that of minor mental
disorders at the rate of 5% of population.
SOURCE: National Survey of Mental Health Resources carried out by the Directorate General of Health Services, Ministry of Health &
Family Welfare during May and July, 2002
Source: Rajya Sabha Unstarred Question No. 4439 dated 7 May 2013
-12-
ANNEXURE-II
Source: Ibid.
-13-
ANNEXURE - III
List of Govt. Mental Hospitals/Institutes
S. No.
State
1.
Andhra
Pradesh
2.
3.
4.
Institute of Mental Health, Govt. Hospital for Mental Care, S.R. Nagar,
Hyderabad
Government Hospital for Mental Care, Chinnawaltair, Vishakapatnam.
Assam
Bihar
5.
6.
Jharkhand
7.
Delhi
Institute of Human Behavior & Allied Sciences, G.T. Road, Jhilmil, Delhi
8.
Goa
9.
10.
11.
Gujarat
12.
13.
14.
15.
Hospital for Mental Health, Behind Kapadia High School, Outside Delhi
Gate, Shahibaug Road, Ahamedabad
Jammu &
Kashmir
16.
Karnataka
17.
18.
19.
20.
Kerala
-14S. No.
21.
22.
State
Madhya
Pradesh
23.
24.
25.
26.
27.
28.
29.
Nagaland
30.
Orissa
31.
Punjab
32.
33.
34.
35.
36.
Uttar
Pradesh
37.
38.
39.
40.
41.
West
Bengal
42.
43.
Source: Lok Sabha Unstarred Question No. 1728 dated 16 August 2013
-15-
ANNEXURE - IV
Grant-in-aid provided to Govt. Mental Hospitals under National Mental Health
Programme for their Modernisation
Sl. No. States
Year
Institute
Institution of Mental Health, Hyderabad
Government Hospital for Mental Care,
Vishakhapatnam.
Lokopriya Gopinath Bordoloi Regional Institute
of Mental Health, Tezpur (Central Govt.
Institute)
Hospital for Mental Health, Ahmedabad
Hospital for Mental Health, Vadodara
Hospital for Mental Health, Jamnagar
Govt. Psychiatric Diseases Hospital, Srinagar.
Ranchi Institute of Neuro Psychiatry & allied
sciences, Ranchi
Karnataka Institute of Mental Health,
Dharwad.
Mental Health Centre, Kozhikode
Mental Health Centre, Thrissur
Mental Health Centre, Trivandrum
Gwalior Mansik Arogyasala, Gwalior
Mental Hospital, Indore
Regional Mental Hospital, Yervada/ Pune
Regional Mental Hospital, Thane
Regional Mental Hospital, Nagpur
Regional Mental Hospital, Ratnagiri,
Meghalaya Institute of Mental Health &
Neurological, Shillong
Mental Hospital, Kohima
Mental Health Institute, Cuttack
Psychiatric Centre, Jaipur
Mental Health Institution, Kilpauk
Mental Hospital Bareily
Institute of Mental Health and Hospital, Agra.
Mental Hospital, Varanasi
Pavlov Mental Hospital, Kolkata
Behrampore Mental Hospital, Murshidabad
Institute of Mental Health Care, Purulia
1.
Andhra Pradesh
2005-06
2.
Andhra Pradesh
2006-07
3.
Assam
2005-06
4.
5.
6.
7.
Gujarat
Gujarat
Gujarat
Jammu & Kashmir
2005-06
2005-06
2005-06
2007-08
8.
Jharkhand
2004-05
9.
Karnataka
2006-07
10.
11.
12.
13.
14.
15.
16.
17.
18.
Kerala
Kerala
Kerala
Madhya Pradesh
Madhya Pradesh
Maharashtra
Maharashtra
Maharashtra
Maharashtra
2005-06
2005-06
2005-06
2005-06
2006-07
2005-06
2005-06
2005-06
2008-09
19.
Meghalaya
2008-09
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Nagaland
Orissa
Rajasthan
Tamil Nadu
Uttar Pradesh
Uttar Pradesh
Uttar Pradesh
West Bengal
West Bengal
West Bengal
2007-08
2005-06
2007-08
2005-06
2005-06
2006-07
2006-07
2005-06
2005-06
2005-06
Source: Ibid
-16-
Annexure-V
Statement Indicating State-wise details of funds released under DDRS to the
various NGOs for the rehabilitation of MR persons.
S. No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
2010-11
2011-12
2012-13
Andhra Pradesh
Assam
Bihar
Chhattisgarh
Delhi
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Karnataka
Kerala
Madhya Pradesh
Maharshtra
Manipur
Meghalya
Mizoram
Odisha
Punjab
Rajsthan
Tamil Nadu
Tripura
Uttar Pradesh
Utrakhand
West Bengal
Total
1195.06
34.81
0.00
0.00
24.57
81.74
63.52
5.07
0.00
293.39
722.48
61.89
38.71
151.42
13.8
31.18
160.31
74.82
89.03
92.31
1.19
128.35
47.06
338.15
3648.86
1360.91
35.2
49.86
13.05
8.82
10.06
47.55
6.72
0.00
298.4
784.07
120.12
5.4
86.82
7.16
14.83
217.76
35.44
18.04
152.93
4.6
176.31
24.02
319.92
3797.99
868.621
27.26
9.01
0.00
10.77
3.72
55.54
7.39
3.67
91.28
434.64
48.66
6.44
68.76
0.00
0.00
114.91
23.63
30.32
83.50
6.52
99.18
8.29
166.49
2168.601