Nancy Gittus
“Do you think there is a crisis in mental healthcare in India today?” I ask Dr Manoj Therayil Kumar, Director of the Institute for Mind and Brain in Kerala. “Yes,” comes the resounding answer.
In many ways, India is booming. Its growth rate reached a stunning 7.4% in the 2024-25 financial year. GDP is expected to reach almost £3 trillion this year, and is on course to surpass that of Germany by 2028. Just last week, India hosted the fourth Global Artificial Intelligence Summit, welcoming politicians, diplomats and major tech companies from around the world to New Delhi, marking the country’s position at the forefront of global progress.
However, beneath the surface of this economic success and social advancement lies a silent but growing problem. Faced with crippling workloads, intense job competition and financial pressure, mental health is breaking down. As Dr Kumar told me, “when the economy is growing well there can be high expectations, pressure on people to perform well, to get opportunities”. This is India’s “hidden crisis”.
It was not long ago that India was leading South-east Asian countries in mental healthcare provisions. The country’s launch of the National Mental Health Programme (NMHP) in 1982 made it one of the first countries to provide this kind of support to its citizens. Within its pages, it detailed aims of district mental health units, school mental health programs, training of health personnel, and public mental health education. Since then, however, the development and implementation of programmes on a local level has been a slow and tricky process. In 2023, 41 years after the NMHP was established, there remained 69 out of 724 districts which were not covered by a District Mental Health Programme. The programme’s sluggish expansion across the country’s districts demonstrates the key issue India faces in developing its mental healthcare facilities: there is no political will to engender change.
Suicide remains the leading cause of death in individuals aged 15-29. An estimated 150 million Indians require mental health care. Mental disorder is among the leading causes of non-fatal disease burden in India. Yet, the government allocated just 1.05% of the total health budget to mental healthcare last year. As Dr Kumar states, the crisis in mental health, “has not been recognised as such because of stigma”. He reveals a “gap [in] services at the national level”, stating that “90% of [the government budget for mental health] goes into one or two centres or institutions, that reveals how poorly funded and how poorly thought of our mental health services are”.
One of the few schemes to receive government funding is the Tele-MANAS programme. This 24/7 mental health support service helps to combat several of the logistical problems Indians face when in need of mental health care. By providing free online consultations, the service erases access barriers such as the financial burden imposed by treatment or an inability to travel. However, in 2024, the initial budget for the program was slashed from 900 million (£7.3 million) rupees to 450 million (£3.7 million). The consequence of this underfunding can be seen in the fact that India suffers with one of the world’s highest mental health treatment gaps, with an estimated 70% to 92% of people living with mental illness in India receiving no formal treatment. So why, when faced with the ubiquity of these issues and the massive cost to life, does the Indian government continue to act as if nothing’s wrong?
“Stigma is a universal phenomenon” says Dr Kumar, and India is no different. A recent study carried out on 413 medical students in India showed that 130 students screened positive for depression. Out of that 130, only 57 perceived the need to seek mental health care, and just 12 actually did so. This staggering drop off in willingness to recognise and then take action on mental health problems demonstrates the underlying stigma that India is currently grappling with. Many participants were concerned about judgement from their family, and also feared the professional consequences of having a mental health problem on their record.
Mental illness might also cause problems socially. In some areas, for example, having a mental illness severely limits marriage potential. A study conducted in Faridabad recorded one participant saying, “If there is a mentally ill patient in some house, who would like to get married in that house? No one will”. Furthermore, many of the medical students in the New Delhi study felt they could resolve their depression themselves, or that it was a problem which would go away by itself. If this is the attitude towards mental health problems among those who have dedicated their lives to healthcare, what hope do others have?
Stigma creates a vicious circle. The fewer people there are willing to accept their mental illness, the fewer people are being recorded as having one. Funding is then reduced and, in turn, services are inadequate and education is poor. This fuels stigma. The lack of a nationwide School Mental Health Programme has also meant that many individuals still hold outdated beliefs. In the study conducted in Faridabad, mental illness was not only often thought shameful, but some also believed that it was contagious. One participant told the researchers: “Some think that by touching, the disease can spread, so they stay away”. Those living in rural communities will, moreover, often seek a traditional healer before thinking of seeing a doctor. Whilst many do believe traditional healers possess spiritual or mystical knowledge, traditional healers are also often the only option. One participant in the Faridabad study related their experience trying to find mental health treatment for a relative: “First, we showed it to Baba [traditional healer], but there was no benefit. Then we took him to the medical, but medical is very far away, and there is a very long line. So again, he was taken to Baba”. And it is not only long waiting times which drive people away from seeking medical help. Complex bureaucratic procedures, shortages of medicine in government hospitals, and unaffordable costs in private institutions all present insurmountable barriers to many trying to access mental healthcare.
So what is the way forward then? How can India make progress towards enabling all those who are in need to access mental health care without shame or fear of repercussion?
“If you look at the national level, the most important thing,” Dr Kumar tells me, “is to have a universal healthcare strategy”. Without this, it falls to the people to find their own health services. Government services often do not have the medicine needed to aid those suffering from poor mental health. In a study conducted across 83 public facilities in Delhi, the average availability in clinics of three frontline medicines used in treating mental disorders – amitriptyline, diazepam, and fluoxetine, which are all included on the Delhi State Essential Medicines List – was 6%, 11%, and 4%, respectively. Clearly, the quality of mental healthcare a patient might receive in India is largely dependent on purchasing power, and it is because of this that Dr Kumar argues, “universal mental healthcare is an essential step”.
He adds that, “people also need to accept mental health as on parity with physical health”. In this regard, the tide is beginning to turn. In some states such as Kerala, where literacy rates are high and mental health services are relatively widespread, “more and more people are seeking care.”
Dr Kumar ends our interview on a more hopeful note: in Kerala today, “there is more understanding of chronic emotional difficulties, there is more sense that we can change the quality of life, people are more invested in quality of life and they are demanding services”.
“In a nutshell”, Dr Kumar summarises, there are two key things India must work on: “one is around the quality of mental healthcare […] and second is general understanding about the need for seeking help for mental health problems when people face that. If these two [things] change, that will be a big shift in our progress.”