The Economic Survey 2023-24 on July 22 flagged a rise in mental health issues among Indians, calling for a paradigm shift towards a bottom-up, whole-of-community approach to address the problem.
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Paying attention to mental health in society is both a health and an economic imperative, the policy document asserted while dwelling on the topic in a vast and detailed manner for the first time highlighting the various socio-economic repercussions of the issue.
Economic Survey 2023-24 updates
“Mental health drags down productivity more widely in the ecosystem than individuals’ physical health issues,” it noted.
Quoting the National Mental Health Survey (NMHS) 2015-16 data, the survey said 10.6% of adults suffered from mental disorders in India while the treatment gap for mental disorders ranged between 70-92% for various disorders.
“Further, as per the NMHS, the prevalence of mental morbidity was higher in urban metro regions (13.5%) as compared to rural areas (6.9%) and urban non-metro areas (4.3%),” it added.
"The second and more expansive NMHS is currently in progress. According to Dhyani et al. (2022), individuals aged 25-44 years are the most affected by mental illnesses," it noted.
Citing NCERT's Mental Health and Well-being of School Students Survey, the survey said there is an increasing prevalence of poor mental health among adolescents, exacerbated by the COVID-19 pandemic, with 11% of students reported as feeling anxious, 14% as feeling extreme emotion and 43% experienced mood swings. Fifty per cent of students cited studies as a reason for anxiety, and 31% cited examinations and results.
"Mental health problems affect the quality of life of an individual and constrain the realisation of an individual's potential. At an aggregate economic level, mental health disorders are associated with significant productivity losses due to absenteeism, decreased productivity, disability, and increased healthcare costs," it pointed out.
On the policy side, the document noted that India is creating positive momentum in policy development by recognising mental health as a fundamental aspect of overall well-being.
However, it said, "While most of the policy design is in place, proper implementation can accelerate the improvement on the ground. That said, there remain certain gaps in the existing programmes which need to be addressed to maximise their effectiveness."
“The fundamental issue of the lack of awareness about mental health and the stigma surrounding it can render any sincerely crafted programme unfeasible,” it added.
"Hence, there is a need to bring about a paradigm shift and utilise a bottom-up, whole-of-community approach in addressing the topic of mental health. Breaking the stigma starts with taking cognisance of the natural human tendency to accept physical ailments and seeking treatment for the same while being in denial about mental health issues," the Economic Survey for 2023-24 said.
“To an extent, the denial is an outcome of fear about social attitudes and social acceptance after one ‘comes out’ with mental health issues,” it said.
According to Dhyani, et al (2022), individuals aged 25-44 years are the most affected by mental illnesses. Twenty-two mental disorders are covered under the Ayushman Bharat-PMJAY health insurance.
"For public health officials, tackling mental health requires acknowledging and addressing this fundamental reluctance. Arguably, mental health issues drag down productivity more widely in the ecosystem than individuals' physical health issues. Hence, paying attention to mental health issues in society is both a health and an economic imperative," the document noted.
The survey suggested that effective pathways for integrating mental health interventions in schools can include developing an age-appropriate mental health curriculum for teachers and students, encouraging early intervention and positive language in schools, promoting community-level interactions, and balancing the role of technology.
The increase in mental health issues in children and adolescents is often linked to the overuse of the internet and, specifically, social media. Unrestrained and unsupervised use of the internet by children can culminate in a range of problems, from the more prevalent obsessive consumption of social media or 'doom scrolling' to severe ones such as cyberbullying.
“In the Indian context, the rising usage of the Internet on mental health has been indicated by a 2021 study on ‘Effects of using Mobile Phones and other devices with Internet accessibility by children’ by the National Commission for Protection of Child Rights, according to which 23.8% of children use smartphones while they are in bed, and 37.2% of children experience reduced levels of concentration due to smartphone use,” it noted.
Need to increase psychiatrists’ numbers
“There remain certain gaps in the existing programmes that need to be addressed to maximise their effectiveness,” it said. For instance, doubling the efforts to increase the number of psychiatrists, from 0.75 psychiatrists per lakh population in 2021 to the WHO norm of 3 per lakh population (Garg, Kumar and Chandra 2019), the report pointed out.
The report stressed on developing comprehensive guidelines for the excellence centres' services alongside mental healthcare professionals.
The report called for nurturing peer support networks, self-help groups, and community-based rehabilitation programmes to destigmatize mental disorders and develop a sense of belongingness in their victims.
The report suggested developing an age-appropriate mental health curriculum for teachers and students and encouraging early intervention and positive language.
