Social determinants play a vital role in access to healthcare and financial protection among individuals with mental disorders in India. Studies have shown that India needs to address gaps in access and financial protection for individuals with mental disorders to achieve Universal Health Coverage (UHC).
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Highlighting concerning trends regarding the reporting of mental disorders in India, a recent study by researchers from the Indian Institute of Technology (IIT) Jodhpur, revealed that self-reporting rates for mental health problems were notably low. The study - based on the 75th Round National Sample Survey (NSS) 2017-2018 - revealed that the self-reporting of mental illness was less than 1% in India.
The NSS completely relied on self-reporting by individuals. The data was collected from 5,55,115 individuals (3,25,232 from rural areas and 2,29,232 from urban areas), in 8,077 villages and 6,181 urban areas. These were randomly selected. It also included 283 outpatient and 374 hospitalisation cases involving mental disorders in India.
Published in the International Journal of Mental Health Systems, the study has been co-authored by Alok Ranjan, Assistant Professor, School of Liberal Arts (SoLA), IIT Jodhpur and Jewel Crasta, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, U.S.
The 2017 National Mental Health Survey (NMHS) by NIMHANS indicated that around 150 million individuals had mental illness that required treatment, in India. The NMHS - conducted on a nationally representative sample of 34,802 individuals, sampled from 12 States of India - used a structured diagnostic instrument which is equivalent to clinical assessment.
Out-of-pocket expenses
The IIT - Jodhpur study threw light on the significant out-of-pocket expenses incurred by individuals seeking mental health services. This is largely due to reliance on the private sector, pointed out the study that was done based on logistic regression models. The findings revealed that individuals with higher incomes were 1.73 times more inclined to report health problems compared to those with lower incomes, uncovering a socioeconomic divide.
The average out-of-pocket expenditures for both hospitalisation and outpatient care were significantly higher in the private sector than in the public sector, the study pointed out.
Economic burden
Girish N. Rao, professor of Epidemiology at NIMHANS, who was one of the co-Principal Investigators of the NMHS-2017, said the economic burden of mental disorders in India is huge. In the absence of State or insurance coverage for most families, a large proportion of payments for treatment are out-of-pocket expenses, he said.
“The findings of the NMHS revealed that the economic burden was reportedly higher in middle aged individuals, where disability due to mental illness significantly affected their productivity resulting in a sizeable economic impact in a cumulative manner, on the country. Poverty and disability catalysed by poor access to care and treatment significantly affects the quality of life of persons with mental illness as well as their families. The survey showed that families had to spend nearly Rs 1,000 – Rs 1,500 a month mainly for treatment and travel to access care. The hidden and intangible costs are difficult to monetise and add to this burden,” Dr. Girish Rao said.
Pointing out that low levels of education and income are closely linked to mental disorders, which in turn contribute to impoverishment, Dr. Rao said: “Data from the NMHS revealed that mental disorders were significantly higher in households with lower income, poor education and limited employment. It is evident that these individuals have a greater vulnerability to mental disorders moderated by adverse social and economic determinants of health.”
Low self-reporting
The study by IIT- Jodhpur revealed that self-reporting of mental disorders in India is considerably lower than the actual burden of the disease. This disparity suggests a significant gap in identifying and addressing mental health issues.
The private sector emerged as a major provider of mental health services, accounting for 66.1% of outpatient care and 59.2% of inpatient care. A mere 23% of individuals hospitalised for mental disorders had health insurance coverage at the national level.
Asserting that stigma in society acts as a significant barrier to reporting mental health issues, Dr. Alok Ranjan, said: “In today’s society, the reluctance to report mental health issues persists due to the prevailing stigma. Individuals, fearing social judgment, often choose silence over seeking help. Destigmatising mental health is crucial to fostering an environment where seeking support is embraced.”
Corroborating this, Dr. Girish Rao said stigma contributes to the huge burden of mental morbidity, being a road-block to treatment seeking. “NMHS findings revealed that nearly 80% of persons suffering from mental disorders, had not received any treatment despite the presence of illness for more than 12 months. Stigma associated with mental disorders affects access to work, education and marriage of those with a disorder and it also affects family members of those affected,” he added.
Published - February 09, 2024 10:05 am IST
