Economic Survey 2024: Integrating Mental Health Economically

For the first time ever, the Economic Survey 2023-24 tabled by the Union Minister of Finance and Corporate Affairs Smt. Nirmala Sitharaman in Parliament today, talks extensively about mental health, its significance and implications on policy recommendations.

National Prevalence of Mental Health

Acknowledging mental health as a principally impactful driver of individual and national development, the Survey notes that as per the National Mental Health Survey (NMHS) 2015-16, 10.6% adults in India suffered from mental disorders while treatment gap for mental disorders ranged between 70% and 92% for different disorders. Further, 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%). Citing NCERT’s Mental Health and Well-being of School Students Survey, the Survey highlights 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% experiencing mood swings.

Mental Health Issues through the lens of Economics

The Survey points out that at an aggregate economic level, mental health disorders are associated with significant productivity losses due to absenteeism, decreased productivity, disability, increased healthcare costs, etc. There is also evidence of poverty affecting the risk of mental health via stressful living conditions, financial instability, and a lack of opportunities for upward mobility, which contribute to heightened psychological distress.

Recognizing mental health as a fundamental aspect of overall well-being, the Survey underscores key initiatives and policies taken by the Government in this regard:

• National Mental Health Programme: Under the District Mental Health Programme of this scheme,  more than 1.73 lakh Sub Health Centres, Primary Health Centres, Urban PHCs and Urban Health and Wellness Centres were upgraded to Ayushman Arogya Mandirs providing mental health services.
• National Tele Mental Health Programme: With over 1600 trained counselors in over 20 languages, 53 Tele MANAS cells were set up in 34 states/UTs and more than 8.07 lakh calls handled since Oct 2022, as of 31 March 2024.
• Increasing mental health personnel: 25 Centres of Excellence were sanctioned to increase PG students’ intake, support provided to 19 Government medical colleges/institutions to strengthen 47 PG Departments, mental health services provisioned for 22 AIIMS, and three Digital Academies providing online training courses to general healthcare medical and paramedical professionals set up.
• Rashtriya Kishor Swasthya Karyakram: Adolescent Friendly Health Clinics (AFHC) and Peer education programmes were conducted across the country.

In addition to national initiatives, the Survey also highlights unique, independent initiatives implemented at the state level. These state-level initiatives, the Survey states, complement national efforts in addressing mental health and well-being among children and adolescents.

Policy Recommendations on Mental Health

The Survey stresses on proper implementation to accelerate the improvements made in mental healthcare on the ground and address gaps in the existing programmes to maximize their effectiveness. Important policy recommendations include:

• Re-doubling 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
• Developing comprehensive guidelines for the excellence centers’ services alongside mental healthcare professionals and users to understand their needs.
• Assessing the effectiveness of the programmes by gathering feedback from the users, professionals, and stakeholders to make necessary changes and meet the needs of a wider population.
• Nurturing peer support networks, self-help groups, and community-based rehabilitation programmes can help de-stigmatization of mental disorders and develop a sense of belonging.
• Partnering with NGOs to scale up efforts, share knowledge, and leverage resources to enhance future policies, to aid in identifying areas of improvement.
• Involving individuals with personal experience with mental health problems in decision-making, service planning, and advocacy efforts can increase the person-centricity and recovery orientation of mental healthcare services
• Sensitization of mental health at the preschool, Anganwadi level to provide precious early identification of disorders.
• Standardization of guidelines for mental-health services across government and private sector
• Effective pathways for integrating mental health interventions in schools including 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.
• A bottom-up, whole-of-community approach in addressing the topic of mental health and breaking the stigma.

• For public health officials, tackling mental health by acknowledging and addressing the fundamental reluctance at personal level