Integrating mental health into primary healthcare in India: Challenges & Way forward

Neglecting these problems can lead to adverse outcomes for the population hence significantly compromising the combined health of the society, writes Dr. Preeti Singh, Chief Medical Officer, LISSUN

About Author: Dr. Preeti Singh has joined LISSUN as Chief Medical Officer in its journey to normalize and personalize mental health in India and beyond. She has an illustrious career of 20+ years working in the healthcare industry across two decades with children, adolescents, and adults. Throughout her career she has been associated with marquee names in the healthcare industry and academics as Senior Clinical Psychologist such as Paras Hospital Gurgaon, to MDI. She is an M. Phil & Ph.D. in Clinical Psychology from NIMHANS, Bangalore and Punjab University, Chandigarh, respectively.

A healthy body means a healthy mind as well. It was formally accepted in 1948, when WHO‘s constitution attributed health to a state of complete physical, psychological and social well-being being, not only the absence of a disease or illness. Years later, despite the constitution of the importance of other aspects of health, many countries and their healthcare system fail to focus on the mental health facilities for their population, including India.
Mental health disorders are highly prevalent in India and discussions about it continue to be a taboo. Consequently, it stimulates immense suffering, increases mortality rates, and declines the quality of life to such a level that ignoring it is no longer an option.
A fundamental shift is required in Indian healthcare programs- a change that converts the system from one that violates human rights when it comes to caregiving through psychiatric institutions to a system that provides reasonable health solutions through the integration of mental healthcare in the primary health care system.
Following are the challenges in the way of mental health integration into primary healthcare-
  • Less accessibility to mental problem treatment
In many areas, psychiatric institutions are the only form of mental health care facility available in this country. Additionally, these centres are primarily located in major cities and towns wherein only a small number of people can access them. This deprives many people who wish to get their condition diagnosed or seek professional help for mental health issues. And in specific cases where patients with severe mental diseases get proper treatment, they often feel isolated due to living far from their loved ones to seek help where it is offered. This further increases anxiety, stress and depression.
In such a scenario, primary healthcare is considered the most accessible and closest form of care available medically, as they are located near small communities. Hence, integration of mental health in these centres would benefit a large population.
  • Taboos related to mental health and treatment in Indian society
Mental health is a sensitive matter; unlike physical illnesses, patients require emotional, mental and social support to thrive and overcome the problem successfully.
In the wake of Covid-19 pandemic, crippling problems like social isolation, mental depression, and anxiety are taking over the population and loss of employment is adding to the woes. Neglecting these problems can lead to adverse outcomes for the population hence significantly compromising the combined health of the society.
According to the world health organisation (WHO), 7.5% of Indians suffer from at least one kind of mental disorder. Around 56 million Indians have depression, whereas 38 million suffer from anxiety-related disorders. Despite these critical statistics, Indians shy away from acknowledging or even identifying society’s mental health as the quintessential topic it is.
Many individuals with behaviour that doesn’t comply with society’s standards or is ‘abnormal’ are traditionally advised to visit a psychiatrist, not understanding what the underlying problem is or if  it could be treated with regular therapy in the first place. Furthermore, people who seek treatment are put to shame by society, by being called mentally sick or unfit for work or marriage. This discourages an individual who want to seek help from professionals but are afraid of how others will perceive their disorder.
Some ways forward to promote the addition of mental healthcare into primary healthcare system-
People must become aware of the myths related to mental disorders and their treatments. Talks around mental health should be normalized, and be non-judgemental. This is the only way society can move forward and support those suffering in silence.
  1. Implementing mental healthcare policies and laws to ignite people’s awareness
Mental healthcare practices, policies, and laws should be established by developing a robust primary healthcare system in India that addresses the importance of mental health within itself. For example, medical insurance policies should cover mental health OPD and therapies as well.
Only with a formal allegiance through the highest level of government can this implementation truly succeed. Mental health plans should clearly define the objectives, outlining the specific actions and strategies required for achieving them.
Mental health laws will help clarify the system’s legal framework enforcing policy objectives to remove the partiality between physical and mental healthcare facilities in India and provision the practice in the primary healthcare system.
  1. Training staff members and hiring proper supervision
Another vital aspect is training staff members accordingly. They should be given education and training to identify and treat the majority of the OPD cases related to mental disorders just as they manage the physically injured patients. Including how to cope with severe cases and transfer them to the specialist of the diseases. For instance, an OCD symptomatic patient can be transferred to a psychiatrist on call; however, they should be specially referred to an OCD specialist in their staff to benefit the most. A referral system between primary and secondary healthcare facilities can effectively improve the quality of treatment delivery of mental healthcare in primary healthcare.
  1. Funding mental healthcare apps and digital ventures
Government should fund and support start-ups in this sector, as they too can provide expert and bespoke services to a wider audience and take the stress off the fragile medical infrastructure of the country. In the recent budget, govt. announced its tele-mental health scheme, which is a welcome move in this direction.