Measuring the Pulse: Evaluating India’s Mental Health Infrastructure and Policy Implementation

Mental health care in India is the elephant in the room that we have long attempted to ignore. It is still one of the most underrepresented areas of public health, even though an alarming 150 million Indians require it (National Mental Health Survey, 2016). The decriminalisation of suicide and the promise of care were two of the much-needed reforms and rights-based measures included in the 2017 Mental Healthcare Act (MHCA). The problem is that, especially in a complicated nation like India, impressive policy declarations rarely result in real services. Examining the policy environment, systemic flaws, and the few encouraging indications of innovation that suggest what might be, let’s explore the positive, negative, and painfully unchanged. 

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Mental Health Policy: Broad Concepts, Basic Principles 

The National Mental Health Programme (NMHP) was introduced in 1982, marking the official start of India’s mental health policy journey. Its main goal? Include mental health in general healthcare to reduce stigma and increase easy access. Over time, it evolved and expanded, particularly with its District Mental Health Program (DMHP). However, by 2023, only about 43% of India’s districts (329 out of 766) had a functioning DMHP (NHM Program Implementation Plans, 2023-24). It’s a serious implementation crisis, not just a hiccup. 

On paper, however, the MHCA (2017) seemed revolutionary. It promised easily accessible, reasonably priced care, decriminalized suicide, and required insurance coverage for mental illness. In order to safeguard patients’ rights, it even established Mental Health Review Boards (MHRBs). However, reality is slow. Only roughly half of India’s states and union territories had operational MHRBs in place as of 2023 (Human Rights Watch, 2023). Despite regulatory mandates, many patients continue to receive a “no” response when they approach insurance providers regarding claims related to mental health (IRDAI Annual Report, 2022–23). 

Then there’s the money—or the startling lack of it. Only 0.05% of the Union Health Budget goes toward mental health (NITI Aayog, 2019). That is pennies in comparison to the nearly 15% of India’s total disease burden that is caused by mental disorders (Lancet, 2020). Ambition for policy? Out of the charts.

According to Assistant Professor, Dr Garima Ranjan, as a Psychology Professor and Mental Health Expert, I recognise the progressive intent behind India’s mental health policies, especially the Mental Healthcare Act, 2017. However, on-ground implementation continues to fall short. There is a stark gap between policy and practice, largely due to insufficient funding, lack of trained professionals, and poor integration of mental health into primary care. Additionally, stigma and limited mental health literacy further hinder help-seeking behaviours. For these policies to truly serve their purpose, we need stronger intersectoral collaboration, robust training initiatives, and community-based mental health programs that are culturally sensitive and accessible across diverse populations.

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People and Places: The Crisis in Infrastructure 

In India, there are a few exceptional psychologists, psychiatrists, and social workers, but not enough to meet the demand. The WHO recommends three psychiatrists per 100,000 people, but the country only has about 0.75 psychiatrists per 100,000 people (WHO Mental Health Atlas, 2020). For psychiatric social workers and clinical psychologists, the figures are even more alarming: 0.07 per 100,000 (NMHS, 2016). It’s like attempting to run a marathon with one leg tied, to put it simply. 

However, geography may be the greater problem. Although only 28% of the population lives in urban areas, nearly 80% of psychiatrists are concentrated there (NIMHANS, 2020). As a result, over two-thirds of the country’s population lives in rural areas, which are essentially a care desert. Less than 5% of rural Primary Health Centres (PHCs) regularly have access to psychiatrists, and less than 10% have any medical officers with training in mental health (Lancet Commission on Global Mental Health, 2020). 

Not even the facilities are dispersed equally. While many districts lack even a basic inpatient psychiatric ward in a general hospital, urban tertiary care centres take centre stage. Rehabilitation services? Minimal. Care in the community? In many ways, it’s almost legendary. 

Read More: Mental Health Insurance in India

Where Good Policy Meets Hard Reality 

So why aren’t things improving faster? Several roadblocks lie in the way—and they’re more social and systemic than just technical. 

1. Stigma Still Rules the Roost

Stigma isn’t just a buzzword; it’s a wall. Most people still avoid seeking help because mental illness is often seen as a moral failure, a curse, or worse—an embarrassment. According to NMHS (2016), over 80% of people with severe mental illness hadn’t received any treatment in the past year. Studies like the one by The Live Love Laugh Foundation (2018) reveal that supernatural explanations and blame-game mentalities are still worryingly common. 

2. Primary Care Isn’t Ready (Yet)

On paper, mental health should be a part of everyday healthcare, just like vaccinations or blood pressure checks. But primary care doctors often lack training, and community health workers like ASHAs and ANMs aren’t equipped to spot or support mental health conditions (WHO-mhGAP Review, 2021). Add to that an overworked staff, limited time, and lack of medications, and you’ve got a recipe for chronic neglect. 

3. Poor Data

Poor Decisions: India’s last comprehensive mental health survey came out in 2016. Since then, there’s been a lot of guesswork. Without updated, district-level data, policymakers are flying blind. No one’s tracking how many people use mental health services or whether interventions are working (NITI Aayog, 2019). 

4. Funding Is Mismanaged

Even the little money that is set aside for mental health doesn’t always get spent. Why? Bureaucratic logjams, a shortage of trained staff, and the overall low priority of mental health at the local governance level (NHM Audit Reports, 2020–2023). 

Read More: Emerging Trends in Digital Mental Health Interventions 

Hopeful Hints: What’s Effective 

There are a few promising bright spots despite all that rain. 

1. Task-Sharing Activities

Who said mental illness could only be treated by psychiatrists? Effective identification and management of depression can be achieved by trained village health workers, as shown by Madhya Pradesh’s VISHRAM program (Patel et al., Lancet, 2017). More people in Kerala were diagnosed and treated as a result of ASHA employees conducting mental health screenings (WHO Case Study, 2022). 

2. Digital Assistance Is Growing

Let’s introduce Tele-MANAS, India’s national, round-the-clock mental health hotline that was established in 2022. Nearly 700,000 individuals had reached out to them by the beginning of 2024 (MoHFW, 2024). It’s a start, but there is still more to be done in terms of confidentiality, digital access in remote areas, and quality control. 

3. Community is Crucial

By bringing mental health into communities through campaigns to raise awareness, peer support groups, and the support of local leaders, NGOs such as Sangath and Basic Needs India are making significant improvements (Chatterjee et al., BJPsych International, 2021). The message resonates when the recipient has faith in the messenger. 

4. Fixing the MHCA Screws

Legal frameworks are only effective if people are aware of and utilise them. There could be significant benefits from strengthening MHRBs, educating the police and judiciary about patient rights, and requiring insurers to abide by MHCA provisions (Centre for Mental Health Law & Policy, 2023). 

Read More: The National Workshop on Mental Health inaugurated by a member of NITI Aayog

What Must Take Place Next (Yes, Immediately) 

Though rocky, the path ahead is not unpaved. India should prioritise the following, ideally yesterday: 

• Place Money in the Right Place: It would be revolutionary to increase funding for mental health to even 5–10% of the overall health budget. Don’t just throw money at the issue, though; allocate it to infrastructure, workforce development, drugs, and grassroots initiatives. 
• Train More People, Faster: We urgently need thousands more social workers, psychologists, and psychiatrists. Increase the number of postgraduate seats available, provide primary care physicians with crash courses, and create incentives for professionals to work in rural and semi-urban areas. 
• Take MHCA Implementation Seriously: Every state needs to establish operational MHRBs. Strict regulation of the insurance companies is necessary. And everyone, from judges to nurses, needs to be aware of what the law says. A multilingual, widely reported awareness campaign might be beneficial. 
• Mental Health at the Primary Level: Teach physicians to regularly check for anxiety or depression in the same manner that they check blood pressure. Stock up on prescription drugs. Continue to mentor and support them. For a wider audience, make use of Ayushman Bharat’s Health and Wellness Centres. 
• Update the Data NOW: It’s past time for a new National Mental Health Survey. To keep an eye on services, results, human resources, and financial expenditures, every district also requires its data system. 
• Change Minds to Save Lives: Start a national anti-stigma campaign that is consistent and culturally appropriate. Make use of educators, religious leaders, influencers, TV, and movies. Normalise is discussing mental health in all Indian languages, not just English. 

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Towards a Mentally Healthier INDIA 

When it comes to mental health, India has plenty of vision, but without action, that vision is a hallucination. One of the most progressive mental health laws in the world, the MHCA 2017 runs the risk of becoming a paper tiger in the absence of adequate funding, infrastructure, trained staff, and enforcement. Inaction has a human cost; it is not an abstract one. It is felt in our streets, homes, workplaces, and schools. India must treat the topic of mental health as essential to national development, human dignity, and public health rather than as an additional problem if it hopes to make a difference. Symbolic gestures are beyond style. Human-centred, system-wide, sustained action is what we urgently  need

FAQs 

1. What is the Mental Healthcare Act (MHCA), 2017? 

It’s a rights-based law that decriminalizes suicide and guarantees access to affordable mental healthcare. It also mandates insurance coverage and patient protection through Mental Health Review Boards. 

2. Why is mental health funding in India considered inadequate?

Mental health gets only 0.05% of the Union Health Budget despite accounting for nearly 15% of India’s disease burden. This financial gap severely limits service availability and expansion. 

3. What are the major barriers to mental healthcare access in rural areas?

Shortages of trained professionals and poor infrastructure make rural mental health services almost inaccessible. Most psychiatrists are concentrated in urban centres. 

4. What is the purpose of Tele-MANAS? 

Tele-MANAS is a 24/7 national mental health helpline launched in 2022 to provide free tele-counselling. It has received over 700,000 calls, showing high public demand. 

5. How can non-specialists help in improving mental health access?

With proper training, frontline workers like ASHAs and nurses can identify and manage common disorders. This “task-sharing” approach helps bridge the treatment gap in underserved areas. 

6. What steps can improve mental healthcare in India? 

Key measures include higher budget allocation, scaling up human resources, enforcing the MHCA, and running national anti-stigma campaigns. Integration into primary care is also vital.