ISSN 2411-7323

Int Journal of Social Sciences Management and Entrepreneurship 3(2):72-78, November2019

© SAGE GLOBAL PUBLISHERS www.sagepublishers.com

MENTAL HEALTH ISSUES AND CHALLENGES IN INDIA: A REVIEW

VENKATASHIVA Reddy
Abstract
Review was done to assess the burden of mental disorders and to study the various issues and
challenges at community level. We searched the electronic databases for studies related to prevalence
of various psychiatric morbidities and associated factors at community level. World Health
Organization estimated that mental and behavioural disorders account for about 12 percent of the
global burden of diseases. In India the burden of mental and behavioural disorders ranged from 9.5 to
102 per 1000 population. Burden of mental disorders seen by the world is only a tip of iceberg.
Various studies had shown that the prevalence of mental disorders were high in females, elderly,
disaster survivors, industrial workers, children, adolescent and those having chronic medical
conditions. There is need to have better living conditions, political commitment, primary health care
and women empowerment.

Key Words: Mental health, Mental disorders, Psychiatric disorders, Psychiatric illness

Introduction
Burden of mental disorders had risen over last few decades. Mental health is a state of well-being in
which the individual realizes his or her own abilities, can cope with the normal stresses of life, can
work productively and is able to make a contribution to his or her community. WHO estimated that
globally over 450 million people suffer from mental disorders? Currently mental and behavioural
disorders account for about 12 percent of the global burden of diseases. This is likely to increase to 15
percent by 2020. Major proportions of mental disorders come from low- and middle-income
countries. There are lacunae in psychiatric epidemiology due to intricacy related to defining a case,
sampling methodology, under reporting, stigma, lack of adequate funding and trained manpower and
low priority of mental health in the health policy.

Methodology
We searched the PubMed and Google Scholar for studies related to prevalence of various mental
disorders and associated factors at community level. All databases were searched from inception and
searches were updated on 30 November 2012. In addition, we checked reference lists of reviews and
retrieved articles for additional studies. From the searches we reviewed the title and abstract of each
paper and retrieved potentially relevant references.
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Burden of Mental Disorders

A study conducted in Pune in 2012 reported the overall life time prevalence of mental disorders to be
nearly 5 percent. Males were reported to be at higher risk. Major cause was depression followed by
substance abuse and panic disorders [3]. These findings were similar to results of the meta-analysis,
which estimated the prevalence of mental disorders to be 5.8 percent among the Indian population [4].
In 2010, a study conducted in NIMHANS, Bangalore reported that the burden of mental and
behavioural disorders ranged from 9.5 to 102 per 1000 population. Reason behind such a wide range
of prevalence could be that few studies had focused on isolated settings.

Another study among elderly done in South India in 2009 found the prevalence of depression to be
12.7 percent. On the contrary, the prevalence of mental disorders was reported to be as high as 26.7
percent by a study in elderly with predominant depressive disorders, dementia, generalized anxiety
disorder, alcohol dependence and bipolar disorder [6]. The prevalence of dementia was found to be
33.6 per 1000 by a study done in urban population of Kerala in 2005. Alzheimer’s disease was the
most common cause (54%) followed by vascular dementia (39%). In 2000, a review of
epidemiological studies estimated that the prevalence of mental disorders in India was 70.5 per 1000
in rural and 73 per 1000 in the urban population.

In 1999, a study stated that the prevalence of mental disorders in child and adolescent population was
9.4 percent. Similarly, another study from Bangalore in 2005 documented the burden of mental
disorders to be 12.5 percent. The study also showed that there were no significant differences among
prevalence rates of mental disorders in urban middle class, slum and rural areas with annual incidence
of 18 per 1000 population. The prevalence of mental disorders among 0-3 yr old children was 13.8
percent, most commonly due to breath holding spells, pica, behavior disorder NOS, expressive
language disorder and mental retardation. The prevalence rate in the 4-16 yr old children was 12.0
percent mainly due to enuresis, specific phobia, hyperkinetic disorders, stuttering and oppositional
defiant disorder.

Compared with the general population, industrial workers were more predisposed to mental disorders.
In 2002, the prevalence rate of mental disorders in the Indian industrial population was estimated to
be 14 to 37 percent. On the contrary, western world reported it to be nearly 75 percent. Another study
among industrial workers mentioned the lifetime prevalence of mental disorder to be more than 50
percent. Most common associated factor in industrial workers was substance abuse (12.3%).

Besides substance abuse, suicide among young people has emerged as a major public health issue.
National crime record bureau, India reported, 27.7 percent increase in recorded number of suicides

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between 1995 and 2005 with suicide rate of 10.5 per million. Also, a study from Hyderabad stated
that nearly 35 percent of suicides occur amongst youth (15–29 years) with rate of 152 per lakh for
girls and 69 per lakh for boys. Compared with the suicide rates from high income countries, these
rates were four times higher for boys. In 2009, a study revealed that overall 3.9 percent youth reported
suicidal behaviour. A study conducted in rural areas of south India, in 2010 reported 37% of those
who died by suicide had a mental disorder. The two most common reasons were alcohol dependence
(16%) and adjustment disorders (15%).
The prevalence rates of mental disorders reported in India are very low compared to studies done in
the western world. This is may be due to that Indian epidemiological studies were not able to measure
mental disorders adequately or prevalence rates of mental disorders are truly low in India because of
genetic reasons, good family support, cultural factors, lifestyle and better coping skills and
comfortable environment.

Issue and Challenges of Mental Disorder

Most strongly associated factors with mental disorders are deprivation and poverty. Individuals with
lower levels of education, low household income, lack of access to basic amenities are at high risk of
mental disorder. Lifetime risk of affective disorders, panic disorders, generalized anxiety disorder,
specific phobia and substance use disorders is found to be highest among illiterate and unemployed
persons. Suicidal behavior was found to have relation with female gender, working condition,
independent decision making, premarital sex, physical abuse and sexual abuse. Ongoing stress and
chronic pain heightened the risk of suicide. Living alone and a break in a steady relationship within
the past year were also significantly associated with suicide. Work environment, school environment
and family environment plays important role in pathogenesis of mental disorders.

Females are more predisposed to mental disorders due to rapid social change, gender discrimination,
social exclusion, gender disadvantage like marrying at young age, concern about the husband’s
substance misuse habits, and domestic violence. Divorced and widowed women are at slightly
elevated risk of mental disorders. In India domestic violence is a big problem. A survey done in
Maharashtra reported that 23 percent of women had been beaten in the last six months and of these 12
percent had explicitly been threatened to be burned. Poorer women are more likely to suffer from
adverse life events, to live in crowded or stressful conditions, to have fewer occupational
opportunities and to have chronic illnesses; all of these are recognized risk factors for common mental
disorders. Psychological factors such as headache and body ache, sensory symptoms and nonspecific
symptoms such as tiredness and weakness also makes people vulnerable to mental disorders.
Biological factors affecting mental disorders are genetic origin, abnormal physiology and congenital
defect.

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Disasters are potentially traumatic events which impose massive collective stress consequent to
violent encounters with nature, technology or mankind. Various international studies had shown 30-
70 percent of mental health morbidity. A meta-analysis showed that post-traumatic stress disorder,
generalized anxiety disorder and panic disorder were common among disaster victims. Stigma related
to mental disorders, lack of awareness in common people, delayed treatment seeking behavior, lack of
low cost diagnostic test and lack of easily available treatment are the main hurdles in combating the
problem of mental health in India. In addition factors pertaining to traditional medicine and beliefs in
supernatural powers in community delays diagnosis and treatment. India had focused its attention
mainly to maternal and child health and communicable diseases. This leads to lack of political
commitment to non-communicable diseases further aggravating the load of mental disorders.

Way Forward

Burden of mental disorders seen by the world is only a tip of iceberg. To promote mental health, there
is a need to create such living conditions and environment that support mental health and allow people
to adopt and maintain healthy lifestyle. A society that respects and protects basic, civil, political, and
cultural rights is needed to be built to promote mental health. National mental health policies should
not be solely concerned with mental disorders, but should also recognize and address the broader
issues which promote mental health. This includes education, labour, justice, transport, environment,
housing, and health sector. For attaining this, intersectional coordination is a mainstream.

It is increasingly recognized that the prodromes of many mental disorders start at such an early age.
India needs to aim at improving child development by early childhood interventions like preschool
psychosocial activities, nutritional and psychosocial help to give roots for a healthy community.
Presently the community is also demanding the skills building programme and child and youth
development programme.

To reduce the burden of mental disorders in women, there is need to do socioeconomic empowerment
of women by improving access to education and employment opportunities. Women should be
involved in group activities like farmer’s clubs, mahila mandal and adolescent girls' groups. These
group activities will bring people together for social, health and educational reasons as well as income
generation activities. Society needs to be free of discrimination and violence. Reducing discrimination
against sex, caste, disability and socioeconomic status is an important aspect to reduce mental
disorders.

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Social support for elderly people needs to be strengthened. More community and day centres for the
aged should be developed. Programmes targeting towards indigenous people, migrants and people
affected by disasters need to be established. Programme could be implemented through school like
programmes supporting ecological changes in schools or at work place like stress prevention
programmes. Various organizations across the globe are now largely focusing on mental health.
World Health Organization mental health Gap Action Programme aims at scaling up services for
mental, neurological and substance use disorders. Since its launch, over millions of people across the
world are treated for depression, schizophrenia and epilepsy, prevented from suicides and begin to
live a normal life. This was especially efficient in low and middle income countries having scarce
resources.

Another key to reduce mental morbidity is to strengthen the treatment of mental disorders at the level
of primary health care. There are multiple interventions needed to prevent the progression of mental
disorders from early manifestations to more serious and chronic cases. There is an urgent need of
simple, easily available diagnostic test and low cost treatment to provide better primary health care.
Psychiatric epidemiologists need to reorient their research in such a way that true burden of mental
disorders are estimated at community level. This would provide true situation of the mental health
problem. Secondary prevention must focus on strengthening the ability of primary care services to
provide effective treatment.

Conclusion
Mental disorders are seen to vary across time, within the same populations at the same time. This
dynamic nature of the psychiatric illness impacts its planning, funding and healthcare delivery.
Various studies had shown that the prevalence of mental disorders is high in female gender, child and
adolescent population, students, elderly population, people suffering from chronic medical conditions,
disabled population, disaster survivors, and industrial workers. Community surveys have the
advantage of being more representative.

References
Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad J et al. Suicides in young people in rural
southern India. Lancet. 2004;363(9415):1117–18.
Bhaskaran K, Seth RC, Yadav SN. Migration and mental ill health in industry. Indian J Psychiatry.
1970; 12:102–16.
Deswal BS, Pawar A. An Epidemiological Study of Mental Disorders at Pune, Maharashtra. Indian J
Community Med. 2012;37(2):116-21.

76
 VENKA Int. j. soc. sci. manag & entrep 3(2):72-78, November 2019

Ganguli HC. Epidemiological findings on prevalence of mental disorders in India. Indian J

Psychiatry. 2000;42(1):14-20.
Ganguli HC. Prevalence of psychological disorders in an Indian industrial population. I, II and III.
Indian J Med Res. 1968;56(5):754–76.
Hackett R, Hackett L, Bhakta P, Gowers S. The prevalence and association of psychiatric disorder in
children in Kerala, South India. J Child Psychol Psychiatry. 1999;40(5):801-7.
Jain D, Sanon S, Sadowski L, Hunter W. Violence against women in India: evidence from rural
Maharashtra, India. Rural Remote Health. 2004;4(4):304.
Kar N, Dutta S, Patnaik S. Mental health in an Indian industrial population: Screening for psychiatric
symptoms. Indian J Occup Environ Med. 2002;6:86–8.
Kermode M, Herrman H, Arole R, White J, Premkumar R, Patel V. Empowerment of women and
mental health promotion: a qualitative study in rural Maharashtra, India. BMC Public Health.
2007,7:225.
Kessler RC. Psychiatric epidemiology: selected recent advances and future directions. Bull World
Health Organ. 2000;78(4):464-74.
Kumar PK, Jayaprakash K, Monteiro NP, Bhagavath P. Psychiatric Morbidity in Industrial Workers
of South India. J Clin Diagn Res. 2011:5(5):921-925.
Leo DD. The Interface of Schizophrenia, Culture and Suicide, Suicide Prevention – Meeting the
Challenge Together. Hyderabad, India. Orient Longman; 2003.
Manoranjitham SD, Rajkumar AP, Thangadurai P, Prasad J, Jayakaran R, Jacob KS. Risk factors for
suicide in rural south India. Br J Psychiatry. 2010;196(1):26-30.
Math SB, Girimaji SC, Benegal V, Uday Kumar GS, Hamza A, Nagaraja D. Tsunami: Psychosocial
aspects of Andaman and Nicobar Islands: Assessments and intervention in the early phase. Int
Rev Psychiatry. 2006;18(3):233-9.
Math SB, Srinivasaraju R. Indian Psychiatric epidemiological studies: Learning from the past. Indian
J Psychiatry. 2010;52:95-103.
Nandi PS, Banerjee G, Mukherjee SP, Nandi S, Nandi DN. A study of psychiatric morbidity of the
elderly population of a rural community in West Bengal. Indian J Psychiatry. 1997;
39(2):122-9.
National Crime Record Bureau. Accidental Deaths and Suicides in India. New Delhi: Ministry of
Home Affairs, 2005.
Patel V, Kirkwood BR, Pednekar S, Weiss H, Mabey D. Risk factors for common mental disorders in
women. Population-based longitudinal study. Br J Psychiatry. 2006,189:547-55.
Patel V, Kleinman A. Poverty and common mental disorders in developing countries. Bull World
Health Organ .2003;81(8):609-615.

77
 VENKA Int. j. soc. sci. manag & entrep 3(2):72-78, November 2019

Pillai A, Andrews T, Patel V. Violence, psychological distress and the risk of suicidal behavior in
young people in India. Int J Epidemiol. 2009;38(2):459–69.
Reddy VM, Chandrasekhar CR. Prevalence of mental and behavioral disorders in India: A meta-
analysis. Indian J Psychiatry.1998;40(2):149-57.
Seby K, Chaudhury S, Chakraborty R. Prevalence of psychiatric and physical morbidity in an urban
geriatric population. Indian J Psychiatry. 2011;53(2):121-7.
Shaji S, Bose S, Verghese A. Prevalence of dementia in an urban population in Kerala, India. Br J
Psychiatry. 2005; 186:136-40.
Srinath S, Girimaji SC, Gururaj G, Seshadri S, Subbakrishna DK, Bhola P et al. Epidemiological
study of child & adolescent psychiatric disorders in urban & rural areas of Bangalore, India.
Indian J Med Res. 2005;122(1):67- 79.
World Health Organization. The world health report 2001 - Mental Health: New Understanding, New
Hope. World Health Organization 2001, Geneva.

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