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Mental illness India’s ticking bomb, only 1 in 10 treated: Lancet study

In 2013, 36 million years of healthy life were lost to mental illness in China, and 31 million in India.

Written by Anuradha Mascarenhas | Pune |
May 19, 2016 5:07:44 am

A new report says the burden of mental illness will increase more rapidly in India than in China over the next 10 years and the two countries account for one third of the global burden of mental illnesses, a figure greater than all developed countries put together.

Data shows that despite the rising figures in India, only about one in 10 people with mental health disorders are thought to receive evidence-based treatment.

The report will be published Thursday in The Lancet and The Lancet Psychiatry to mark the launch of the China-India Mental Health Alliance, a long-term project that brings together experts from China and India to look at the current status of mental health and mental health services in the two countries.

In 2013, 36 million years of healthy life were lost to mental illness in China, and 31 million in India. Estimates now suggest that by 2025, 39.6 million years of healthy life will be lost to mental illness in China (10 per cent increase), and 38.1 million in India (23 per cent increase).

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The report, based on data from an analysis of the Global Burden of Disease (2013), shows that in both countries, substance use disorders were more common in men than women — the burden of drug dependence disorders was more than twice as high for men as women, and the burden of alcohol use disorders was nearly seven times higher for men as women.

China alone accounted for 17 per cent of the global mental, neurological and substance-use disorder burden, whereas India accounted for a further 15 per cent.

Dementia is also a growing problem for both countries.

From 2012 to 2025, the number of healthy years lost to dementia will increase by 82 per cent in India (from 1.7 million to 3.2 million) and by 56 per cent in China (from 3.5 million to 5.4 million).

Dr Vikram Patel, international mental health professor at the London School of Hygiene & Tropical Medicine and lead author of one of the papers that took a review of the unmet mental health needs of adults in China and India, said most people with mental disorders in India and China do not receive needed treatment.

There are 0·3 psychiatrists per 100,000 people in India while in China, there are 1·7 psychiatrists per 100,000 people. In China, less than 6 per cent of people with common mental health disorders (mood or anxiety disorders), substance use disorders, dementia and epilepsy seek treatment. Among people with psychotic disorders, 40 per cent have never sought treatment from mental health professionals.

With a combined population of over 2.5 billion, China and India make up 38 per cent of the world population. The aim of the China-India Mental Health Alliance is to identify evidence-based solutions to their shared problems. Three papers, which are part of the Lancet report, are the first of several publications to be released over the coming year.

Dr Rahul Shidhaye, Research Scientist, Public Health Foundation of India, who co-authored the first paper in the series, said projected changes in disability adjusted life years or DALYs (reflecting years of healthy life lost due to morbidity and mortality — life lost due to disease and death) for all mental, neurological ,and substance use disorders are expected to increase more sharply in India than in China.

In India, the proportion of all burden explained by mental, neurological, and substance use disorders rose from 3 per cent in 1990 to 6 per cent in 2013. Between 2013 and 2025, the population in both countries is expected to increase — from 1·39 billion to 1·45 billion in China, and from 1·25 billion to 1·45 billion in India.

The absolute number of DALYs in India is expected to increase for all 13 conditions over the next 12 years, whereas the number in China is expected to fall for three of the thirteen conditions (ADHD, conduct disorder and illicit drug use disorders) and to increase by no more than 5 per cent for five other disorders (anxiety disorders, autism spectrum disorders, idiopathic intellectual disabilities, alcohol use disorders and epilepsy).

In India, the District Mental Health Programme (DMHP) covers 200 districts so far. The effectiveness of the programme varies across states because of restricted funding, shortages of human resource, and low motivation among service providers at all levels.

In practice, DMHP is largely limited to psychiatric outreach clinics in a few primary healthcare centres, and more than 60 per cent of people with mental disorders access care directly at a district hospital, rather than the primary healthcare centres.

Access to mental health services in India continues to be a major challenge as up to 40 per cent of patients travel more than 10 km to access DMHP services.

India has 443 public mental hospitals, but six states, mainly in the northern and eastern regions with a combined population of 56 million people, are without a single mental hospital, whereas other states have several mental hospitals. NGOs that provide mental health services are also concentrated in the southern and western regions of the country.

In India, although the funding for NMHP in 1985-90 was only 10 million rupees, the programme enjoyed a substantial increase in funds in subsequent two 5-year plans (1997-2007). But the proportion of total health budget that is allocated to mental health still remains very low. In 2012-13, only 1·3 per cent of the Ministry of Health and Family Welfare expenditure was spent on the NMHP.

Authors have said that community engagement, increased support for community health workers and collaboration with traditional and alternative medicine practitioners are key to providing more accessible, affordable and acceptable mental health care in India and China.

Patel said while China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Decentralisation of planning in the 1980s and investment in expanding mental health services since 2000 has led to substantial increase in mental health resources in China, which outperforms India on most indicators, for example with eight times more mental hospital beds per person.


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