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Mental Health: The Missing Piece in Indian Healthcare Policy

Introduction

Mental health remains a neglected component of India’s healthcare policy, despite its significant social and economic burden. Referred to as the “missing piece,” mental health struggles to gain traction in policy and budgetary discussions due to cultural stigma, systemic barriers, and competing health priorities. This brief addresses key questions from a multi-segment discussion, exploring why mental health is sidelined, its manifestations in daily life, and actionable steps forward, drawing on recent research and policy analyses. Despite legislative advancements like the Mental Healthcare Act (MHCA), 2017, and the National Mental Health Policy (NMH Policy), 2014, mental health continues to be sidelined in policy and budget discussions.


Reasons for Side-lining Mental Health in Policy and Budget Discussions


India’s Dual Stigma: Cultural Misbeliefs and Structural Neglect


Cultural vs. Structural Stigma: Mental health stigma in India is both cultural and structural. Culturally, mental disorders are often viewed as personal weaknesses or supernatural afflictions, rather than medical conditions, leading to social ostracism. Structurally, the lack of mental health infrastructure and trained professionals reinforces neglect, as public systems offer limited access. In everyday life, stigma manifests in families concealing mental health issues, reluctance to seek professional help, and derogatory language (e.g., “pagal” for mentally ill). Urban populations, particularly younger individuals, show increasing openness due to education and digital awareness, while rural and older populations often remain silent, associating mental health with shame. Unique to India is the interplay of traditional beliefs, such as attributing mental illness to karma or spirits, with modern pressures like academic competition and social media, creating a complex avoidance pattern.


The Broken Bridge — Integration into Primary Healthcare


Resistance to Integration: Resistance stems from both inadequate training and perceptions that mental health is less “real” than physical health. Primary care providers often lack skills to diagnose or treat mental disorders, and stigma among healthcare workers compounds this. Global Examples: The UK’s NHS integrates mental health through Improving Access to Psychological Therapies (IAPT), offering scalable counselling within primary care. Chile’s community-based mental health model trains general practitioners to address common disorders, reducing specialist dependency. India could adapt these by training Accredited Social Health Activists (ASHAs) and integrating mental health into Ayushman Bharat’s primary care framework, leveraging existing infrastructure.


Insufficient Data and Research

The lack of robust, real-time data hampers mental health advocacy. The National Mental Health Survey (NMHS) of 2015–16 reported a 10.6% prevalence of mental disorders among adults, with a treatment gap of 70–92%. However, outdated and fragmented data obscure the crisis’s magnitude, including its economic impact, estimated at $1.03 trillion in lost productivity by 2030. Limited research capacity and administrative barriers, such as delayed ethical approvals, further constrain evidence-based policymaking.


Budgetary Constraints and Competing Priorities

India’s healthcare budget, at approximately 2.1% of GDP in 2023–24, is insufficient to address all health needs. Mental health receives less than 1% of this allocation, dwarfed by funding for communicable diseases, maternal health, and infrastructure. The National Mental Health Policy, 2014, lacks earmarked funds, leading to under-implementation. Policymakers prioritize short-term, measurable outcomes over the long-term benefits of mental health investments, which are harder to quantify.


Workforce and Infrastructure Shortages

Compared to the WHO's recommended 3 psychiatrists per 100,000, India has a serious deficit of mental health specialists, with only 0.75 psychiatrists per 100,000 people. Service scalability is limited by a lack of facilities and skilled staff, which deters governments from investing in a sector that is thought to be underequipped. This feeds a vicious cycle of neglect: minimal investment is justified by poor infrastructure, which further reduces capacity.


Policy Fragmentation and Implementation Challenges

The MHCA, 2017, and NMHPolicy, 2014, are progressive but face implementation hurdles. The NMHPolicy aims to promote mental health, reduce stigma, and ensure rights-based care, yet its rollout is hampered by insufficient funding and coordination. District Mental Health Programs (DMHPs) cover only 60% of districts, often with limited resources. State-level variations in governance and funding further fragment efforts, undermining policy effectiveness.


Lack of Political and Economic Incentives

Compared to high-profile projects like hospital construction or immunization programs, mental health lacks political appeal. Issues that appeal to voters and produce results right away are given priority by politicians. Disenfranchised populations are disproportionately affected by mental health, which has trouble gaining political traction. Furthermore, less is known about the financial cost of mental illnesses, which lessens the motivation for investment.


Implications of Neglect

India's economic and public health problems are made worse by the disregard for mental health. Substance misuse, societal problems including homelessness, and high suicide rates (14.5 per 100,000 in 2021) are all influenced by untreated mental illnesses. The financial toll, which includes lost production and medical costs, puts pressure on the economy. Significant caring responsibilities fall on families, which exacerbates shame and poverty. These disparities were brought to light during the COVID-19 pandemic, when 30–40% of people reported psychological anguish, but little mental health interventions were implemented. These disparities are particularly stark across socioeconomic, gender, and regional lines, with rural communities and lower-caste groups facing limited access to care due to a severe shortage of mental health professionals. Women, burdened by societal stigma and domestic responsibilities, are less likely to seek help, while marginalized groups like migrant workers and tribal communities receive minimal targeted support, deepening their vulnerability.


Recommendations


Schools and Workplaces—Where Policy Meets Daily Life


Risks in Schools: Neglecting mental health in schools exacerbates risks for teenagers facing identity struggles, academic pressure, and social media-driven anxiety. The NMHS reported a 7.3% prevalence of mental disorders among adolescents. Untreated issues lead to poor academic performance, substance abuse, and long-term mental health challenges. To address these risks, schools should integrate mental health education into curricula to raise awareness and reduce stigma. Establishing on-site counseling services with trained professionals can provide immediate support for students.


Workplace Incentives: Companies can be incentivized through tax benefits, mandatory mental health compliance under labor laws, or public-private partnerships. Policies could mandate Employee Assistance Programs (EAPs) or mental health leave, as seen in some Western models, to foster workplace well-being. Enforcing mandatory mental health training for managers can help create supportive work environments and reduce stigma. Additionally, establishing partnerships with mental health NGOs can provide resources and expertise to small and medium enterprises, ensuring broader access to mental health support across industries.


The Road Ahead—Participation


Universal Health Coverage (UHC): Mental health must be integral to India’s UHC goals under Ayushman Bharat. Including mental health services in insurance coverage, as mandated by MHCA, 2017, would ensure affordability and access. Integration with primary care and telehealth platforms like Tele MANAS (1.81 million calls by February 2025) can bridge gaps, particularly in rural areas.

  1. Increase Budget Allocation: Allocate at least 5% of the healthcare budget to mental health, with dedicated funds for DMHP expansion and workforce training.

  2. Enhance Data Systems: Conduct regular, nationwide mental health surveys and integrate mental health indicators into the NITI Aayog Health Index.

  3. Combat Stigma: Launch nationwide awareness campaigns leveraging traditional and digital media to normalize mental health care.

  4. Strengthen Implementation: Ensure full DMHP coverage with clear funding mechanisms and intersectoral coordination.

  5. Leverage Technology: Expand initiatives like Tele MANAS, which handled over 1.81 million calls by February 2025, to improve access in rural areas.

  6. Integrate with Primary Care: Embed mental health services in primary healthcare to enhance accessibility and reduce costs.


Conclusion

Mental health’s marginalization in India’s healthcare policy stems from cultural, systemic, and economic barriers. Despite progressive policies like the NMHPolicy, 2014, and MHCA, 2017, implementation gaps and inadequate funding persist. Addressing these challenges requires increased investment, robust data, and public advocacy to integrate mental health into the mainstream healthcare agenda. By prioritizing mental health, India can foster a healthier, more equitable society.


References

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  • World Health Organization. (2020). Mental Health Atlas 2020: India Country Profile. https://www.who.int/publications/m/item/mental-health-atlas-2020-country-profile--india 

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  • Wikipedia. (2025). Mental Health in India.Notes low public budget allocation (0.16%), human resource scarcity, and landmark 2017 Act Wikipedia page

  • The Lancet Psychiatry. (2025). India’s mental health budget 2025 needs urgent reform.Highlights that only 1.05% of the total health budget is allocated to mental health  Abstract at The Lancet

  • PMC – Mental health services in rural India: a big challenge still to be met. (Year unspecified).Reviews rural–urban disparities, NMHP coverage of nearly all districts, and 70–90% treatment gap  Full text at PMC

  • The Wire. (2025). Mental Health Funding in India: When Economic Surveys and Budget Realities Diverge.Reports Rs 1,004 crore allocated in 2024–25, with 92% directed to large institutions; notes underutilization  Read on The Wire

  • PIB Press Release. (2022). Government launched National Tele Mental Health Programme (Tele-MANAS).Details implementation since October 2022: 53 Tele-MANAS cells, 1.8M+ calls across 36 states/UTs Official release on PIB

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  • Times of India. (May 2025). Call for help: 1 in 3 says “mazaa nahi aa raha.”Reports ~16,700 Tele-MANAS calls in Gujarat, revealing help-seeking behavior and prevalent mood/anxiety issues

  • Times of India. (June 2025). 60-day deadline: Punjab races against time to enforce Mental Healthcare Act after HC rap. Covers Punjab HC's ultimatum to implement MHCA fully, including new rules around addiction and rights 

  • Times of India. (May 2025). Punjab battles drug crisis, MHCA yet to be fully enforced. Summarizes challenges in aligning addiction services with MHCA, highlighting need for evidence-based approaches

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