National Mental Health Survey of India 2015-16

NMHS
limited in scope with the advent of new
psychotropic medications, rehabilitation
programmes and community care(13).
The lack of a comprehensive and integrated
systems approach to mental health care,
results in poorly functioning or absent
mental health systems. The consequent
inefficiencies, service gaps, and compromised
mental health outcomes limits the health
systems’ response to manage the burden of
mental disorders adequately. There is a huge
gap between the need for treatment and its
provision, all over the world. In LMICs,
nearly 76% - 85% of people with severe
mental disorders received no treatment
for their problems, while surprisingly 35%
-50% even in high- income countries had not
received treatment. Among those who had
received treatment, the problem was further
compounded by the poor quality of care(12).
Without satisfactory quality in mental health
care, people with mental disorders, their
families, and the general public become
disillusioned with mental health treatment
and care. Lack of focus on quality also results
in resources being wasted.
Thus, a good mental health system broadly
integrated into the larger national and
regional health systems, plays a key role in
delivering effective, safe, and high-quality
care to those who need it, when they need
it and with minimal waste. Focus on quality
helps to build trust in the effectiveness of the
system, overcomes barriers for appropriate
care and ensures maximum effectiveness
with the efficient use of available resources.
Public health approaches and their
several components within health
systems, and mental health systems in
particular, contribute towards the effective
functioning of the system. These include
identified governance and structure, a
well-articulated policy, strategic action
plan(s), implementation of targeted and
defined programmes, supportive structures,
resource allocation and development.
Prioritization of activities, well established
coordination mechanisms between the
centre and the state, steps to engaging the
community and civil society, reporting and
monitoring of frameworks and evaluation
plans are absolute necessities. In reality,
all these components make a public health
framework and will essentially lead to a
systems approach.
Specifically, for India, the limited reach and slow
expansion of mental health programmes and
services can be broadly attributed to the lack of an
efficient public health framework and inadequate
and poorly developed systems for mental health
care. While the need for planning, program
development and implementation based
on good quality data is often reiterated, the
public health and a systems perspective
of services and resources has been totally
missing.
In view of the need for a systems approach and
one built on a larger public health framework,
a good understanding of the current level of the
mental health system in India is necessary. This
will provide a clearer and more comprehensive
picture of the major weaknesses as also essential
information for planning and strengthening
mental health services along with identifying the
areas of integration within the existing system to
improve mental health care. Undoubtedly, a wellplanned
and organised mental health system has
immense scope for enhanced service delivery,
positive outcomes and improved human rights
for people with mental disorders.
SMHSA
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