The World Health Organisation defines health as ‘a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’. However, the majority of healthcare systems across the globe only concentrates on physical care, and fails to provide adequate mental healthcare to its populations.

Mental health disorders are largely evident in all countries, and cause immense suffering, lead to poor quality of life, and adversely affect a country’s economic and social costs. The National Health Survey of 2015-16 estimated that around 14% of India’s population required active mental health interventions. The COVID-19 pandemic with its disastrous effects has brought forth the focus on mental health issues in the country. In order to analyse the current state of mental illness in the country, the National Institute of Mental Health & Neuro Sciences (NIMHANS), in association with the Ministry of Health & Family Welfare is currently conducting the National Mental Health Survey.

Mental illness cannot continue to be ignored or sidelined anymore. The current times call for a system that respects the basic human right for healthcare (both physical and mental) and promotes holistic good health outcomes by integrating mental healthcare into the primary healthcare system.

Primary healthcare systems in any country acts as the first line of defence against illness and diseases for individuals, and are also the closest and easiest to access, since the primary healthcare centres are located within the community. Meanwhile, mental healthcare institutions are typically located away from the population clusters, which consequently leads to people failing to seek the care they need. This also means that people who do seek treatment in these mental healthcare institutions are usually isolated from their families and have limited access to their emotional or social support networks. By integrating mental healthcare within the primary healthcare ecosystem would mean that people will have ready access to the care they need along with their support systems. 

Along with the growing burden of mental health issues in the country, the stigma and taboo around these illnesses continue to grow. This significantly hampers and prevents people from seeking mental health treatment and diagnosis. Impeded awareness and lack of enough healthcare professionals also widens the gap. The World Health Organisation states that the mental health workforce in India is severely understaffed. There should be more than three psychiatrists and psychologists for every 100,000 population. However, in India, per 100,000 population there are only 0.3 psychiatrists, 0.12 nurses, 0.07 psychologists and 0.07 social workers.

Integration of mental healthcare into primary healthcare involves participation of multiple stakeholder groups ranging from governmental and non-governmental bodies, local governance bodies, institutions at community levels (both rural and urban), and involvement of medical professionals. Health and mental health policies, plans and laws should all reinforce the development of a strong primary healthcare system as well as the integration of mental health within that system. 

Two significant developments heralded the integration of mental health into primary care in India – the launch of the National Mental Health Programme in 1982, and the revision of the National Health Policy, which specified the inclusion of mental health in general health services, in 2002. In India, several policies re-emphasise the need for consolidated services in the existing healthcare paradigm. These include National and District Mental Health Programmes (NMHP, 1982; DMHP, 1995), and the Mental Healthcare Bill (2016-17).

Integrating mental health services into primary healthcare can be an important solution to addressing human resource shortages to deliver mental health interventions. At same time there needs to be sufficient numbers of primary healthcare workers (including general practitioners, general nurses, mid-wives, nursing assistants and community health workers) with the requisite skills and competencies to identify mental disorders, provide basic medication and psycho-social interventions, undertake crisis interventions, refer to specialist mental health services where appropriate, and provide psycho-education and support to patients and their families.

However, all these efforts would be futile if no action is taken to address the lack of mental health awareness, and if no actions are taken to pull out mental health from the trenches of social stigma and taboo. The private sector along with their non-profit partners, as part of their corporate social responsibility programmes, can play an absolutely pivotal role in this. Corporations can formulate social awareness programmes that look at disseminating knowledge about the importance of mental health and why it cannot be ignored. 

Half of the battle is won, if awareness and behavioural change is achieved within the society. Battle against mental health must be fought at all fronts and with all guns blazing.