Mental health disorders cause productivity losses due to absenteeism, high healthcare costs: Economic Survey

The Economic Survey 2023-24 has highlighted how not paying adequate attention to mental health could have an adverse impact on economic growth. The survey has pointed out that there are a host of programmes around mental health well-being of India, but their effective implementation is a challenge.

As per the World Health Organisation, in 2019, one in every eight people, or 970 million people globally, were living with a mental disorder, with anxiety and depression being the most common conditions. The COVID-19 pandemic led to a 27.6% increase in cases of major depressive disorders and a 25.6% increase in cases of anxiety disorders globally in 2020. According to a large-scale study co-led by researchers from Harvard Medical School and the University of Queensland, one out of every two people in the world will develop a mental health disorder in their lifetime. In India, the National Mental Health Survey (NMHS) of 2015-16 showed that 10.6% adults suffered from mental disorders in India while treatment gap for mental disorders ranged between 70 to 92% for different disorders. Further, according to the survey, the prevalence of mental morbidity was higher in urban metro regions (13.5%) as compared to rural areas (6.9%) and urban non-metro areas (4.3%). The second, and more expansive NMHS is currently in progress.

The Economic Survey states that mental health problems affect the quality of life of an individual and constrain the realisation of an individual’s potential. “At an aggregate economic level, mental health disorders are associated with significant productivity losses due to absenteeism, decreased productivity, disability, increased healthcare costs, etc.”

Apart from mental health impacting economic development, there is also evidence of poverty affecting the risk of mental health via stressful living conditions, financial instability, and a lack of opportunities for upward mobility, which contribute to heightened psychological distress. According to a 2016 study across 36 countries, the benefit-to-cost ratio of substantially scaled-up treatment of depression and anxiety in 2016-30 was estimated as 2.3-3.0:1 considering economic benefits only, and 3.3-5.7:1 when the value of health returns is also included (Chisholm et al. 2016). In the Indian context, Math et al. (2019) estimate the return on investment in the implementation of the Mental Health Care Act 2017 by the Government to be 6.5 times.

The Economic Survey has called out for redoubling efforts to increase the number of psychiatrists, from 0.75 psychiatrists per lakh population in 2021 to the WHO norm of 3 per one lakh population. Not only is it important to have better implementation of the existing mental health programmes, the Survey has also called out the need for assessing the effectiveness of the programmes by gathering feedback from users, professionals and stakeholders. “It will help make necessary changes and meet the needs of a wider population. Nurturing peer support networks, self-help groups and community-based rehabilitation programmes can help de-stigmatisation of mental disorders and develop a sense of belonging. Partnering with NGOs to scale up efforts, share knowledge, and leverage resources to enhance future policies will also aid in identifying areas of improvement."

The Economic Survey also recognises that the biggest stumbling block for mental health interventions is the stigma attached to it. "The fundamental issue of the lack of awareness about mental health and the stigma surrounding it can render any sincerely crafted programme unfeasible. Hence, there is a need to bring about a paradigm shift and utilise a bottom-up, whole-of-community approach in addressing the topic of mental health. Breaking the stigma starts with taking cognisance of the natural human tendency to accept physical ailments and seeking treatment for the same while being in denial about mental health issues. To an extent, the denial is an outcome of fear about social attitudes and social acceptance after one ‘comes out’ with mental health issues."