Investing in preventive and promotive mental health: a call for public financing reform in India’s primary health care

INTRODUCTION

The World Health Organization (WHO) defines mental health as a state of well-being that enables people to cope with the stress of life, realize their potential, learn well, work well, and contribute to society.¹ In 2019, one in eight people, or approximately 970 million people worldwide, had mental disorders, which include conditions like anxiety and depression.² Non-exposure to adversity at a young age has been identified as a preventable risk factor for mental disorders.¹ The contribution of mental health issues to the total disability adjusted life years (DALYs) has increased from 2·5% in 1990 to 4·7% in 2017.³ In 2017, it was estimated that 197·3 million people in India had a mental disorder, of which 45·7 million had depressive and 44·9 million had anxiety disorders, which has increased by 25% in the first year of the pandemic itself.^3,4 The WHO estimates the economic loss in India due to mental health amounts to USD 1.03 trillion, between 2012-30 if unaddressed.⁵Thus, we see poor mental health as a huge contributor to the burden of disease, as well as having social, economic, and medical determinants.

MENTAL HEALTH INITIATIVES IN INDIA

The National Mental Policy 2017 highlights the necessity of increasing financial allocation for promotive, preventive, and treatment aspects of mental health. Additionally, it advocates the promotion of contributions from various non-governmental organizations (NGOs). However, India’s mental health activities are predominantly linked with the National Mental Health Program (NMHP), established in 1982, which emphasizes integrating mental health care with primary healthcare services. Over the decades, the program has evolved to focus on integrating mental health services into general healthcare services through the district mental health program (DMHP), in which the training of human resources and establishing centres of excellence have been the areas of emphasis. The recently introduced Tele-MANAS scheme in 2022 offers tele-mental health services to people in remote or underserved areas.⁶ Also, the program has structured its objectives to ensure accessibility to vulnerable communities, promote community participation in improving mental health, and stimulate efforts towards self-help in the community.⁷

India’s flagship scheme, the Ayushman Bharat (AB) initiative, has envisaged mental health components at the primary care level, which comply with the objectives of the NMHP. Apart from these, centrally funded institutes of excellence, like the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, and LGB Regional Institute of Mental Health, Tezpur, provide services like inpatient and outpatient treatment, rehabilitation services, and research activities.⁸

BUDGETARY ALLOCATION TOWARDS MENTAL HEALTH IN INDIA

In the union budget, the specific budgetary allocations for mental health, encompassing related schemes, programs, and activities, fell within the estimates for the ministries of health and family welfare (MoHFW) and the Ministry of Social Justice and Empowerment (MoSJE). The total allocation to mental health is less than 1% of the total government of India budget. Figure 1 represents the trend of budgetary allocation towards mental health. The total mental health budget has increased consistently, from ₹932·13 crores in 2021-22 to ₹1,614 crores in 2024-25. The most significant jump is seen in the latest financial year (2024-25), where the total allocation increased by ₹415 crores (34.6%) compared to 2023-24.

Table 1 indicates a reduction in the revised estimates, suggesting potential under-utilization of funds in NMHP, especially in financial years 2018-19 and 2019-20, which could be attributed to inadequate coordination between the central and state authorities in fund disbursement or other factors.⁸ In the Budget 2023-24, the NMHP has been subsumed and is no longer a separate line item.⁶ The Tele-MANAS component was introduced as a new line item, receiving 15% of the total funds allocated for mental health, which is a clear indication of the change in the government's focus on strengthening digital health.⁶

*Budget for mental health- analysis of union budget 2021-22- Indian mental health observatory report

The NMHP, tasked with implementing the DMHP at both the tertiary and district levels, has consistently faced limited financial support.⁹ With this, the spending towards preventive and promotive care in mental health through the components of NMHP, which included components like early detection and treatment, public awareness generation, and capacity building of the health workforce, has been diminished.¹⁰ Therefore, this downward trend, as well as an undefined breakup in budgetary support, indicates a lower priority shown by various governments towards preventing and promoting efforts in mental health.

Over the past five years, budgetary allocations and expenditures have largely prioritized palliative and rehabilitative care for premier institutions like NIMHANS and LGB Institute, with minimal focus on preventive and promotive measures. While some state governments have initiated adolescent mental health programs, these efforts have predominantly centred on awareness generation rather than comprehensive screening to identify hidden mental health issues. Thus, the lack of focus on preventive and promotive components within these programs highlights a critical gap in policy implementation in both the National and State Budgets, which reflects this trend.

In brief, the inadequate funding for mental health falls short of meeting the population’s needs when viewed through a public health lens. This calls for emphasizing the intersectoral collaborations for a robust mental health system. Many review articles have stressed the effectiveness of various mental health initiatives at schools, colleges, workplaces, etc.¹¹

Workplace mental health initiatives, like corporate wellness programs (work-life balance strategies, wellness sessions like yoga, meditation), counselling services, peer support programs with the services of mental health advocates, peer-to-peer counselling, etc., have been found effective in our settings as well.¹² Similar strategies can be applied in the case of schools and colleges, like integrating mental health services in routine teaching activities, building good teacher-student relationships and thereby providing emotional security and nourishment, protecting them from failings and adversities, and providing counselling by specialists. ¹³

WHAT IS THE NEED OF THE HOUR?

From a health financing perspective, it asserts that the responsibility of investing in national or state-level mental health programs should not solely fall on the health ministry. Furthermore, the stigma surrounding mental health, prevalent across socio-economic groups, often leads to underreporting and reluctance to seek care, further exacerbating funding and implementation challenges. Awareness campaigns and mental health champions could normalize discussions and promote acceptance.

The present trend of union budgetary allocations to public institutions ultimately addresses the prevalence of mental health disorders, once viewed through a public health lens. This underlines the importance of emphasizing primary care, which has to adopt a ‘prevention first-mental health strategy’ within national health policies. The governments have to mandate minimum budgetary allocations for preventive and promotive public mental health services.

The most essential thing is to establish cross-sector governance bodies to coordinate funding and service delivery. Following this, investment has to be made in monitoring and evaluation systems to track long-term impact. Research and evidence synthesis should be promoted to assess the effectiveness and further cost-effectiveness of these cross-sector collaborative initiatives, which will enhance the primary mental health care efforts.

ACKNOWLEDGMENTS

Authors would like to thank to Dr. Nabil Abdul Majeed and Dr. Rakhal Gaitonde for their valuable guidance, constructive feedback, and support during the development of this manuscript.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

1. 1. WHO. Comprehensive Mental Health Action Plan 2013-2030. 1st ed. Geneva: WHO; 2021: 1.
2. 2. Arias D, Saxena S, Verguet S. Quantifying the global burden of mental disorders and their economic value. eClinicalMedicine. 2022;54:101675.
3. 3. Sagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A, et al. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990-2017. The Lancet Psychiatry. 2020;7(2):148-61.
4. 4. WHO. WHO highlights urgent need to transform mental health and mental health care. 2022. Available at: https://www.who.int/news/item/17-06-2022-who-highlights-urgent-need-to-transform-mental-health-and-mental-health-care. Accessed 12 September 2025.
5. 5. WHO. Mental health - India, 2025. Available at: https://www.who.int/india/health-topics/mentahealth. Accessed on 29 May 2025.
6. 6. Mind Matters: India’s Mental Health Budget Crisis. Speaking of Medicine and Health. 2023. Available at: https://speakingofmedicine.plos.org/2023/05/25/mind-matters-indias-mental-health-budget-crisi. Accessed on 10 April 2025.
7. 7. Singh OP. District Mental Health Program - Need to look into strategies in the era of Mental Health Care Act, 2017 and moving beyond Bellary Model. Indian J Psychiatry. 2018;60(2):163-4.
8. 8. Fernandes T. Budget for Mental Health Analysis of Union Budget 2021-2022. 2022.
9. 9. Issue-Brief-DMHP. Available at: https://cmhlp.org/wp-content/uploads/2021/08/Issue-Brief-DMHP-IV.pdf. Accessed on 29 May 2025.
10. 10. DGHS I. National Mental Health Programme. 2022. Available at: https://dghs.mohfw.gov.in/national-mental-health-programme.php. Accessed on 29 May 2025.
11. 11. Margaretha M, Azzopardi PS, Fisher J, Sawyer SM. School-based mental health promotion: A global policy review. Front Psychiatry. 2023;14:1126767.
12. 12. Pandya A, Khanal N, Upadhyaya M. Workplace Mental Health Interventions in India: A Rapid Systematic Scoping Review. Front Public Health. 2022;10:800880.
13. 13. Lai KYC, Hung SF, Lee HWS, Leung PWL. School-Based Mental Health Initiative: Potentials and Challenges for Child and Adolescent Mental Health. Front Psychiatry. 2022;13:866323.
14. 14. Mehra D, Lakiang T, Kathuria N, Kumar M, Mehra S, Sharma S. Mental Health Interventions among Adolescents in India: A Scoping Review. Healthcare (Basel). 2022;10(2):337.
15. 15. Biswas J, Kumar S. Prevalence of Work Stress among Private and Public Sector Employees in Delhi: A Differential Study. Int J Indian psychol. 2021;9(2):1376-87.