India’s path towards better mental health in a pandemic

Avanti Andhale, Nanditha Venkatesan, Siddesh Zadey


COVID-19 has wide-ranging effects on population health including mental health, particularly in low-and-middle-income countries (LMICs). Outbreak and interventions such as quarantine and isolation against it have contributed to psychosocial adversities. We aimed to review the state of India’s mental healthcare planning, identify the gaps in the health systems and policies, and present cost-effective and scalable solutions. Necessary background information was triangulated through an iterative literature review of the policy, preprint, and peer-reviewed research literature. We focused on the following themes-a) health system capacity, policy, and law for India, b) psychological impact of COVID-19 outbreak in India, c) psychological impact of interventions against COVID-19, and d) best practices across countries for mental health management during the pandemic. We used qualitative synthesis to identify health systems and policy gaps to generate short- and long-term solutions supported by high-grade evidence for effectiveness, cost-effectiveness, and adaptation feasibility in India. The Indian health system has several shortcomings in its mental health care that became pronounced during the current COVID-19 pandemic. To overcome these, long-term goals should include increased public financing, increased human resources production, integration of health emergency and mental health policies and legislation. Immediate needs could be met by scale-up of task-shifting initiatives and telepsychiatry services in rural regions. In the ongoing pandemic, employing school-based psychosocial interventions, public awareness campaigning, subverting misinformation through broadcast legislations, and stigma reduction for general mental illnesses are pertinent. These solutions can help bridge the gaps in mental health care in India.



COVID-19, Mental health, India, Health policy, Health systems, Pandemic

Full Text:



Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020;14:779-88.

The Lancet Infectious Diseases. The COVID-19 infodemic. Lancet Infect Dis. 2020;20:875.

Campion J, Javed A, Sartorius N, Marmot M. Addressing the public mental health challenge of COVID-19. Lancet Psych. 2020;7:657-9.

Roy D. Study of knowledge, attitude, anxiety ampamp; perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr. 2020;51:102083.

Asmundson GJG and Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. J Anxiety Disorders Vol. 2020;71:102211.

Jaiswal R. Impact of the coronavirus disease 2019 pandemic on resident doctors in India. Cancer Res Statistics Treatment. 2020;3:87.

Sarkar S. Religious discrimination is hindering the COVID-19 response. BMJ. 2020;369:m2280.

Jeong, H. et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol. Health. 2016;38:e2016048.

Brooks SK. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912-0.

CDC. Older Adults. Available at: Accessed on 20 Jan 2021.

WHO and the Calouste Gulbenkian Foundation. Social determinants of mental health. 2014. Availabe at: /gulbenkian_paper_social_determinants_of_mental_health/en/. Accessed on 20 Jan 2021.

Singh OP. Mental health of migrant laborers in COVID-19 pandemic and lockdown: Challenges ahead. Indian J. Psychiatry. 2020;62:233-4.

Institute of Medicine (US) Committee on Health Care for Homeless People. Health Problems of Homeless People. National Academies Press (US). 1988.

Praveen, M. P. Spurt in illegal brewing of liquor in Ernakulam. The Hindu. 2020. Available at: Accessed on 20 Jan 2021.

Ministry of Health and Family Welfare, Government of India. National Mental Health Policy of India. 2014.

The Disaster Management Act, 2005;200553:53.

Tewari, M. Tiwari, 2020. OBSERVER RESEARCH FOUNDATION. 2020. Available at: Accessed on 20 Jan 2021.

The Public Health (Prevention, Control and Management of Epidemics, Bio-Terrorism and Disasters) Bill, 2017.

Office of the Attorney General. electronic Irish Statute Book (eISB). (Office of the Attorney General. 2020.

India State-Level Disease Burden Initiative Mental Disorders Collaborators. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990-2017. Lancet Psychiatry. 2020;7:148-61.

Ambekar A, Rao R, Agrawal A. Magnitude of Substance use in India. 2019.

Murthy RS. National mental health survey of India 2015-2016. Indian J Psychiatry. 2017;59(1):21-6.

Munjal, D. Huge gap in India’s mental health budget. The Hindu BusinessLine. 2020. Available at: 30733494.ece. Accessed on 20 January 2021.

Math SB. Cost estimation for the implementation of the Mental Healthcare Act 2017. Indian J Psychiatry. 2019;61:S650-9.

Ministry of Health and Family Welfare, Government of India. About Pradhan Mantri Jan Arogya Yojana (PM-JAY). Available at: pmjay. Accessed on 20 Jan 2021.

World Health Organization. Mental Health Atlas, 2017. (World Health Organization, 2018). Available at: Accessed on 20 January 2021.

Garg K, Naveen Kumar C, Chandra PS. Number of psychiatrists in India: Baby steps forward, but a long way to go. Indian J Psychiatry. 2019;61:104.

Satpathy S. Determination of the Cost of Training of Undergraduate Medical (MBBS) Student at All India Institute of Medical Sciences, New Delhi, India. Int J Res Foundation Hospital Healthcare Administration. 2013;1:1-7.

Kaul R. Ayush practitioners are growing in India, says Ayush minister Naik. Hindustan Times, 2017. Available at: health/ayush-practitioners-are-growing-in-india-says-ayush-minister-naik/story-jQkGyZAv9SLdy6RhLlO DbI.html. Accessed on 20 Jan 2021.

Sidana A. Community psychiatry in India: Where we stand? J Mental Health Human Behaviour. 2018;23:4.

Fathima I. Over 300 trained in Karnataka to rid stigma against COVID-19 health workers. The New Indian Express, 2020. Available at: Accessed on 20 Jan 2021.

De Silva MJ, Cooper S, Li HL, Lund C, Patel V. Effect of psychosocial interventions on social functioning in depression and schizophrenia: meta-analysis. Br J Psychiatry. 2013;202:253-60.

Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, De Silva MJ et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376:2086-95.

World Health Organization. Draft menu of cost-effective interventions for mental health, 2019. Available at: Accessed on 20 Jan 2021.

Math SB, Manjunatha N, Kumar CN, Basavarajappa C, Gangadhar BN. Telepsychiatry Operational Guidelines 2020. NIMHANS, Bengaluru, 2020.

Innovative provision of primary mental health care in rural India - SMART Mental Health Programme. Available at: Accessed on 20 Jan 2021.

Moirangthem S, Rao S, Kumar CN, Narayana M, Raviprakash N, Math SB et al. Telepsychiatry as an Economically Better Model for Reaching the Unreached: A Retrospective Report from South India. Indian J Psychol Med. 2017;39:271-5.

Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry. 2016;6:269-82.

Dalton L, Rapa E, Stein A. Protecting the psychological health of children through effective communication about COVID-19. Lancet Child Adolesc Health. 2020;4:346-7.

Patel V, Chisholm D, Dua T, Laxminarayan R, Medina-Mora ME. Mental, Neurological, and substance use disorders. World Bank. 2016.

Shivani MG, Greeshma AS, Kumar R, Menon S. Enhancing mental health literacy in India to reduce stigma: the fountainhead to improve help-seeking behaviour. J Public Ment Health. 2014;13:146-58.

Petersen, I. Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility? Soc Sci Med. 2020;51:321-34.

Funke D, Flamini D. A guide to anti-misinformation actions around the world-Poynter. Poynter Accessed on 20 Jan 2021.

Jain K, Singh B. Disinformation in times of a pandemic, and the laws around it. The Economic Times. Available at: https://economictimes. Accessed on 20 Jan 2021.

COVID-19: WHO, UNICEF and UNDP partner with WhatsApp to get real time health information to billions around the world. UNDP. Available at: Accessed on 20 Jan 2021.

Duffy RM. Stigma, inclusion and India’s Mental Healthcare Act 2017. J Public Ment Health. 2019;18:199-205.

Hocking B. StigmaWatch-Tackling Stigma Against Mental Illness and Suicide in the Australian Media: A SANE Report. SANE Australia. 2014.

Griffiths KM, Carron-Arthur B, Parsons A, Reid R. Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry. 2014;13:161-75.

Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv. 2012;63:963-73.

Committee on the Science of Changing Behavioral Health Social Norms, Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education and National Academies of Sciences, Engineering, and Medicine. Approaches to Reducing Stigma. (National Academies Press (US), 2016.