Expenditure on treatment of mental illness pushes 20% Indian households into poverty, finds new study

Critical need to provide financial risk protection to reduce the monetary impact of healthcare expenditure on mental illness among households in India, says paper  

By Rajat Ghai
Published: Tuesday 04 April 2023
Photo from iStock used for representation

As many as 20 per cent of Indian households become poor as a result of spending money for treatment of mental illnesses, a new research paper has highlighted.

Some 18.1 per cent of a household’s monthly consumption expenditure was spent on healthcare due to mental illness of a member, it found.

States and Union territories like Daman and Diu (19.4 per cent), Himachal Pradesh (18.0 per cent), Sikkim (17.4 per cent), Lakshadweep (14.6 per cent), Maharashtra (13.7 per cent), Telangana (13.3 per cent), Punjab (12.7 per cent) and Uttarakhand (12.5 per cent) reported higher healthcare burden due to mental illness than the national average for India (10.4 per cent).

On the other hand, Mizoram (0.5 per cent), Andaman and Nicobar Islands (1.2 per cent), Puducherry (1.7 per cent), Dadra and Nagar Haveli (2.0 per cent), Arunachal Pradesh (3.0 per cent) and Nagaland (3.5 per cent) reported lower healthcare burden.

There is a critical need to accelerate on-ground measures for early diagnosis and management of mental illness in India to reduce its poverty impact, the paper added.

Burden of mental illness

The study’s aim was to highlight the burden of mental illness and the gaps in seeking care for mental health issues in India.

It sought to focus on the need for formulating and strengthening financial risk protection policies for those affected by mental illness in India. The paper noted:

Majority of people in low- and middle-income countries with mental illness do not receive healthcare, leading to chronicity, suffering and increased costs of care. This study estimated the out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and poverty impact due to mental illness in India.

OOPE usually refers to expenses that one has to pay for with their own money rather than an alternative source.  

CHE is money spent on healthcare that exceeds some specified critical level of tolerance or threshold from the household total income in a given specified period.

The researchers acquired data from the 76th round data of the National Sample Survey (NSS) on the theme ‘Persons with Disabilities in India Survey’, July-December 2018. Data of 6,679 persons who reported mental illness during the survey was included for analysis.

Those aged 60 years and above reported the highest OOPE on mental illness in the last 365 days across all age groups. About 59.5 per cent and 32.5 per cent of the households were exposed to CHE based on 10 per cent and 20 per cent thresholds, respectively.

Most of the 20 per cent households forced into poverty due to expenses on mental illness treatment were rural (22.5 per cent) as compared to urban (17 per cent), according to the study.

Globally, the disease burden for mental illness (or mental disorders) accounts for 32.4 per cent of years lived with disability and 13 per cent of disability-adjusted life-years, according to 2016 estimates.

More than 11.1 per cent of the total disease burden is due to mental health disorders in low-and middle-income countries (LMICs). Yet, they receive less than one per cent of many of these countries’ health budgets, the study noted.

In India, mental illness constitutes one-sixth of all health-related disorders.

There have been rising cases of mental issues in India, particularly depression, anxiety, bipolar disorders and schizophrenia, and suicide being a leading cause of deaths among young people.

The National Mental Health Policy 2014 and the Mental Healthcare Act, 2017 have proposed several steps to combat mental illnesses through promoting awareness, ending the stigma associated and provision of good quality and affordable care for mental illnesses in the country.

Catastrophic Health Expenditure and Poverty Impact Due to Mental Illness in India was published in the Journal of Health Management on March 30, 2023.

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