National Mental Health Survey (NMHS)

About the National Mental Health Survey

• NMHS was a unique collaborative endeavour undertaken across 12 states of India with active engagement of more than 400 persons during 2014-16. 
• The project was funded by the Ministry of Health and Family Welfare, Government of India. 
• It was coordinated by the National Institute of Mental Health and Neurosciences, Bengaluru.
• The National Mental Health Survey of India-2016 was conducted on a nationally representative sample of 34802 individuals, sampled from 12 states of India.

Focus of NMHS

The NMHS was conceptualised to cover a representative national population, examine all priority mental disorders, focus on the treatment gap, service utilisation, disability and impact along with an assessment of resources and systems in a sample of Indian states; simultaneously and with uniform methodologies. 

The population selected and interviewed was drawn based on scientific sampling methods by including individuals aged 18 years and above

The objectives 

• Estimate the prevalence and pattern of various mental disorders in a representative Indian population 
• Identify treatment gap, health care utilisation, disabilities and impact
• Assess the current mental health services and systems in the surveyed states

Key findings of the survey

• Mental disorders contribute to a substantial disease burden in India: it is estimated that, excluding tobacco use disorders, mental morbidity of individuals above the age of 18 years currently was 10.6%. The lifetime prevalence in the surveyed population was 13.7%. 
• Prevalence of mental morbidity is high in Indian urban metros: The prevalence of schizophrenia and other psychoses (0.64%), mood disorders (5.6%) and neurotic or stress related disorders (6.93%) was nearly 2-3 times more in urban metros

• Common mental disorders affect significant sections of society:  
  • Common mental disorders (CMDs), including depression, anxiety disorders and substance use disorders are a huge burden affecting nearly 10.0% of the population. 
  • This group of disorders are also closely linked to both causation and consequences of several non- communicable disorders (NCD), thereby contributing to a significantly increased health burden

1 in 20 people in India suffer from depression: 

• • The weighted prevalence of depression for both current and life time was 2.7% and 5.2%, respectively, indicating that nearly 1 in 40 and 1 in 20 suffer from past and current depression, respectively. 
  • Depression was reported to be higher in females, in the age-group of 40-49 years and among those residing in urban metros. Equally high rates were reported among the elderly (3.5%)

There is a high prevalence of psychoactive substance use: 

• Substance use disorders (SUDs), including alcohol use disorder, moderate to severe use of tobacco and use of other drugs (illicit and prescription drugs) was prevalent in 22.4 % of the population above 18 years in all the 12 surveyed states
• The survey also revealed that 0.6% of the 18+ population were recognised with illicit substance use disorders (dependence + abuse) which included cannabis products, opioid drugs, stimulant drugs, inhalant substances and prescription drugs. 
• Among adult males this was 1.1%.

High suicidal risk is an increasing concern in India: Nearly 1% of the population reported high suicidal risk. The prevalence of high suicidal risk was more in the 40-49 age group (1.19%), among females (1.14%) and in those residing in urban metros (1.71%). 

Severe mental disorders are equally important: 

• Nearly 1.9% of the population were affected with severe mental disorders in their lifetime and 0.8% were identified to be currently affected with a severe mental disorder. 

• The current prevalence of severe mental disorders in most states was less than 1%, excepting in Manipur and West Bengal. 

• Productive age groups are affected most: Males in the age group of 30 – 49 years were the most affected indicating that mental disorders contribute to greater morbidity in the productive population

• Both genders are affected – variation across disorders exists:  

• The overall prevalence of mental morbidity was higher among males (13.9%) than among females (7.5%). 

• However, specific mental disorders like mood disorders (depression, neurotic disorders, phobic anxiety disorders, agoraphobia, generalised anxiety disorders and obsessive compulsive disorders were higher in females.

Children and adolescents are vulnerable to mental disorders: 

• • • Prevalence of mental disorders in age group 13-17 years was 7.3% and nearly equal in both genders. 
    • Nearly 9.8 million of young Indians aged between 13-17 years are in need of active interventions. Prevalence of mental disorders was nearly twice (13.5%) as much in urban metros as compared to rural (6.9%) areas. 
    • The most common prevalent problems were Depressive Episode & Recurrent Depressive Disorder (2.6%), Agoraphobia (2.3%), Intellectual Disability (1.7%), Autism Spectrum Disorder (1.6%), Phobic anxiety disorder (1.3%) and Psychotic disorder (1.3%)

• Neurosis and stress related disorders affect women disproportionately: Neurosis and stress related disorders affected 3.5% of the population and was reported to be higher among females (nearly twice as much as males).

• Variations in prevalence exist at the regional and state levels: 
  • • While the overall current prevalence estimate was 10.6% in the total surveyed population, significant variations in overall morbidity are seen across the different surveyed states, ranging from 5.8% in Assam to 14.1 % in Manipur. 
    • Three states Assam, Uttar Pradesh and Gujarat reported prevalence rates less than 10%; in 8 of the 12 states, the prevalence varied between 10.7% and 14.1%

Epilepsy is an important public health problem:  

• Epilepsy is a major public health problem in India and several studies have documented its prevalence and characteristics. 
• Under the NMHS, epilepsy was identified using the screener instrument recommended by WHO. 
• The prevalence of epilepsy (Generalized Tonic Clonic Seizures) was 0.3%, with nearly 2 million persons requiring care

Persons with Intellectual disability need comprehensive management:  

• • In NMHS, 2015-16, the assessment of Intellectual disability was undertaken using a screener instrument. 
  • The prevalence of this condition was 0.6% in the surveyed population, resulting in nearly 4 million persons requiring care.