An estimated 197.3 million people have mental disorders in India, and majority of the population have either no or limited access to mental health services. Thus, the country has a huge burden of mental disorders, and there is a significant treatment gap. Public mental health measures have become a developmental priority so that sustainable gains may be made in this regard. The National Mental Health Program (NMHP) was launched in 1982 as a major step forward for mental health services in India, but it has only been able to partially achieve the desired mental health outcomes. Despite efforts to energize and scale up the program from time to time, progress with development of community-based mental health services and achievement of the desired outcomes in India has been slow. Public health measures, along with integration of mental health services in primary healthcare systems, offer the most sustainable and effective model given the limited mental health resources. The main barriers to this integration include already overburdened primary health centres (PHCs), which face the following challenges: limited staff; multiple tasks; a high patient load; multiple, concurrent programs; lack of training, supervision, and referral services; and non-availability of psychotropic medications in the primary healthcare system. Thus, there is an urgent need for a fresh look at implementation of the NMHP, with a focus on achieving sustainable improvements in a timely manner.
Barriers to the provision of community-based mental health services at primary healthcare level in northern Nigeria – a mixed methods study