High spending on mental disorders pushed 20 percent of Indian families into poverty: ICMR study 

NEW DELHI: High expenditure on mental disorders is shooting up families' healthcare budget, as it is pushing an estimated 20 percent of Indian households into poverty, according to the latest Indian Council of Medical Research (ICMR) study.

The findings are based on a survey of 1.18 lakh households and 5.76 lakh individuals in the National Sample Survey (NSS) held between July and December 2018. The study covered 6,679 individuals who reported mental illness during the survey.

The study, a first of its kind in India, found that 18.1 percent of the household's monthly expenditure on health care was on mental illnesses.

These mental conditions have been categorised as having abnormal thoughts, emotions, behaviour, and relationships apart from bipolar mood disorders, depression, dementia, and intellectual impairments. 

People in smaller regions like Daman and Diu (23.4 percent), Himachal Pradesh (23.9 percent), and Sikkim (31.9 percent) spend the most on mental disorders compared to other parts of the country.

Among the bigger states, Maharashtra (21.3 percent) and Telangana (22.2 percent) top the charts.  

According to the study, a large number of households - 59.5 percent - had "catastrophic" health expenditures.

The study said India faces a severe mental health crisis, with illnesses constituting one-sixth of all health-related disorders. The rising cases of depression, anxiety, bipolar disorders, and schizophrenia have been a cause of concern.

"Overall, 20.7 percent of the households were pushed into poverty," said the study.

“There is a critical need to accelerate on the ground various measures for early diagnosis and management of mental health issues in order to reduce out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and poverty impact due to healthcare expenditure in the country,” said Dr. Denny John, Adjunct Faculty, Amrita Institute of Medical Sciences and Research Centre, Kochi, a co-author of the study, told this paper.

The study, which also involved researchers from the Mehac Foundation, Kerala, and Amrita Institute of Medical Sciences and Research, Kochi, said there is a critical need to provide financial risk protection to reduce the impact of healthcare expenditure on mental illnesses.

Global mapping of data, as per 2016 estimates, show that mental illnesses formed 32.4 percent of all disabilities. In low-income countries, the mental illness burden was 11 percent of all diseases.

In India, according to the WHO data, depression comprised 7.1 percent of disabilities, while anxiety formed 2.5 percent of the disease burden.

The study took a monthly expenditure of Rs 972 in rural and Rs 1407 in urban areas as the poverty line recommended by the Rangarajan committee based on 2012 data. 

"The percentage of households falling below the poverty line was higher among rural residents than urban residents. About 22.5 percent of rural households were pushed from being on-poor to below poor compared to 17 percent in patients from urban households," said the study adding that the average percentage shortfall in income from the poverty line due to mental illness treatment care expenditure was 7.6 percent.

 
States and union territories to report higher healthcare burden than the national average for India which stands at 18.1%

Daman and Diu (23.4%); Himachal Pradesh (23.9%); Sikkim (31.9%); Lakshadweep (14.6%); Maharashtra (21.3%); Telangana (22.2%); Punjab (17.3%); Uttarakhand (38.6%); 

On the other hand, Mizoram (2.5%), Andaman and Nicobar Islands (1.2%), Puducherry (1.7%), Dadra and Nagar Haveli (2.0%), Arunachal Pradesh (12.7%) and Nagaland (26.2%) reported lower healthcare burden.

Overall, 20.7% of the households were pushed into poverty.

The higher proportion of people with mental illness is seen in the economically productive age group of 19-55 years