State of mental health in South Asia

The World Mental Health Day, observed annually on October 10, is a reminder of the importance of good mental health and the need to prioritise and invest in good mental health.

Worldwide, over one billion people, i.e. around one in eight persons, live with a mental health disorder. Anxiety and depression are the most common that are among the top 10 leading causes of health loss globally.

In South Asia, the increasing burden from mental, neurological and drug-use, problems make mental health a major public health issue. Over a quarter of the South Asian population live with mental health problem. The major challenges include stigma, a shortage of specialist providers, insufficient government allocation to the mental health sector, and lack of appropriate policy directives. Hence, the services are not keeping pace, resulting in a significantly large treatment gap, and disproportionately affecting the have-nots.

Mental health in Afghanistan is a major problem driven by decades of conflicts, poverty, stigma, and serious restrictions on women and children. This has led to very high rates of depressions (around 75 per cent) and anxiety (over 70 per cent), especially among women and children. The problem isfurther compounded by a lack of accessible services, and a shortage of trained professionals, thereby the vast majority of the Afghans receive little or no support.

In Bangladesh, mental health is a growing concern, with around one-fifth of adults and 13 per cent of children and adolescents suffering from mental health disorders. There are problems of stigma, limited access to services more so in rural areas, an acute shortage of specialist providers, thereby creating a huge treatment gap.

In 2023, there were over 11,000 people affected with mental and behavioral disorders in Bhutan.Mental and behavioral disorders due to alcohol and depression are among the other top causes of mental illnesses.Mental health faces considerable challenges such as stigma, a shortage of trained providers, and inadequate resources.

With around 150 million people with a mental health morbidity in 2025, it is a major public health concern in India, especially affecting women and other vulnerable population groups. There is a huge gap in mental health resources, resulting in a significant treatment gap.

Mental health is an emerging public health concern in the Maldives. The challenges include stigma, drug use, limited healthcare facilities especially outside of the capital city, a shortage of trained providers, shortages of certain medications, and the dispersed population that make service delivery difficult and costly.

In 2020, around 10 per cent of adults in Nepal have had a mental disorder in their lifetime, with the current prevalence of around 4 percent. Adolescents have a current prevalence of around 5 percent. The most common are depression and anxiety. The challenges include cultural stigma, a shortage of specialist providers, limited access to services, further compounded by poverty and unemployment.

Around 45 million people (adults, adolescents and the youth) suffer from depression and anxiety in Pakistan, more among women (around 45 per cent) than among men (around 22 per cent). The challenges include cultural stigma, a shortage of specialist providers, a lack of accessible services, and inadequate resources.

Sri Lanka faces huge mental health challenges, showing increasing trends in recent years. Challenges includestigma, limited infrastructure, a shortage of skilled professionals especially in rural areas, limited access to care in rural areas, and a history of conflict and disasters. Common mental illnesses include anxiety, depression, and stress, affecting adults, adolescents and the youth.

To improve mental health, there is a need, among other things, to focus on healthy lifestyle choices; and build and foster strong social connections.

In most South Asian countries, public health spending is less than the WHO-recommended dose required for universal health coverage, and out-of-pocket spending accounts for a significant portion of total health expenditure. Worse still, those countries spend a tiny percentage of their national budgets on mental health. India spends only around 0.8 per cent and Bangladesh less than 0.5 per cent on mental health. Because of this underfunding, there is a lack of adequate treatment facilities, and a lack of specialist providers. This particularly affects the poor and the needy. Not surprising therefore, out-of-pocket expenditure is quite high across the region.

There is a serious shortage of psychiatrists in South Asia. India has only around 3000 psychiatrists for its population of over one billion people, and Bangladesh has about 270 psychiatrists for its population of around 170 million. The problem is exacerbated by the fact that psychiatrists are mostly concentrated in urban areas, thereby leaving rural people with very limited access to mental healthcare services.

Undoubtedly, there is a need to attach considerably much higher priority to the overall health sector, including the mental health sector, by developing accessible infrastructures, train specialist professionals, increase funding to the WHO-recommended dose. Such investments will not only help people achieve their desired health status but also save them and their countries from huge expenses incurred on such care. Furthermore, enhancing the health status will raise labour productivity, and contribute to the process of overall socio-economic development of the countries in the region.

Barkat-e-Khuda, PhD is Former Professor and Chairman, Department of Economics, University of Dhaka. Email: barkatek@yahoo.com