Abstract
Mental health care is a national health priority in India. The flagship National Mental Health Programme (NMHP) has been in place since 1982. 1 In 1996, the programme was expanded with the District Mental Health Programme (DMHP), based on the successful Bellary model of Karnataka state. A recent addition to India’s NMHP is the digital component, TELEMANAS, which aims to provide universal access to mental health care. 2 Despite repeated efforts, the availability of mental health services in rural areas is limited, and the overall burden continues to be high. According to the estimates of the World Health Organization, India has a huge burden of mental health problems, which are estimated to account for 2,443 disability-adjusted life years (DALYs) per 100,000 population, with the associated economic loss projected at $1.03 trillion between 2012 and 2030. 3 In light of this, India must give equal priority to community-based preventive strategies and institution-based mental health care.
In this context, India has an opportunity to act on the recommendations of the third report of the Lancet Psychiatry Physical Health Commission. 4 The report recognises differences in infrastructure, workforce capacity and service delivery across countries, and offers strategies that can be adapted to diverse contexts. Its guidance has broad applicability, and India is well placed to translate these recommendations into practice through existing national and state mental health programmes.
The Lancet Psychiatry Physical Health Commission highlights the stark disparities in physical health faced by people living with mental illness. Cardio-metabolic risk is 1.4-2 times higher compared to the general population. Physical health conditions account for ~70% of the deaths of people with severe mental illness, driving an average reduction in life expectancy of between 13 and 15 years.
The third report from the Lancet Psychiatry Physical Health Commission focuses on modifiable lifestyle risk factors, such as high smoking rates, low physical activity, high levels of sedentary behaviour, low cardiorespiratory fitness, lower diet quality, detrimental eating behaviour and poor sleep hygiene, which are more prevalent in this population. The report emphasises upstream determinants such as inequities in income, food security and access to care. Importantly, the Commission provides adaptable and cost-effective strategies to improve physical activity, nutrition, sleep and smoking cessation across diverse settings.
The macro-level priorities for action such as collaborative governance, meso-level actions such as strategic alignment between the integration of lifestyle interventions and organisational strategy and capacity building for the implementation and delivery of lifestyle interventions are relevant for all mental care services. Actions such as integrating qualified dietitians and exercise professionals into the interventions and implementation of job shadowing will be more resource-intensive, while task-shifting and training of non-specialist workers to deliver lifestyle interventions and engaging family members and friends can be relevant everywhere. In India, these priorities could be embedded within existing programmes such as the DMHP to strengthen both mental and physical health outcomes. States like Kerala, where DMHP coverage is universal, offer a strong platform for demonstrating how lifestyle interventions can be integrated into routine care. In settings with limited resources, the focus may need to be on training of existing staff, while simultaneously embedding exercise and nutrition specialists into the mental health services in the apex training and research institutions to drive long-term systemic change.
The third report of the Lancet Psychiatry Physical Health Commission will be a landmark contribution to global mental health care. By generating recommendations through the inclusion of lived experience and Global South perspectives, and rigorous evidence, it offers governments a practical roadmap for improving health outcomes in people with mental illness. For India, the integration of these recommendations into national initiatives such as the NMHP, DMHP and TELEMANAS will improve the outcomes in all dimensions of health.