Date Published: October 25, 2018
Publisher: Public Library of Science
Author(s): Banandur S. Pradeep, Gopalkrishna Gururaj, Mathew Varghese, Vivek Benegal, Girish N. Rao, Gautham M. Sukumar, Senthil Amudhan, Banavaram Arvind, Satish Girimaji, Thennarasu K., Marimuthu P., Kommu John Vijayasagar, Binukumar Bhaskarapillai, Jagadisha Thirthalli, Santosh Loganathan, Naveen Kumar, Paulomi Sudhir, Veena A. Sathyanarayana, Kangkan Pathak, Lokesh Kumar Singh, Ritambhara Y. Mehta, Daya Ram, Shibukumar T. M., Arun Kokane, Lenin Singh R. K., Chavan B. S., Pradeep Sharma, Ramasubramanian C., Dalal P. K., Pradeep Kumar Saha, Sonia Pereira Deuri, Anjan Kumar Giri, Abhay Bhaskar Kavishvar, Vinod K. Sinha, Jayakrishnan Thavody, Rajni Chatterji, Brogen Singh Akoijam, Subhash Das, Amita Kashyap, Sathish R. V., Selvi M., Singh S. K., Vivek Agarwal, Raghunath Misra, Pallab K. Maulik.
Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014–15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015–16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015–16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.
Robust and good quality data is an essential pre-requisite to plan, develop, implement, monitor, evaluate and strengthen mental health services globally and especially in Low- and Middle-Income countries (LMICs) like India. There is a strong need to understand the pattern of mental disorders prevailing, the consequent health-burden, as well as delineate gauge the currently available resources to plan and deliver services across the country. Alongside the existing National Mental Health Policy , the Mental Health Action Plan  and the recent promulgation of the Mental Health Care act 2017  (replacing the earlier one) , along with increased budgetary allocation to mental health care in India, an understanding of mental health burden will pave the way to implement effective mental health services. Furthermore, with the expansion of state and district mental health programmes to all states and districts, there has been a felt need for good quality data to strengthen mental health services in India.
The NMHS was undertaken on a representative population covering 12 states across 6 regions of India. The states included were from the Northern (Punjab and Uttar Pradesh), Southern (Tamil Nadu and Kerala), Eastern (Jharkhand and West Bengal), Western (Rajasthan and Gujarat), Central (Madhya Pradesh and Chhattisgarh) and North-Eastern regions (Assam and Manipur) of the country. The selected states comprised of diverse ethnicities varying in socioeconomic and cultural characteristics. The national survey included all individuals 18 years and above (and a limited sample of adolescents in 13–17 years in 4 states), in all the 12 selected states and used a combination of quantitative and qualitative methods to assess the burden of mental health problems and the status of mental health systems in India.
The International Classification of Disease, 10threvision, Diagnostic Criteria for Research (ICD-10 DCR)  was used to classify the different mental disorders in the NMHS. Current (Point) prevalence was reported for all diagnostic groups, while life-time prevalence (ever in the life of an individual in the past) for select conditions like bipolar disorders and psychotic disorders were reported as they were captured by MINI.
The NMHS was carried out during 2015–16 across 12 states which included 43 districts, 80 sub-districts, 729 clusters, 10152 households and 34802 individuals. Overall household response rate was 91.1% (range– 75.6% in the southern state of Kerala to 99.3% in the northern state of Punjab) with 10 states having more than 85% response rate (Table 1). The overall individual response rate was 88% ranging from 78.7% in Kerala to 96.1% in Rajasthan. Data collection was started on 2nd October 2015 (after all preparations and planning in place) in western state of Gujarat and completed on 10th June 2016 in the central state of Madhya Pradesh (Table 1).
The National Mental Health Survey of India (2015–16) is a nation-wide representative survey conducted by adopting a uniform, standardized scientific methodology to arrive at estimates of mental morbidity and their related characteristics in India. The unique nature of the NMHS is its comprehensiveness, and that it provides vital information on the burden, treatment gap, health care seeking, service utilization patterns, disability status and impact of these disorders utilizing both quantitative and qualitative research methods. Furthermore, it also examined the preparedness and response to deliver mental health care to populations by examining mental health systems; all at one point of time.