Uvais Nalakath Arakkal
The enactment of India’s Mental Healthcare Act (2017) by the Indian Parliament on April 7, 2017, heralded a transformative, rights-based paradigm shift in the delivery of mental healthcare. The act unequivocally asserts that access to high-quality mental healthcare is an inherent right of individuals living with mental health conditions. Throughout the drafting process and subsequent to its enactment, the act encountered considerable opposition from various stakeholders, notably mental healthcare professionals.
A primary source of dissent stemmed from concerns regarding the substantial financial burden that the implementation of the act would impose, particularly in light of the exceedingly low budgetary allocations for mental health. Consequently, mental health professionals deemed the act impractical and unfeasible. However, some mental health professionals contend that this legislation can be leveraged to enhance fiscal allocations for mental healthcare. In instances where the government fails to disburse adequate funding, any concerned individual may seek recourse through the courts to compel the release of the necessary resources.
What transpired subsequent to the enactment of the legislation regarding financial allocations for mental healthcare, as well as its efficacy in fulfilling the objectives delineated by the act, warrants thorough examination. However, the absence of economic datasets at both national and state levels specifically pertaining to mental health renders this endeavor considerably challenging. A pragmatic approach to evaluate whether the act effectively “moved the money” is to scrutinize the approvals for the District Mental Health Programme (DMHP) both prior to and following the fiscal year 2017–18, which constitutes the principal component of the National Mental Health Programme (NMHP).
Using state-year approvals from 2015 to 2024, I examine national momentum, state variability, and the timing of policy implementation through both descriptive visualizations and straightforward causal timing models.
What the data say at a glance
Following the enactment of the Act, national-level approvals for the DMHP experienced a substantial increase and remained elevated in the ensuing years (Figure 1). This surge is particularly significant, as an interrupted time series analysis of national totals indicates not only a substantial level increase but also a shift in the trajectory following the policy implementation. This suggests a structural transformation in the financing trajectory, transcending mere year-to-year fluctuations.
Figure 1: National DMHP Approvals by Year
However, the state-level landscape of financial allocation for the DMHP is markedly uneven, with certain states, such as Uttar Pradesh and Andhra Pradesh, demonstrating the most pronounced increases. Tamil Nadu, Gujarat, Kerala, and Chhattisgarh also recorded substantial surges in allocation, while Bihar and Rajasthan exhibit the steepest declines in post-policy averages compared to pre-policy levels, with significant reductions also observed in Mizoram and Delhi. Madhya Pradesh and Sikkim further underscore that local implementation and priorities play a crucial role (Figure 2). This heterogeneity is precisely what one would anticipate when the intent of policy encounters diverse administrative capacities and competing priorities.
Figure 2: Heatmap of Approvals by State/UT and Year
Pre/post differences reinforce the picture
When we delineate the series at 2017–18, the national mean approval rate is substantially higher in the post-policy period compared to the pre-policy phase (254.52 vs. 325.19). At the state level, the average post-policy approvals surpass those of the pre-policy era in numerous states; however, the dispersion is considerable. This dispersion encapsulates the essence of the narrative: while rights-based national policy can recalibrate the center of gravity, the efficacy of implementation is contingent upon the subnational capacities at the state level.
Figure 3: Scatter of state average approvals, pre vs post 2017–18
Timing evidence: ITS and state fixed effects
To better understand the above trends, I fitted two simple econometric models.
First, I explored a national interrupted time series analysis on annual totals of financial allocations for DMHP with a break at 2018 estimates: three components: the baseline trend, the immediate level shift at the break, and the change in trend afterward. The model fits well and indicates a statistically meaningful step-up and slope change following the MHA period (Immediate level shift (2018): p < 0.001; Change in trend after 2018: p < 0.001; Post-2018 trend (implied): p < 0.01) (Figure 4). Though, the changes were positive, the analysis indicates a slower growth path compared to the previous year’s trend, revealing a complex picture.
Figure 4: National interrupted time series (break at 2018)
Second, I explored a state fixed-effects segmented-trend model using the full state-year panel to partial out time-invariant differences across states. Cluster-robust standard errors by state account for serial correlation. The results indicate that the post-policy timing trends remain positive on average, consistent with a broad national shift while acknowledging large cross-state variation (Figure 5).
Figure 5: State fixed-effects segmented-trend
What this means for policy and management
The implementation of the IMHCA (2017) led to a significant and persistent increase in DMHP funding approvals nationally. Though, there are variations in state-level financial allocations, the above fact indicates that the rights-based act actually ignited some sort of momentum in the financing side, indicating the right intent from the policymakers and the government bodies. However, how much money is spent on various mental healthcare initiatives and the effectiveness of such programs remains relatively under-documented.
There is a need for establishing proper institutional safeguards that can supervise whether this increased momentum in financial allocation is adequate to actualize the objectives of the act on the ground or if more funding is necessary by routinely monitoring the financial disbursement, procurement and hiring pipelines, services, and meaningful outcomes.
Limitations and next steps:
This current study looked only at the financial approvals, not the actual expenditure or any meaningful outcomes. The pragmatic next step would be to merge state-wise financial approvals for DMHP with real-world expenditure, mental health service delivery in terms of the number of facilities supported, the staff pattern, and the number of patients accessing such facilities, and wherever feasible, the outcomes of such services. Through such a systematic approach, we can make sense of the effectiveness of the act in achieving its objectives from the financial side.
Bottom line
Yes—the enactment of the IMHCA (2017) is significantly associated with moving the money for mental health, with a distinct step-up and steeper growth in DMHP approvals after the policy period. But the benefits are not even or self-executing. What caused such disparity in financial allocation at the state level is a subject of another research. However, one can speculate that where states policy makers and bureaucracy matched the momentum created by the act in financial allocations through proper follow-ups, it translated into higher financial allocations. The opportunity now is to consolidate gains and close the delivery gap so that money is distributed equitably across the Indian states, leading to improved mental health outcomes at the national level.
About the contributor: Dr. Uvais Nalakath Arakkal is a fellow of DAPRF Data Analytics for Policy Research Fellowship – Cohort 3.0.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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Acknowledgement: This article was posted by Urvashi Singhal, Visiting Researcher and Assistant Editor at IMPRI.
