Can impact finance help solve India's mental health crisis?

Around 15% of India's population suffer from poor mental health - and the number of people afflicted has been increasing steadily, from 125 million in 1990 to 197 million in 2017. Suicide ranks as the second-biggest cause of death among Indian adults of working age. However, despite being a huge burden, and having recent policy and legislative attention, India spent less than 1% of its total healthcare budget on mental health in 2017.

This low level of spending on mental health is further exacerbated by underutilization of funds, low prioritization of mental health by individual Indian states, and low coverage of health insurance for mental, neurological and substance use (MNS) disorders. The COVID-19 pandemic has only underscored the need for additional financing of mental health services, with a focus on increased mobilization and effective allocation of finances to address priority needs.

There are several challenges along the patient care journey of mental health in India, as illustrated in the figure below.

Effective and innovative mental health interventions can be scaled up quickly in order to improve mental healthcare delivery in India. These can include the following:

● Embedding the awareness and detection of mental health problems, counselling and referral into well-defined care pathways through frontline workers at the community level.

● Conducting behavioural change communication campaigns to destigmatize mental health issues and to present options for care for both patients and caregivers.

● Enabling anonymous methods of seeking help, such as helplines or apps.

● Improving accessibility by leveraging digital tools and technologies and strengthening mental health service delivery at the primary and secondary care levels.

● Using digital tools for the training of frontline workers to screen, diagnose and manage at-risk individuals, and of primary care doctors to treat mental health patients.

● Using mobile-based (digital) decision support systems to improve patient management, wherein patient information can be accessed by frontline workers for effective delivery of mental health services.

● Improving adherence to care through psycho-social education, setting up follow-up mechanisms or changes of treatment regimen with increased adherence.

Over the past few years, impact financing has emerged as a significant method of mobilizing capital into investments that target measurable socio-economic/health impact along with financial returns. In order to address two inherent issues with mental health financing, such as low-spending and underutilization of available expenditure, there is a need to bring in impact financing to increase access as well to improve the efficiency of mental health funding in India. Here's how this can help:

1. Increase access to funding

Innovative impact finance instruments can attract private capital into areas it does not traditionally fund, such as mental health, by reducing or externalising the risks during the early stages. Philanthropic actors can provide seed capital in the form of convertibles or competitive awards to fund innovative models across the mental healthcare spectrum. This can help develop proof-of-concepts that could be scaled by traditional venture capital or private sector players. Grand Challenges Canada’s Global Mental Health programme, for instance, focuses on funding high-impact innovations that improve treatments and/or expand access to care for people, especially youth, living with or at risk of mental disorder.

2. Improve funding efficiency

Innovative finance can also be an effective mechanism for improving outcomes-per-dollar by ensuring incentives are aligned towards maximising outcomes. Service providers often face challenges in securing funding for large scale, multi-year programmes. Pay-for-success mechanisms (including impact bonds) and conditional financing instruments (such as milestone-based payments) help secure long-term commitments by allowing for donors to only pay for successful outcomes. These models can be particularly advantageous as donors only pay for measurable results, while the programme implementor is made accountable to ensure the best programme delivery. The Resolve Social Benefit Bond in Australia, for example, has funded a recovery-orientated community support programme that aims to support people who spend long periods admitted to mental health inpatient facilities or who require frequent repeat care. This has generated savings for the New South Wales Government through a reduction in participants’ utilisation of health and other services.

India needs impact financing for mental healthcare to complement public funding and for mobilizing resources from private sector and philanthropy, to bring innovative mental healthcare delivery models to scale.

Disclaimer: The views expressed in the article belong solely to the authors, and not necessarily to the World Economic Forum or/and the author's employer, organization, committee, or other group or individual.