Hit hardest, healed least: disruption and incomplete recovery of public mental-health outpatient services across two COVID-19 waves in India, 2017-2022
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Background
India’s COVID-19 waves disrupted essential health services, but the impact on public mental healthcare has been documented only through provider surveys and single-facility reports. We quantified the disruption and recovery of mental-health outpatient services nationally, using routine administrative data, and compared it against physical-health services over the same period.
Methods
Interrupted time-series analysis of India’s Health Management Information System (HMIS), April 2017 to March 2022. Monthly mental-illness outpatient (OPD) visit counts and adolescent counselling contacts were extracted for all states and districts. Expected counts from March 2020 were projected from log-linear trend plus calendar-month seasonality fitted on the 35 pre-pandemic months, with a no-trend same-month-mean counterfactual as sensitivity analysis. District-level recovery was classified from final-year (April 2021-March 2022) observed/expected ratios among districts with stable reporting.
Results
Public mental-illness OPD visits, which had grown from 4.1 to 6.1 million per year between 2017-18 and 2019-20, fell to 31% of expected in April 2020 — a deeper acute shock than any maternal-child health indicator in the same reporting system (38-84%). Recovery was slower and less complete: mental-illness OPD averaged 43% of expected during the Delta wave and 58% in the final study year, versus around 90% for a composite of physical-health services. The cumulative two-year deficit was 18.5-47.1% across counterfactuals; absolute visits in 2021-22 (5.36 million) remained below the 2019-20 actual (6.10 million). Among 220 districts with stable reporting, 79% had not returned to within 85% of expected by the final year, the median district operated at 41% of expected (IQR 16-78%), and districts hit hardest in April-June 2020 remained furthest behind (Spearman rho=0.60). Adolescent counselling contacts showed the same twin-shock, partial-recovery pattern (final-year ratio 72-74%). Cumulative state deficits exceeded 60% in eleven states.
Conclusion
Public mental-health outpatient care in India was hit harder by COVID-19 than physical-health services and, uniquely among major service lines, had not recovered two years on. These findings provide the missing quantitative baseline for evaluating India’s post-pandemic mental-health investments, including the National Tele Mental Health Programme (Tele-MANAS) launched in October 2022, and argue for district-targeted service restoration rather than uniform national programming.
