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Title: Enhancing Support for Mental Illness in India’s Disability Benefits: Lessons from the UK
Dear Editor,
Fazilet Hadi’s article on the UK’s £5 billion disability benefit cuts highlights the ongoing challenges in supporting individuals with disabilities, including those with mental illness (BMJ 2025;389:r811, doi:10.1136/bmj.r811) [1]. Drawing on India’s experience, particularly in the area of disability benefits for mental illness, there are valuable lessons for strengthening inclusion in line with the Rights of Persons with Disabilities (RPwD) Act, 2016 [2].
The RPwD Act formally recognizes mental illnesses—such as depression and schizophrenia, which significantly impact daily functioning—as disabilities, entitling affected individuals to benefits including transport concessions, health insurance, employment support, pensions, and educational opportunities [2]. While notable progress has been made, further steps could better enable individuals with mental illness to fully access these entitlements.
Currently, Indian Railways offers fare concessions (75% in multiple classes and 50% on season tickets) for individuals with intellectual disabilities who require an escort [3]. Extending these concessions to persons with mental illness, as recognized under the RPwD Act, could greatly enhance access to healthcare and employment opportunities. Notably, only 0.34% of disability certificates in some states pertain to mental illness, indicating the need for streamlined and accessible certification processes [4].
India’s health insurance schemes, including Ayushman Bharat and various state programs (e.g., Telangana’s Aarogyasri), predominantly emphasize hospital-based care [5]. Expanding coverage to include outpatient mental health services, as mandated under the Mental Healthcare Act, 2017, could significantly reduce out-of-pocket expenditures, which currently account for 70% of mental health costs [6]. This mirrors the UK’s imperative to bolster health service access in the wake of benefit reductions [1].
Rural employment initiatives such as the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) provide job opportunities for persons with disabilities. Tailoring program features, such as offering flexible work schedules, could increase participation among individuals with mental illness [4]. Similarly, while pension schemes (e.g., Indira Gandhi National Disability Pension Scheme) and tax exemptions under Section 80U of the Income Tax Act exist, awareness and uptake remain low; only 12% of eligible individuals access these benefits, with 88.75% of caregivers unaware of available entitlements [4].
India’s situation parallels challenges noted in the UK, where benefit cuts risk exacerbating poverty and health inequalities. Both nations can benefit from a rights-based approach aligned with the UN Convention on the Rights of Persons with Disabilities (UNCRPD). To
(a) Updating program guidelines to explicitly include mental illness in eligibility criteria.
(b) Streamlining the disability certification process for greater accessibility.
(c) Conducting targeted awareness campaigns to bridge the 88.75% caregiver knowledge gap [4].
(d)Promoting participatory policymaking by involving persons with disabilities directly, as recommended by Hadi for the UK.
India’s RPwD Act offers a strong legislative foundation that could inform the UK’s efforts to rebuild inclusive disability benefits. Emphasizing rights, dignity, and co-production of policies can help both countries advance toward a more equitable future for persons with mental illness.
Yours sincerely,
Dr. Om Prakash
Professor Psychiatry
Institute of Human Behaviour and Allied Sciences
Word Count: 590
Competing Interests: None declared.
References:
1. Hadi F. UK government’s disability benefit cuts are cruel and unfair. BMJ. 2025;389:r811. doi:10.1136/bmj.r811
2. Rights of Persons with Disabilities Act, 2016. India Code. https://www.indiacode.nic.in/handle/123456789/2070
3. Indian Railways. Concession Rules for Persons with Disabilities. http://www.indianrailways.gov.in/
4. National Institute of Mental Health and Neurosciences. Disability Certification in Mental Illness: Challenges and Prospects. Indian J Psychiatry. 2021;63(Suppl 2):S200-S205. doi:10.4103/indianjpsychiatry.indianjpsychiatry_200_21
5. Math SB, Gowda GS, Basavaraju V, et al. Cost estimation for the provision of mental health care in India. Indian J Psychiatry. 2019;61(Suppl 4):S759-S764. doi:10.4103/psychiatry.IndianJPsychiatry_191_19
6. Mental Healthcare Act, 2017. India Code. https://www.indiacode.nic.in/handle/123456789/2249
7. Garg K, Kumar CN, Chandra PBS. Mental health financing in India: The way forward. Indian J Psychiatry. 2019;61(Suppl 4):S711-S716. doi:10.4103/psychiatry.IndianJPsychiatry_208_19
Competing interests:
No competing interests
25 April 2025
Om Prakash
Professor of Psychiatry
Institute of Human Behaviour and Allied Sciences (IHBAS)
Department of Psychiatry, Institute of Human Behaviour (IHBAS), New Delhi India
Enhancing Support for Mental Illness in India’s Disability Benefits: Lessons from the UK
Title: Enhancing Support for Mental Illness in India’s Disability Benefits: Lessons from the UK
Dear Editor,
Fazilet Hadi’s article on the UK’s £5 billion disability benefit cuts highlights the ongoing challenges in supporting individuals with disabilities, including those with mental illness (BMJ 2025;389:r811, doi:10.1136/bmj.r811) [1]. Drawing on India’s experience, particularly in the area of disability benefits for mental illness, there are valuable lessons for strengthening inclusion in line with the Rights of Persons with Disabilities (RPwD) Act, 2016 [2].
The RPwD Act formally recognizes mental illnesses—such as depression and schizophrenia, which significantly impact daily functioning—as disabilities, entitling affected individuals to benefits including transport concessions, health insurance, employment support, pensions, and educational opportunities [2]. While notable progress has been made, further steps could better enable individuals with mental illness to fully access these entitlements.
Currently, Indian Railways offers fare concessions (75% in multiple classes and 50% on season tickets) for individuals with intellectual disabilities who require an escort [3]. Extending these concessions to persons with mental illness, as recognized under the RPwD Act, could greatly enhance access to healthcare and employment opportunities. Notably, only 0.34% of disability certificates in some states pertain to mental illness, indicating the need for streamlined and accessible certification processes [4].
India’s health insurance schemes, including Ayushman Bharat and various state programs (e.g., Telangana’s Aarogyasri), predominantly emphasize hospital-based care [5]. Expanding coverage to include outpatient mental health services, as mandated under the Mental Healthcare Act, 2017, could significantly reduce out-of-pocket expenditures, which currently account for 70% of mental health costs [6]. This mirrors the UK’s imperative to bolster health service access in the wake of benefit reductions [1].
Rural employment initiatives such as the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) provide job opportunities for persons with disabilities. Tailoring program features, such as offering flexible work schedules, could increase participation among individuals with mental illness [4]. Similarly, while pension schemes (e.g., Indira Gandhi National Disability Pension Scheme) and tax exemptions under Section 80U of the Income Tax Act exist, awareness and uptake remain low; only 12% of eligible individuals access these benefits, with 88.75% of caregivers unaware of available entitlements [4].
India’s situation parallels challenges noted in the UK, where benefit cuts risk exacerbating poverty and health inequalities. Both nations can benefit from a rights-based approach aligned with the UN Convention on the Rights of Persons with Disabilities (UNCRPD). To
(a) Updating program guidelines to explicitly include mental illness in eligibility criteria.
(b) Streamlining the disability certification process for greater accessibility.
(c) Conducting targeted awareness campaigns to bridge the 88.75% caregiver knowledge gap [4].
(d)Promoting participatory policymaking by involving persons with disabilities directly, as recommended by Hadi for the UK.
India’s RPwD Act offers a strong legislative foundation that could inform the UK’s efforts to rebuild inclusive disability benefits. Emphasizing rights, dignity, and co-production of policies can help both countries advance toward a more equitable future for persons with mental illness.
Yours sincerely,
Dr. Om Prakash
Professor Psychiatry
Institute of Human Behaviour and Allied Sciences
Word Count: 590
Competing Interests: None declared.
References:
1. Hadi F. UK government’s disability benefit cuts are cruel and unfair. BMJ. 2025;389:r811. doi:10.1136/bmj.r811
2. Rights of Persons with Disabilities Act, 2016. India Code. https://www.indiacode.nic.in/handle/123456789/2070
3. Indian Railways. Concession Rules for Persons with Disabilities. http://www.indianrailways.gov.in/
4. National Institute of Mental Health and Neurosciences. Disability Certification in Mental Illness: Challenges and Prospects. Indian J Psychiatry. 2021;63(Suppl 2):S200-S205. doi:10.4103/indianjpsychiatry.indianjpsychiatry_200_21
5. Math SB, Gowda GS, Basavaraju V, et al. Cost estimation for the provision of mental health care in India. Indian J Psychiatry. 2019;61(Suppl 4):S759-S764. doi:10.4103/psychiatry.IndianJPsychiatry_191_19
6. Mental Healthcare Act, 2017. India Code. https://www.indiacode.nic.in/handle/123456789/2249
7. Garg K, Kumar CN, Chandra PBS. Mental health financing in India: The way forward. Indian J Psychiatry. 2019;61(Suppl 4):S711-S716. doi:10.4103/psychiatry.IndianJPsychiatry_208_19
Competing interests: No competing interests