{
  "abstract": "BackgroundIndias 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.\n\nMethodsInterrupted time-series analysis of Indias 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.\n\nResultsPublic 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.\n\nConclusionPublic 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 Indias 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.",
  "abstract_shown": true,
  "affiliations": [
    "Ruxmaniben Deepchand Gardi Medical College (RDGMC)"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "V. Mishra"
    },
    {
      "name": "K. S. Parihar"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/efbzqd7zjfeg2.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.11.26362835",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.11.26362835v1.full",
  "id": "efbzqd7zjfeg2",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.11.26362835v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health systems and quality improvement"
    ],
    [
      "openalex",
      "3203|COVID-19 and Mental Health"
    ]
  ],
  "openalex": "W7212444521",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.11.26362835v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-11",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/efbzqd7zjfeg2.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:28Z",
      "native_id": "10.64898/2026.09.11.26362835",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.11.26362835v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health systems and quality improvement",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Hit hardest, healed least: disruption and incomplete recovery of public mental-health outpatient services across two COVID-19 waves in India, 2017-2022",
  "title_text": "Hit hardest, healed least: disruption and incomplete recovery of public mental-health outpatient services across two COVID-19 waves in India, 2017-2022",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:28Z",
  "url": "https://research.draconitic.com/paper/efbzqd7zjfeg2",
  "venue": "medRxiv",
  "versions": []
}