Despite a growing burden of mental ailments among the population, mental health is yet to find priority in the government’s plan of action through budgetary allocation and policy implementation.
The recently-presented Budget 2020-21 too has failed to address the need and the outlay of mental health remains insignificant at below one per cent.
As per the National Mental Health Survey, 2016, the prevalence of mental disorders in adults over the age of 18 years is about 10.6 per cent. However, as per the study titled The burden of mental disorders across the states of India: the Global Burden of Disease study 1990 – 2017 published in the Lancet Psychiatry in December 2019, one in every seven people in India has mental disorder.
The District Mental Health Programme (DMHP) under the National Mental Health Programme (NMHP), which covers 655 districts in the country has a mere allocation of ₹4 lakh for every district annually for IEC (information, education and communication) activities. Dr Lakshmi Vijayakumar, consultant, World Health Organisation, says that it is a paltry sum. “We need clear and marked mental health allocation with clear outcomes. At the moment, the money allocated for DMHP in parts remains unutilized and sent back.”
Need to explore PPP model
Dr Lakshmi adds that public private partnership in mental health has to be explored in detail. “It is important to release the funds at the right time for the projects. We often have organisations ready with projects, but the funds are released with much delay. A majority of the mental health activities have been taken up by NGOs as those involved in activities concerning women, health and children have a stake in it.”
The high investment in mental health care is also necessary to remove the stigma attached to the illnesses, points out Dr KV Kishore Kumar, director at Banyan, an NGO that works in mental health in states across India.
“These changes can happen only by investment by administrators and policy makers to provide quality service, respect the rights of people and ensure social participation and inclusion in the community. If this doesn’t happen, you are going to remove the disabled and mentally ill far from mainstream and perpetuate the stigma,” he says.
While he admits that neither the government alone nor the NGOs on their own can take responsibility for it, a comprehensive mental healthcare will be the responsibility of multiple stakeholders. “The government, however, is a torchbearer with NGOs and civil society playing a part,” he says.
Grassroots reach, suicide prevention vital
Dr Kumar says that a fund allocation of just about ₹4.2 crore annually per district is inadequate for a DMHP project that aims to reach out to the last mile through early detection, management and treatment of mental disorders or illnesses. He says a robust primary care can meet the requirements of 70 per cent of the people, while the remaining will require high level care, long term care, day care, sheltered workshop, supported living and rehabilitation centres.
“At the moment, a government sponsored day care in a district can have only about 30 people, when the number of those who need it is in thousands,” he said.
Around the same time, there is a need to increase expertise with more psychiatrists and psychologists, say experts.
The Institute of Mental Health (IMH) which had a few takers for specialisation in psychiatry some years ago will now annually produce 18 specialists, says Dr P Poorna Chandrika, director, IMH.
However, she admits that the Tamil Nadu model doesn’t represent the country. “The DMHP is comprehensive and can be implemented only with a good manpower of psychiatrists, psychologists and social workers,” she added.
A suicide prevention policy, which was submitted last year to the Union government is awaiting approval, says Dr Lakshmi who worked on it.
“The policy covers three kinds of intervention strategies — universal, selective and indicated intervention. The first kind involves restricting access to pesticides, a strategy that is recommended by the WHO as well, apart from limiting access to alcohol, as 1/3rd of suicides happen under the influence of alcohol. The selective category of intervention covers those who are at a higher risk — with physical illness, mental illness, environmental stress. Indicated intervention includes those who are already suicidal and those who have attempted suicides. There is evidence that if you are in contact with them for one-and-a-half years, there is reduction in suicide attempts.
(If you are in crisis and need help, call 104 for Tamil Nadu health department’s helpline or helplines like SNEHA: 044- 24640050, Roshni: 914066202000; Cooj: 918322252525)