According to a 2019 article on Economic Times, 7.5 percent of India’s population was affected by mental health disorders—an abysmal number in a country of 1.3 billion people. Even this number could be a gross underestimation of the degree to which mental health concerns plague India, as a 2016 study conducted by the National Institute of Mental Health & Neurosciences (NIMHANS) revealed that an approximate of 150 million Indians were in need of intervention and healthcare facilities, with under 30 million people actually receiving it. In 2019, an average of 381 people died by suicide daily, according to the National Crime Record Bureau (NCRB), an increase of 3.4 percent as compared to the estimates of 2018. The World Health Organisation (WHO) had anticipated that up to 20 percent of India’s population would suffer from mental illness by 2020—and this was before the coronavirus pandemic swallowed the country. These are all statistics that were found after the National Mental Health Policy came out in 2014. So, where is the problem?
An article on The Diplomat tells us that despite being the world’s fifth-largest economy, “India has spent only 0.05 percent of its health budget annually on mental health over the last few years, much lower than even the average spending of low-income countries, which comes to about 0.5 percent of their healthcare budgets,” and the money allotted to it has been reducing.
As pointed in The Diplomat, “the amount spent on mental health comes about to 33 paisa per mental health patient,” and is comparable with what Mukesh Ambani makes in only 3 hours, considering that the actual expenditure on mental health in 2019 was actually only 50 million Rupees. As a country that makes up to 28 percent of suicide across the globe, can we afford to divert such little attention to mental health? What happened to the implementation of the National Mental Health Policy (2014), with its promise of universal access to mental health services?
Access to mental health services is affected by two main reasons: shortage of mental health professionals and the problem of affordability.
A 2019 article on The Hindu points out that “mental health hospitals run by the State government have insufficient psychiatrists and its District Mental Health Programme (DMHP) is severely understaffed.” As a result, the DMHP has only one psychiatrist to a population of 1 lakh to 10 lakhs. It is hardly surprising that there exists a massive treatment gap between the number of people suffering from mental illness and the number who actually get help for the same. Data from the WHO in 2005 indicated the following availability of mental health resources in India:
Fast-forward to a 2017 report by the WHO, which suggested that only 2 mental health professionals were available for every 100,000 people, “drastically lower than the global average of nine.” Matters are worse for those living in rural areas, where, as of 2014, a Human Rights Watch report concluded that only 25 percent of India’s healthcare related infrastructure was located. It is no wonder that mental health services are such an expensive ordeal for most.
A Livemint article explains, “The acute shortage of mental health professionals in India means most people who require mental healthcare need to access private mental health professionals. This comes at a heavy cost.” Another 2019 article on Times of India cited an independent study by the Cosmos Institute of Mental Health and Behavioural Sciences (CIMBS) and World Federation of Mental Health, wherein 49 percent of participants had a mental health facility within a 20km radius, and 26 percent would have to go to a facility within a staggering 50km radius.
Is it possible for the majority of Indians to spend up to Rupees 2000 to 4000 an hour for therapy?
The pool of people who can even think of accessing these resources (which take quite some time before making visible impact) is already limited as prices soar with scarcity of mental health staff.
There have been multiple studies in India which show “good evidence exists for pharmacological interventions, several randomised controlled trials in India have shown that psychosocial interventions developed in high-income countries can be contextually adapted and effectively delivered by non-physician health workers for various disorders,” even in low-resource settings.
Certain institutes such as the NIMHANS and Central Institute of Psychiatry, in an attempt to build capacity for provision of healthcare, have begun to train members in community healthcare and simplify diagnostic tools so that they can be used even in primary health centres. This is supported by videos for learning as well as post-training services undertaken by a specialist so that detection of mental health concerns can be done at the earliest and thus make it easier to manage. Some other models devoted to training of grassroots workers in mental health management have shown that doing so can lead to decrease in the treatment gap, i.e, the time elapsed between the detection of an issue and the receipt of treatment.
Social workers are also encouraged to inform and raise awareness about mental health in their communities so that they can promote care-seeking behaviour among its members. The benefit of community-led efforts such as these is that the information and healthcare services become more accessible, combating the general consensus that good mental health services are reserved for the elite. However, no conclusive evidence mentions the superiority of one method over another. The quality of healthcare services will need to be continually worked on. The complete impact of these initiatives will only be more evident over time.
It must be noted that the same article mentioning these suggestions also highlights that social workers leading these community oriented, accessible services are also scarce in number. They are therefore burdened with not only carrying out psychosocial interventions like counseling, relaxation techniques, and caregiving, but also with administrative tasks which could negatively affect their ability to provide the support they primarily intend to give.
Alongside improving availability of care services, it is equally important that people are actually seeking out healthcare for mental health concerns. One such initiative that aims to promote care-seeking behaviour is called VISHRAM (Vidarbha Stress and Health Programme), which “aims to understand the mental health needs of rural communities in Vidarbha, train human resources for improving mental health awareness and delivering community-based mental health interventions, and ultimately improve the coverage of mental health services for common mental disorders, alcohol use disorders and childhood mental health disorders.”
It lays emphasis on mental health literacy so that people are encouraged to look for treatment once an issue has been recognised. It does this by “continually holding clinics, meetings, workshops and training programmes to promote mental health, prevent psycho-social distress and manage mental disorders in its selected communities.” A study testing its efficiency discovered that, as compared to a control group, the group which was exposed to this programme displayed higher mental health literacy and was more willing to actively look for care for treating depression.
Universal access to mental healthcare is far too often viewed as low priority. We continue to hold stigma about mental health or believe that its treatment is unnecessary for something that is “all in your head.” Mental health affects physical health, recovery rate, everyday functions and work, relationships, and its improvement can result in an increase in overall quality of life. The Mental Health Policy (2014) reminds us that any policy without proper implementation is just an empty promise.
Featured Image Source: Feminism In India