Centre's Mental Health mission needs more than just allocations

The Union Budget found a rare mention of the declining mental health among Indians. In fact, the finance minister, in the budget speech, acknowledged that, “the pandemic has accentuated mental health problems in people of all ages,” leading to the announcement of a ‘National Tele Mental Health Programme’, to “improve the access to quality mental health counselling and care services.”

The programme will include a network of 23 tele-mental health centres of excellence. “The National Institute of Mental Health and Neuro Sciences (NIMHANS) will be the nodal centre and the Indian Institute of Information Technology-Bangalore (IIITB) will provide technology support,” the minister added. She also said in her budget speech that an open platform for the National Digital Health Ecosystem will be rolled out. “It will consist of digital registries of health providers and health facilities; a unique health identity; consent framework, and universal access to healthcare facilities.”

However, apart from this, there is very little to go on, and as the adage does, “the devil is in the details”. Juxtaposing the finance minister’s speech with the incumbent government’s track record on mental healthcare, it is clear that the Centre’s new initiative, promulgated at a much-larger scale, cannot fall prey to the same pitfalls as India’s current flagship programme for mental healthcare, the National Mental Health Programme (NMHP) did.

The NMHP was launched in 1982. A District Mental Health Program (DMHP) was further launched under NMHP in 1996, under the ninth five-year plan. It provides mental health services in 692 districts. Besides the NMHP, the union government also funds two institutes for mental health — NIMHANS in Bengaluru and the Lokpriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur, Assam.

According to the Notes on Demands for Grants, 2022-2023, NIMHANS has been granted the lion’s share of ₹560 crore for expenditure for the upcoming fiscal year, compared to approximately ₹500 crore in 2021-22. The Lokpriya Gopinath Bordoloi Regional Institute of Mental Health has been granted ₹70 crore in expenditure, compared to ₹57 crore granted in the last fiscal. While the expenditure grants were increased for the two centres, grants for the NMHP have remained at the same level as last year — that of ₹40 crore.

The incremental allocation of corpus to mental health institutions notwithstanding, it may be noted that the allocation of funds towards mental healthcare services still make up less than 1% (0.81%) of the total outlay of the ₹71,269 crore corpus of the Ministry of Health and Family Welfare, and it is expected that a majority of NIMHANS’ ₹560 crore grant will be used for the National Tele Mental Health Programme.

Even the funds allocated under the NMHP have been underutilised, even amidst the pandemic. Last year, the Parliamentary Standing Committee on Health and Family Welfare indicted the government for this issue. “The Committee is of the view that a constant underutilisation over the years under this head clearly points towards the Ministry's inability to comprehend the magnitude of mental health burden in the country. Various studies have highlighted the high prevalence of mental illness in the country but no substantial progress has been achieved to facilitate a robust mechanism for delivery of mental healthcare services,” the report by the Committee reads.

The yawning gap between those who need mental healthcare and those who can access lays testament to the urgent intervention by the government to leapfrog the gap. According to WHO estimates, about 7.5% Indians suffer from some mental disorder and it predicted that by 2020, roughly 20% of India will suffer from mental illnesses. A 2019 study by Lancet reads that 14% of India’s population lives with some form of mental illness. The National Mental Health Survey of 2016 reads that there exists a treatment gap of up to 72-92% for various mental disorders. According to the WHO Mental Health Atlas 2017, India has only 1.93 mental health workers and 0.29 psychiatrists per 100,000 population — which is much below the global average. The WHO also estimated that the economic loss due to mental health conditions in India between 2012-2030 is ₹75.84 lakh crore.

This number would have been exacerbated by the pandemic, owing to the aforementioned lacunae in the healthcare infrastructure. In its analysis of the Union Budget 2021–2022, the India Mental Health Observatory mentioned that different population groups have faced varying levels of emotional distress, which in some cases may have been worsened by psychosocial and economic factors, including loss of employment, depleted savings and financial insecurity has plagued large swathes of the population, particularly those working in the informal sector. “The lack of social interaction has implications for the emotional and social development of children,” it adds.

Nevertheless, the initiative taken by the government has garnered appreciation from all quarters. Neerja Birla, the founder and chairperson of Mpower, has welcomed the recognition of the mental health crisis — exacerbated by the ongoing pandemic — in the Union Budget. “The setting up of a National Tele Mental Health Programme will go a long way in helping people of all ages to access quality mental health. Today, having a platform where people can voice their concerns freely and safely is the first step towards mental wellness, and I am confident that with this, India will be able to bring about a much-needed change in society,” she tells Fortune India.

Dr. Pallavi Joshi, the consultant psychiatrist at the Manipal Hospital in Varthur Road, Bengaluru, believes that the move was much needed indeed. “According to the Lancet, the amount of rising depression and anxiety cases was up by 40% each. There is a dearth of psychiatrists in India, we have 1 psychiatrist for 3,500 patients. So, seeing everyone in person was a big challenge; teleconsultation is a big boon for our fraternity,” she says. According to her, patients who are afraid of stigmatisation can consult online from anywhere, and patients can definitely talk more on teleconsultation. “We'll be happy to interact with them and look at their expressions,” she adds.

Birla concurs. “There is a great opportunity for using mobile phones as a tool to reach out to individuals who are in need of a mental health consultation.” She also adds that the government’s decision to set up mental health tele-consultation is a welcome move. “Given the positive steps taken by the government on recognising the need for mental health counselling and digital data protection, it is only a matter of years before India creates a sustainable, accessible and affordable environment for the mental health needs of every Indian,” she says.