Context

• Mental health has long been a neglected issue in India, despite alarming statistics and growing evidence of its profound impact on the population.
• The recent formation of a Task Force by the National Medical Commission to address the mental health and wellbeing of medical students highlights the urgent need for a comprehensive and strategic policy approach to mental health in the country.
• The situation is dire and demands immediate attention and therefore it is important to have an assessment of the current situation of mental health in India and ways ahead to address the gaps in policy.

The Current State of Mental Health in India

• The National Mental Health Survey of 2015-16 provides a stark picture of the mental health crisis in India.
• It revealed that 10.6 percent of the population over the age of 18 suffers from mental health disorders, with 16 percent of those affected being in the productive age group of 30-49 years.
• The survey also highlighted a lifetime morbidity affecting 150 million people, with 1 percent reporting high suicidal risk.
• Despite this, the human resources and treatment facilities required to address these conditions are grossly inadequate, resulting in a treatment gap of 80 percent.
• This gap underscores the critical need for increased policy attention and resource allocation to mental health.

Policy Gaps, Challenges and Resource Allocation in Mental Health

• Overview of Policy Gaps in Mental Health
  • India's approach to mental health has been historically inadequate, marked by significant policy gaps and insufficient resource allocation.
  • Despite the recognition of mental health as a critical public health issue, it has not been matched by appropriate government action or funding.
  • The discrepancy between the growing need for mental health services and the resources allocated to address this need is a glaring issue that has persisted over time.
• Insufficient Funding and Budget Allocation
  • In 2019, the Union government allocated a mere Rs 600 crore to mental health, a fraction of the estimated Rs 93,000 crore required to adequately address the mental health crisis.
  • Even with a slight increase to Rs 1,000 crore in the latest budget, mental health spending remains less than 1 percent of the overall health budget and this is grossly insufficient given the scale of the problem.
  • The underfunding of mental health is further highlighted by the fact that the majority of the allocated funds were directed toward tertiary institutions, such as the National Institute of Mental Health and Neurosciences (NIMHANS) and psychiatry departments of medical colleges.
• Challenges in Community-Based Initiatives
  • The allocation of Rs 40 crore for the District Mental Health Programme (DMHP) and other community-based initiatives is particularly concerning.
  • The DMHP is crucial as it is designed to extend mental health services to the grassroots level, particularly in rural and underserved areas where access to mental health care is limited.
  • However, the minimal funding it receives severely restricts its capacity to operate effectively, leaving large portions of the population without access to necessary mental health services.
• Underutilisation of Allocated Funds
  • Moreover, the actual expenditure of the allocated funds is another area of concern.
  • Of the Rs 40 crore allocated for community-based initiatives, only Rs 2.91 crore was reportedly spent.
  • This underutilisation of funds reflects not only a lack of prioritisation but also possible inefficiencies in the system, such as bureaucratic delays, lack of trained personnel, and inadequate infrastructure.
• Systemic Issues and Knowledge Gaps
  • The gap in knowledge refers to the challenges policymakers face in understanding how to effectively intervene in mental health issues and when such interventions should occur.
  • Unlike other health issues, mental health requires a nuanced approach that considers the socio-economic, cultural, and psychological factors that contribute to mental health disorders.
  • The lack of comprehensive data, limited research, and insufficient training of healthcare professionals further exacerbate the problem, making it difficult for policymakers to design and implement effective mental health strategies.

Legislative Initiatives, Implementation Challenges and Lessons from India’s HIV AIDS Response

• Legislative Initiatives and Implementation Challenges
  • The National Mental Health Policy of 2014 and the Mental Health Act of 2017 marked a shift in policy towards ensuring that mental health is given the same priority as physical health.
  • These initiatives emphasised the need for dignity and equal treatment for those with mental health conditions.
  • However, despite the clear vision provided by these policies, there remains a lack of clarity on implementation, particularly regarding the financial and physical resources required and the timelines for achieving these goals.
  • This disconnect between policy and implementation is a common critique of India’s policymaking system.
• Lessons from India’s HIV-AIDS Response
  • India’s success in addressing the HIV-AIDS epidemic offers valuable lessons for tackling mental health challenges.
  • The National Aids Control Programme (NACP) III, implemented by the National Aids Control Organisation (NACO), demonstrated the effectiveness of strategic interventions based on epidemiological evidence, the importance of modelling different options, and the need for wide-ranging interventions tailored to different geographies and target groups.
  • This approach provided crucial data on cost-effectiveness and scalability, which were essential for scaling up interventions.

Ways Ahead to Address Policy Gaps and Overcome Implementation Challenges

• Need for Holistic Approaches to Mental Health
  • A similar approach on the lines of India’s response to HIV-AIDS is urgently needed to develop an implementable strategy for mental health patients.
  • Like HIV-AIDS patients, individuals with mental health conditions require empathy from society and commitment from various government sectors.
  • Mental health issues are often exacerbated by societal pressures and stressors such as poverty, growing inequalities of opportunity, and discriminatory environments based on caste, gender, and religion.
  • These triggers, if left unaddressed, can cause mental health problems to recur despite medical treatment.
  • Therefore, a purely biomedical approach is insufficient to address mental health conditions; a more holistic approach that includes community-anchored and affordable interventions is necessary.
• The Role of Civil Society
  • Despite the policy vacuum, civil society in India has been active in addressing mental health challenges.
  • Organisations such as Banyan in Tamil Nadu, Sangath in Goa, and the Centre for Mental Health Law and Policy in Pune have pioneered models of rehabilitation and care for individuals with mental disorders.
  • These evidence-based strategies, such as short-stay homes, emergency care centers, and peer-led interventions, need to be studied for potential scaling up.
  • For instance, Banyan’s Home Again intervention, which addresses the needs of an estimated 60 lakh homeless and abandoned women with mental illnesses, offers a comprehensive strategy that includes awareness, rescue, treatment, rehabilitation, and reintegration with family.

Conclusion

• The mental health crisis in India demands urgent and comprehensive policy attention and by learning from the successes of the HIV-AIDS response, India can develop and implement effective strategies to address the mental health needs of its population.
• This will require political will, adequate resource allocation, and active engagement with all stakeholders, including civil society and affected communities.
• Only then can India hope to bridge the treatment gap and ensure that mental health is given the priority it deserves.