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What India’s Refusal To ‘Spend’ On Mental Health Is ‘Costing’ Indians

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Every year, around October, a detailed conversation around mental health sprouts in all corners of public discourse, with people working to dismantle the stigma around mental health challenges and sharing their stories. There’s not a lot of productive discussion around the cash crunch that persists when it comes to access to mental health services.

Government-funded centralised services, well-trained counsellors with an apt doctor to patient ratio and financial aid for mental health is still a distant reality.

In the past year, however, the collective level of distress we’ve faced as a society can not be left unacknowledged. It has become difficult to lend a helping hand or articulate your need for one.

The discussion needs to expand further and include the question of ensuring access to mental health resources, as much as destigmatising the need for that access.

In India particularly, the year has been gruesome. Frontline workers, students, and all those affected financially have lost an innate sense of security that’s necessary to live a healthy and fulfilled life. The external world of normalcy no longer exists. This, in turn, has wreaked a perpetual feeling of hopelessness, affecting our primitive needs of security and belongingness.

Representational image.

It’s Not Just The Stigma. Mental Health Has More Crucial Challenges.

In 2020, amidst a fight for basic necessities and consequent economic turmoil, the number of poor people in the country has doubled.

There’s a direct correlation between a person’s mental health and the social, economic, financial, and environmental factors they grew up in. A perpetual state of poverty and deprivation is bound to create a vicious cycle of long-term mental distress and the inability to cope with routine stress.

Added to this is the tendency of India’s healthcare system to view mental health challenges solely from the biological standpoint instead of adopting a holistic psycho-social view.

The statistics are jarringly alarming.

As reported by the Borgen Project, in India, only 10% of patients suffering from mental health illnesses receive treatment. In theory, everyone has the right to treatment, however, in actuality, accessibility is virtually next to absent. Not only does India spend 0.6% of its budget on mental health but there are only 0.3 psychiatrists per 100,00 people in the country.

The healthcare system is marred by a general attitude of viewing mental health as “self-indulgent”, resolvable by increasing your productivity or “getting your life together”.

These attitudes are naturalised to such an extent that even state initiatives for mental health are based around an aim to invest in increased productivity rather than a fundamental right that everyone should have access to. The World Health Organisation underlines how for every US$ 1 invested in scaled-up treatment for common mental disorders such as depression and anxiety, there is a return of US$ 5 in improved health and productivity.

Such a perspective on mental health challenges in society puts too much emphasis on the rhetoric of a person’s worth in terms of their productivity and employability. It ignores susceptible groups such as children, women working in informal sectors struggling with an unfair wage, or all those who’ve been left jobless by the current global scenario.

It encourages policymakers and governments to be motivated by an end goal of a larger workforce than a community of content and self-actualised individuals. Thus, to tackle such a counter-productive approach towards mental health challenges, de-stigmatisation and grass root level funding should go hand in hand.

But Isn’t The Government Already Allocating Funds?

Sadly, like various other policies in our country, the ground reality depicts a stark contrast.

For the fiscal year 2021, out of the 597 crores for mental healthcare in our country, only 7% of it has been allocated to the National Mental Health Programme which is theoretically accessible and applicable countrywide.

For instance, approximately 20 crore people are affected by mental health distress in our country. With only 7% of the total budget for NMHP, the government is spending a diminutive amount of approximately two rupees on each patient.


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What’s Causing The Hindrance?

Within the policies implemented, programmes initiated, and funds allocated there are numerous operational problems.

Departments such as cardiology are given utmost priority with funds being granted immediately, while the Psychiatry department struggles for medicines. With a larger workforce, these departments exercise immense lobbying and managerial powers, consequently sidelining the importance of the Psychiatry and Mental Health Departments. Due to medical urgency, the perceived importance of other departments is relatively more but it must be realised that prioritising mental health problems is also equally essential.

Most importantly, in India, Health Insurance rarely covers mental health services, most of them being attributed to out of pocket expenditure (the amount paid by the patient directly to the health care provider instead of a third party).

Various government schemes that enlist private hospitals accessible for treatment by the patient do not, in fact, cover mental health illnesses.

Photo: Shweta Bhardwaj and Aadit Devanand/ The Print

Moving Forward

India’s mental health situation is uniquely difficult due to the demographic policymakers are dealing with. Not only is there collective superficiality and stigma, but a large proportion of the population also is not included within the ambit of basic healthcare services.

There’s also multidimensional poverty in the country with challenges of caste, and gender that further add mental distress and inhibit the affected from seeking any help. Due to this consistent societal block, what is prioritised are suppressive, immediate measures with excessive attention given to medication as opposed to altering the system to address the underlying inceptive cause.

In such a charged situation, a two-pronged approach is needed. First, to increase the allocation of funds effectively, distributed in a decentralised manner. This should not only happen in terms of training and facilitating the mental health workforce and awareness campaigns, but also in terms of incentivising private counsellors to distribute their services in government-aided hospitals.

Since the mental health crisis is bound to witness a subtle increase as a consequence of COVID, a viable option would be a telephonic mental health check-in with those affected by the virus, considering how government agencies contact families to ensure correct quarantine protocol is being followed.

The second being a comprehensive school mental health programme (SMHP) to seize the issue by its neck i.e aiding and genuinely helping children to process trauma and develop interpersonal skills.

India being a diverse country in need of intersectional resolution of problems, there is a need to equip mental health practitioners with proper cultural sensitivity and awareness as well.
Our country’s mental health challenge cannot be easily resolved by merely looking at an alternative model and inculcating it.

At one level, we need to overcome any political hindrance and ignorance to facilitate the easy flow of funds. While at another, we have to fundamentally change the way we view health, a change that needs to start early on in life.

The world is already unequal, and mental health in such a world is magnificently important. There’s a need for effective and empathetic policy intervention that reinstates the urgency of the situation as well as the long-term benefits of consistent action.

Note: The author is part of the current batch of the Writer’s Training Program.

Featured image credit: YKA/For representational purposes only.
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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

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MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
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Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
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