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.
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.
India’s mental health budget of Rs 932 crore (~$128 million) is “grossly insufficient”, especially as the #COVID19 #pandemic has triggered mental health issues in India & around the world, according to an analysis by the India Mental Health Observatory (IMHO)
— IndiaSpend (@IndiaSpend) March 18, 2021
The healthcare system is marred by a general attitude of viewing mental health as “self-indulgent”, resolvable by increasing your productivity or “getting your life together”.
These attitudes are naturalised to such an extent that even state initiatives for mental health are based around an aim to invest in increased productivity rather than a fundamental right that everyone should have access to. The World Health Organisation underlines how for every US$ 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.
The road to hell is paved with good intentions. Look no further than the world of mental health.
Let's begin with the climax of the story (so far):
— Tanmoy (@toymango) October 30, 2020
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.
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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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.
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.
We cannot address #Mentalhealth without addressing Poverty.
• Financial poverty in our communities
• Imagination poverty in our policy makers
— Dr Soumitra Pathare সৌমিত্র சௌமித்ரா பாடாரே (@netshrink) September 28, 2021
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.
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.