October is observed as the month to raise awareness on mental health issues across the world. This focus makes visible to some extent the concerns pertaining to mental health by practitioners, experts and those affected by it as individuals or as families. As the World Health Organisation (WHO) reiterates in many of its reports it is time to bring out mental health issues out into the open. The need is to curtail the stigma and discrimination attached to it and become aware of the potential of gains by reducing the burden of mental health in societies. We need to enhance our investment in mental health substantially and we need to do it now, when the world statistics are showing a huge burden of mental health problems and the latest national data is giving a disturbing figure of nearly 150 million needing mental healthcare and less than 30 million seeking care. Along with this in India there is lack of comprehensive public health strategy for mental health even though in recent past the Mental Healthcare Act, 2017 is promising as it seeks to protect, promote and fulfil the rights of the mentally ill and to provide treatment, care and rehabilitation to improve the capacity for full potential to integrate into the community life.
There is an urgent requirement in many countries, including India, for developing adequate infrastructure and services for mental health. It requires huge investment in financial and human resources to provide care for those with mental disorders and to protect and promote mental health through health and social budgets, policies, plans and initiatives from a right based perspective. In India the 2015-2016 National Mental Health Survey (NMHS) conducted by NIMHANS indicates every sixth Indian with no substantial gender difference needs mental health help and more problems exist in working age group as well as among those over 60 years with urban areas most affected and those with low incomes. We, as civil society members, as governments, as organisations and institutions concerned with health and social issues need to talk about mental illness and disorders.
The pertinent question today is are we ready to provide the much-needed services, treatment and support to the growing number of people suffering from mental disorders? Do we have at present services that are more effective and more humane, treatments that help affected individuals avoid chronic disability and premature death and can we provide the much needed support that gives them a life lived with dignity? Do we have provisions and facilities that can help those suffering from mental disorders to increase their productivity and lower the burden of illness in terms of care and cost to society? These concerns are pivotal in the light of NMHS, which reveals that long duration of illness of severe mental disorders exist and at least half of those with a mental disorder reported disability in all three domains of work, social and family life. Significantly, a government facility is the most common source of care, however, there is treatment gap among the 12 states part of the survey and across specific mental disorders. In general, level of mental health infrastructure is low, issues of accessibility to services is common hindrance be it in terms of travelling distance, or availability or quality and further, the integration of mental healthcare in general healthcare is limited with the availability of alternative sources of help being inadequate and of poor standards and in certain areas almost being non-existent.
It is laudable that the Mental Healthcare Act, 2017 empowers the government to set up central mental health authority at national level and state mental health authority in every state. Every mental health institute and mental health practitioners, including clinical psychologists, mental health nurses and psychiatric social workers will have to be registered with this authority, which will also train law enforcement and mental health professions on the provisions of the act, and advise the government on all matters relating to mental healthcare and services.
However, it is important that the government and concerned agencies review the shortage of mental health professionals and care facilities in the country, besides their concentration mainly in metropolitan cities. Many with mental health problems living in rural areas and in districts have inappropriate and inadequate medical attention. WHO 2017 report reveals that for every million people in India, there are just three psychiatrists, and even fewer psychologists, 18 times fewer than the commonwealth norm of 5.6 psychiatrists per 100,000 people. The basic problem or rather the biggest impediment to providing appropriate mental healthcare services and provisions in the country is due to inadequate allocation of funds for mental healthcare facilities. India spends only 0.06 per cent of its health budget on mental healthcare despite mental health diseases constituting up to 13 per cent of the total health burden. The healthcare system in India is far stretch from perfect, and some of the toughest challenges belong to the mental health industry. We need to urgently rectify that.
The writer is an associate professor at Maitreyi College, South Campus, University of Delhi. By training a sociologist, gerontologist, health and development social scientist.
