After two consecutive years of mentioning mental health in the Union Budget, it was unfortunately sidestepped in Finance Minister Nirmala Sitharaman’s speech on February 1, 2023. COVID-19’s impact on psychological well-being may have spurred emphasis on mental healthcare; however, the disease is now endemic in India, and with that, the spotlight on mental health seems to have dimmed.
In the Government of India’s Budget 2022-23, the National Tele-Mental Health Program (NTMHP) was announced, which aimed to improve access to mental healthcare services. It was launched on World Mental Health Day (10th October, 2022) with tele-MANAS -- a 24x7 mental health helpline available in different languages across states and UTs in India. About 121 crores were spent in setting up this initiative. However, NTMHP’s integration with the existing National Mental Health Program (NMHP) has not been elaborated; further, Budget 2023 makes no mention of NMHP, with 133.7 crores allocated toward NTMHP. Prima facie, it is heartening to know that the allocation toward mental healthcare in India is increasing; however, it is certainly confusing when flagship programs like the NMHP (introduced in 1982) make no appearance in recent budgets (although allocations toward NMHP may have been integrated with the National Health Mission, which remains unclear).
Although the NTMHP attempts to make mental healthcare accessible to a wider population, there remains a general inadequacy in the quality and quantity of mental health services available in India. Although there has been an increase in the number of psychiatrists in India from 0.29 to 0.75 per 100000 people, the country still has a long way to go. The ideal number of psychiatrists per 100000 people is 3, which means that India lacks around 27000 psychiatrists to cater to the needs of the population currently. And this does not include deficits in other mental health professionals, such as clinical psychologists and psychiatric nurses.
This inadequacy becomes alarming as depression emerges as the second leading cause of global disease burden in 2020. According to WHO, India has been termed as the world’s most depressed country, with the total mental health burden amounting to 2443 DALYs per 10000 people. This means that in the life span of 10000 people, 2443 years of life have been lost due to the lack of mental well-being. While the mental health burden is the highest in India relative to other nations, communicable, maternal, and nutritional conditions amounted to 8664.24 DALYs per 10000 people in 2019. This greater burden of communicable diseases puts them at a higher priority whenever the Government addresses budgetary allocations to the health sector. This is a dominant finding in most developing countries, where the problem of eradicating communicable diseases is prioritized over mental health concerns.
The reason why mental health was in the limelight during COVID-19 was due to the breakdown of social contact. Social isolation, especially with close ones who were infected with the virus, was a trigger for most people to feel unsettled due to the lack of interaction between their support systems. It garnered attention from the Government, which attempted to address the problem with an increased allocation (by 137%) for the NMHP in 2021-22. Interestingly, in the very year mental health got the largest budgetary allocation ever, the suicide rate in India also hit a record high of 12 suicides for every 100,000 people. But once social systems started reverting to normal, the need to address mental health as a public issue became insignificant.
Essentially, society views mental health as an individual’s problem, not a public issue. If someone is coping with depression, it is seen as that person’s inability to cope with stress, instead of understanding the socio-cultural context of their situation. Another reason why mental health is not given as much importance as physical health is that the manifestation of the problem is more obvious in physical health. Any problem with mental well-being is seen as a simple mood change until it becomes serious enough to affect the biological condition of the patient. Further, mental health is seen as an extension of physical health instead of a separate area of health. Therefore, when an unanticipated public health crisis occurred during the pandemic, the redressal of the problem was also extended to include mental health.
The burden of mental illness in India is vast — from psychological, social, and economic perspectives. Unless we are faced with a crisis at the level of a global pandemic, the current policy-making trends imply that mental health is unlikely to take center stage in conversations among laypersons and policymakers, alike. Budgetary allocations toward mental health initiatives are an initial, but important step. However, multiple other factors (such as training, human resources, and community participation) affect the successful implementation of such programs. By learning policy-level strategies from other low-income countries, we could bolster India’s mental health infrastructure. For instance, Haiti’s Psychological First Aid intervention can be delivered by laypersons, assisting the expansion of community mental health workers in India. There can be several such interventions that can be adapted and implemented in India; however, we would need to allocate resources, time, money, and human effort in a top-down manner to achieve this.
Twinkle Adhikari and Hansika Kapoor
This post was written by Twinkle Adhikari and Hansika Kapoor, researchers at the Departments of Economics and Psychology, respectively, at Monk Prayogshala, Mumbai, India.
