In December 2022, the 5th Global Mental Health Summit, co-hosted by over 6 mental health organizations, was held in Chennai to discuss mental health in the context of human rights, ethics and justice. He stressed the importance of mental health and called for action against the continued neglect by society at large, especially governments at the central and state levels.
In 2015, the GOI conducted the National Mental Health Survey — 2015-16 to assess mental health prevalence in the country. According to the report, 10.6% of people over the age of 18 and 16% of working-age people aged 30-49 have a mental disorder, with a lifetime prevalence of 150 million people, 1% of whom are at high risk of suicide. reported. Lack of manpower and lack of treatment facilities. For example, in Madhya Pradesh he has 0.05 psychiatrists per 100,000 population and the treatment gap in India is about 80%. While it is estimated that more than Rs.93 crore investment is required to combat this colossal morbidity, the federal government has allocated a budget allocation of Rs.6 crore for 2019, of which 93% is Assigned to higher education institutions such as NIMHANS and psychiatry departments of medical colleges. , left only Rs 400 crore for district mental health programs and other community-based initiatives.Of this pitiful sum of his Rs 400 crore, only Rs 2.91 crore was spent.
For policy makers, mental health is a low priority. This lack of interest in policy is often due to the indifference of bureaucrats and politicians. In severely underfunded sectors facing overwhelming demand for funding, those with the ability to shout the loudest get noticed. Mental health is at a huge disadvantage in this regard as it has the weakest lobbying power.
But a more important reason is the substantial gap between ‘knowledge’ and ‘how’ in mental health. The Rights-Based National Mental Health Policy of 2014 and the Mental Health Act of 2017 were decisive shifts in policy by requiring that persons with mental disabilities be treated on an equal footing with those suffering from physical illness and treated with dignity. Did. However, when and how the financial and material resources will be discovered remains unclear.
A good policy has four elements. A design that spells out how to achieve your vision. Amount of resources — financial, human and infrastructure required to implement the design. And finally, concurrent and regular intervals monitoring, data, monitoring and evaluation of results for course correction. First task completed. The rest await action.
Policy design is the most difficult part of policy creation. A common criticism of India’s policy-making system is the substantial disconnect between aspirations of what needs to be done and what can actually be done. Strategic intervention requires a nuanced understanding of the challenges and constraints within which the system works, based on consultation and dialogue between policy makers and those affected by the policies formulated. NACO had nearly 20 technical resource groups with at least 200 members, including sex workers and leading medical professors, to develop policy and implement the NACP III strategy.
Indeed, the example of how India tackled HIV/AIDS can be illustrative. He has four important lessons in the HIV/AIDS story. Second, to provide data related to the cost-effectiveness and efficacy of interventions needed for scale-up, we will conduct research across different target groups to address the wide range of interventions needed in different regions. The importance of modeling different options. Third, to actively advocate for systemic issues among all influencers. Media, judiciary, politicians, police, and other cross-cutting departments directly related to the key populations whose programs and activities address. Fourth is the utilization of peers, his leaders and civil society with more than 25% of the budget allocated. Without the active involvement of community leaders, implementation among the poorest and most marginalized, especially criminal groups, this would not have been possible. Although the Central Sector Program was fully funded by the central government, all interventions were formulated with active participation and dialogue between states and, more importantly, the electoral districts affected.
A similar approach is needed to create good and actionable strategies for mental health. The limitations of biomedical approaches and confining patients to hospitals are now recognized and supported by evidence. Mental health is even more complicated than HIV/AIDS. Because mental illness isn’t just her one-off illness that can be cured with some medicine. It is intertwined with the type of society we live in – pressure and stress due to poverty and growing inequality of opportunity, frustration of unemployment, critical and discriminatory due to social barriers such as caste, gender and religion. environment. Strong triggers — If left unaddressed, the disease may recur despite medication.
The positive news is the availability of high-quality research on people with mental disorders and models of the rehabilitation and care continuum from organizations such as Banyan, Sangath and CHLP. Strategies need to be crafted based on the data and evidence they have. Models such as Banyan’s Home Again and Emergency Care Centers and CHLP’s peer leader-led interventions should be considered for scale-up.
Policy makers should provide resources and fund civil society organizations to implement more affordable, community-based interventions.
The author is a former trade union health secretary and author of Do We Care? Indian healthcare system.
