Talking about mental health issues is no longer enough
In order to raise awareness about issues of mental health and to mobilise efforts to improve it, the World Health Organisation (WHO) has marked October 10 as Mental Health Day. With a different theme every year, WHO aims to build a debate around mental health. The tradition began in 2013. While the previous years' themes were more pointed - looking at older adults and then schizophrenia - this year's theme is pivotal to ensuring holistic mental health care: dignity in mental health.
But what is mental health? Can it only be defined by the presence or absence of a mental illness? Not quite. Mental health is overarching. It is characterised by a state of well-being; it is about how an individual maintains a relationship with herself, with others, and with life in general. If an individual develops a mental illness, she should be guaranteed proper healthcare (medical or otherwise) and a life with dignity, as would an individual with any physical illness.
However, in India, the burden of having a mental illness gets compounded. Such an individual is part of a society that deems one's call for help as a sign of weakness rather than strength. Additionally, there is the challenge of access to appropriate mental healthcare.
We have only about 3,500 psychiatrists for 1.3 billion people. The ministry of health and family welfare believes that we ideally need 11,500 of them. The entire workforce, including psychiatrists, psychologists, focussed nurses and social workers, currently stands at about 7,000 whereas the ideal strength would be around 54,000. The shortage seems scary as projections suggest that 20 per cent of India's population will have some form of mental illness by 2020. The fact that budget allocation to healthcare, in general, is parsimonious only worsens the situation: it stands at roughly one per cent of the GDP. Mental healthcare receives a measly 0.06 per cent of that one per cent.
Poor awareness, tilted access and negligible financing have made mental healthcare an institutional crisis that will hit us squarely in our faces; not only do we lack the physical infrastructure to deal with it but our emotional bandwidth to understand it is also inadequate.
Nonetheless, last year was a significant landmark in India's mental healthcare policymaking. Under Dr Harsh Vardhan, the then Union minister for health, we formulated a National Mental Health Policy.
The policy promises to address issues of access, which arise due to a scarcity of doctors and high costs of treatment. It identifies several groups of vulnerable people; these include homeless persons, children, the elderly, internally displaced persons, marginalised groups and more.
It offers a rights-based approach, upholding the dignity of an individual suffering from a mental illness with a view to create a society that would be free of stigma. It focuses on early intervention; so that a child who has or shows the probability of developing a mental illness can be helped early on, perhaps even in school. Interestingly, it also speaks of decriminalising attempted suicide. To help address all of this, it speaks of increasing financing. It says, and rightly so, that "spending on health by a government is not an expenditure but a social investment and a social right".
On paper, the policy deserves lauding. It is truly as progressive, mindful and inclusive as it claims to be. If the crisis we are facing is as real then a policy like this would offer the archetypal starting points to address it. It lucidly spells out the responsibilities of the central government, the state governments, the local bodies and civil society organisations. This is a good step; given that health is a state subject, efficient centre-state coordination is vital, to ensure that every state is doing its bit in this realm.
The policy was meant to be followed up by the "Mental Health Action Plan 365". However, it has been a year since the action plan was announced and we have hardly heard anything else about it. A small but noteworthy step was taken in December 2014 when the government offered funding to some centres, specialised PG training departments and three central institutes to help address the shortage of mental health professionals, but nothing beyond that.
To get things going, as pointed out by Dr Harsh Vardhan last year, an in-sync Mental Health Bill needs to be passed by Parliament. In 2013, a version had been introduced in the Rajya Sabha and is still pending there. No further legislative action has been taken, almost reducing the policy to just another notification.
Earlier this week, on Last Week Tonight, as John Oliver discussed mental health issues in the United States of America, he said, we at least owe individuals with any form of mental illness a plan; one that provides the much needed care and safeguards rights. Such a plan has been ideated for the citizens of our society but has not been put into practice yet.
As we wait for an update from the government on the Action Plan 365, which will hopefully come soon, one can be glad about the intent and willingness to transform the existing system. However, the inertia is worrisome: we need to talk about mental health, they say, but it is also imperative that we act now.