India may be one of the fastest growing economies in the world, however it is home to a number of mental health afflictions. According to WHO, approximately 7.5% of the Indian population suffers from mental illnesses and this statistic is expected to keep growing in lieu of the pandemic. Moreover, women are more susceptible to these illnesses compared to their male counterparts. It was the first Director-General of the WHO has said that “there cannot be physical health without mental health”. This increasing and everlasting dichotomy between physical and mental health is due to the stigma associated with the latter. This stigma is the direct consequence of ignorance and misinformation. According to a study, mental health literacy among adolescents was found to be very low, i.e., depression was identified by 29.04% and schizophrenia/psychosis was recognized only by 1.31%. Stigma was noted to be present in help-seeking. This calls for an intervention and a paradigm change in order to provide individuals the facilities they deserve for effective functioning along with the need of combating stigma, enhancing prevention, ensuring early recognition, and increasing the number of mental health practitioners in the country which is at a glaring 0.3% per 100,000 population.
India’s National Mental Health Programme introduced by the Central Government in the year 1982 aims to promote mental health, prevent mental illnesses, destigmatise mental health, strengthen the health infrastructure of the country by increasing the number of mental health professionals and providing affordable and quality healthcare service to every individual in the country. The program was initiated keeping in mind the following objectives, providing universal access to mental health care, providing these health care services to the most vulnerable groups of the society free of cost, reducing the incidence of suicides and attempted suicides, to respect the rights of those undergoing mental health issues, to understand the socio-cultural and psychological challenges or barriers associated with the dissemination of mental health care and coming up with solutions for the same.
In addition to this, the Indian Government introduced the Mental Healthcare Act in 2017. According to this Act, people undergoing mental health issues are provided healthcare services by the Government. Revolutionary changes came up such as the decriminalisation of suicide and Electro Convulsive Therapy (ECT) without administering muscle relaxants or anaesthesia, first. Sterilization and solitary confinement of mentally unwell individuals was disallowed. The Act also emphasizes the need for setting up of Central and State Mental Authorities for the efficient training of medical professionals. It also makes it necessary for the insurance companies to provide mental health insurance. Apart from these changes, the Act brought forth various innovative recommendations in the form of the integration of Mental health with National Urban Health Mission and other health programs in order to deal with the mental health challenges that the country faces, especially in the urban areas. Another recommendation suggested the initiation of an incentive-based approach to encourage interest in the fields of psychiatry and psychology in order to increase the number of mental health professionals in the country.
While the aforementioned Act was a step in the right direction, it is not without its drawbacks and shortcomings. The Act ensures that quality health care services are provided at Central, State and District levels of the country at affordable prices. However, it fails to address the fact that the state government will have to bear a huge financial burden unless a large portion of the health care budget is provided to them in order to incur the expenditure. The Act also recognizes the right to live with dignity, protection from cruel, inhuman, or degrading treatment, right to confidentiality, right to access their basic medical records. However, it does not take into account the expenditure required to fulfil these obligations stipulated in the law and the allocation of funds between the Central and state Governments. It also ensures the provision of free and quality services to people living Below the Poverty Line.
However, a country like India which does not spend enough of its health care budget on mental health, it does not estimate the huge financial burden the central government will have to incur for the same. The budget allocated for mental health is only 0.05% of the total healthcare budget which saw a 7% rise from the previous year. India spends significantly less than what Bangladesh does. In order to implement the Mental Healthcare Act, 2017 the Government would incur an expenditure of Rs 94,073 crore, however the official budget allocated does not cover even a fraction of that estimated figure. Developing countries like India, constitute a large number of the world’s mentally ill patients due to a number of reasons mainly, low affordability, stigmatisation, discrimination, superstition and various sociocultural and economic factors. The Act does not deal with aspects of prevention, detection or early intervention.
Therefore, the second most populous country and one of the fastest growing economies of the world needs to realise the importance of rehabilitation, prevention, intervention and it ought to introduce various provisions to address these problems because otherwise, the Act would remain inefficient and futile and the former issues that plague the country in this sector will continue to persist. Therefore, while the Mental Health Act, 2017 is a big step forward and the need of the hour, its proper and effective implementation is necessary.
The views expressed in this article are the author's own.