MEMBER BLOG: Mental health in India’s national budget 2022

Written by Bhawesh Jha & Priti Sridhar, Mariwala Health Initiative

While presenting the national Budget in February 2022, India’s finance minister Nirmala Sitharaman mentioned that there is increasing mental distress in the country. She said that the pandemic had accentuated the mental health problems in people of all ages and announced the plan to set up a National Tele-Mental Health programme in India to improve the access to quality mental health counseling and care services.

This year’s budget was one of those rare occasions when mental health got the attention of the Indian policy makers at the national level. The announcement of this timely intervention was widely covered by the mainstream media. Corporate leaders also hailed the announcement and promised to put in efforts around workplace mental health. The pandemic has compelled many to recognise the pre-existing mental health crisis, which is an opportunity for activists and advocacy groups to enhance the implementation of the mental health services and national legislation. The Mental Health Care Act 2017 which mandates the right to mental health is yet to be implemented in its true spirit in most of the Indian states.

This year 0.8% of the total health budget went towards mental health (US $88 million). About US $83 million (94%) of this goes towards just two tertiary, academic mental health institutions; namely NIMHANS & Lokpriya Gopinath Bordoloi Regional Institute of Mental Health. The remaining $5 million is allocated for the National Mental Health Programme (NMHP), responsible for delivery of 90% of the mental health services across the country. The disproportionate budget allocation to few institutions raises serious health equity concerns.

The NMHP was launched as a centrally sponsored scheme in the 1980s in the aftermath of the Alma Ata declaration of 1978. Today, the programme is facing an existential crisis as it does not even get to utilise the allocated funds, due to poor planning and prioritisation of mental health at both state and central government levels. The actual expenditure in 2020-21 was just $2.64 million out of the $5 million allocated. The programme has not yet adapted to India’s Mental Health Policy formulated in 2014. The policy recognises the spectrum of mental health needs and recommends a family centric service to address needs of persons with Mental Health problems across their lifespan. But the NMHP design is still biomedical in nature and doesn’t account for the complexities of mental illnesses. For example, a person living with serious mental illness would need more than just medication. The programme’s success is measured by the number of individuals who get diagnosed and start treatment. The mental health programmes should be person centric and address the impacts on all important areas of a person's life – including relationships, work, family, housing and education – rather than focusing only on symptom reduction. (WHO, 2021)

Overall, the budget misses the mark of a holistic planning approach to create an optimal mix of services. According to WHO, large-scale custodial care provided by specialist mental hospitals is not justified either by its costs, effectiveness or the quality of care provided. Last year, WHO’s guidance document on community mental health services presented best practices from 22 countries. This featured Atmiyata, a volunteer-based community mental health programme and Iswar Sankalpa’s Naya Daur programme, which offers community-based mental health and psycho-social support to homeless people. The public mental health system could draw insights and build on these innovative models of mental health services delivery.

The policy makers must recognise the diverse mental health needs of the population and move away from a one-size-fits-all approach. The mental health system must have a network of services ranging from primary outpatient care at Primary Health Centres (PHCs), hospital-based services, crisis support, to low-cost community-based mental health care and support groups for service-users and caregivers. Mental health services must be planned while keeping the socio-economic, cultural and structural determinants of mental health issues in mind. Focusing only on tele-mental health models would exacerbate existing mental health care disparities. Additionally, the inaccessibility of internet-based services arising due to cost, poor connectivity, language barriers, and concerns about data protection and privacy of users must be addressed on a priority basis.

 There is an urgent need to invest in global mental health to provide services that are accessible and affordable. Financing universal coverage for mental health services is not only achievable, it's vital. The cost of inaction is high.