The World Health Organization (WHO) defines health as follows:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
However, while health as a whole is an under-funded and under-resourced area in India, it is the mental health in particular that has really suffered over the years.
According to WHO, neuropsychiatric disorders in India are estimated to contribute to 11.6% of the global burden of disease. The suicide rate for men is 12.2 per 100,000 of population, and for women it is 9.1 per 100,000. While 14% of the global burden of diseases is attributable to mental disorders, the access to mental health services is poor across the world. In countries such as India, the WHO estimates that nearly 3/4th of those affected by mental illnesses do not have access to quality mental health services due to various reasons. According to WHO’s estimates, there are 0.301 psychiatrists per 100,000 population, 0.166 nurses, 0.047 psychologists, and 0.033 mental health social workers.
National Mental Health Programme
The National Mental Health Programme (NMHP) has been in existence since 1982. Initially, its objectives were as follows:
- To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, especially to the most vulnerable and underprivileged sections of the population
- To encourage the application of mental health knowledge in general healthcare and social development
- To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community
Under the NMHP, grants are given to individual mental health institutes and hospitals across the country, a record of which can be obtained from the Ministry of Health. The NMHP was upgraded every five years along with the Five Year Plans.In the 11th Plan, the District Mental Health Programme was extended and upgraded to include research and development, modernisation of state-run mental hospitals, and better training of personnel.
Mental Health Care Bill
In October 2014, the government launched the first National Mental Health Policy to provide quality psychiatric care to about 20% of population with mental disorders by 2020. However, the Mental Health Care Bill – which was introduced in the parliament in 2013 and defines patient rights, advanced directives, role of relatives, and decriminalises suicide attempts – is yet to see the light of the day. With the opposition parties’ current tendency to resort to walkouts and boycotts of parliamentary proceedings, one wonders if the Bill will ever be passed.
As it is, several experts – including the Indian Psychiatric Society – have denounced the Bill for ignoring the role of the family in the care of the patient, and for being based on the western model of care.
The Public Health Foundation of India, which was founded in 2006 as a private-public enterprise, is running the Centre for Mental Health to provide evidence-based mental health care and training in this area.
Programmes and Bills to address the problem of mental disorders are, of course, welcome. However, people with mental health issues and their families will continue to suffer, if the situation at the ground level does not change. From the patient’s point of view, it is nothing short of a nightmare when it comes to accessing help, even at premier mental health institutes across the country, let alone primary care centres and government hospitals.
Lack of Quality Infrastructure
As things stand now, there are very few premier institutes such as NIMHANS in Bangalore, and Central Institute of Psychiatry in Ranchi, which are mostly confined to urban and semi-urban areas. Actually it is the poorest of the poor, especially from rural areas, who are most prone to developing mental disorders. Travelling miles to get to the nearest centre – to get treated for mental disorders that are not considered as significant a problem as physical disorders – must be a tall order for the ordinary patient and his family.
Add to this the problem of stigma, which prevents patients and their families from even considering approaching mental health workers, and you begin to see why access to services is so poor.
Mental Health Education: A Neglected Discipline
Mental health education is not seen as a priority in India. As the figures above suggest, very few doctors opt for psychiatry as a career after graduation, and much less actually practise in the country. Stigma related to the profession, its patients, and its professionals is institutionalised, and psychiatry as a specialty is frequently looked down upon – something that professionals who have failed to specialise in more lucrative domains would resort to, as a last option.
In all this, the Medical Council of India is yet to officially recognise foreign postgraduate degrees in psychiatry as being equivalent to Indian degrees, which would help a number of doctors interested in returning to India, make a confident decision about coming back and practising in their native country.
Apart from addressing the above issues, it would also be prudent on the part of the Government and NGOs alike, to raise awareness about mental health issues. Treating mental disorders on par with physical disorders in terms of legislature, funds allocation, resource and manpower enhancement, and reducing stigma by raising awareness are the need of the hour.
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