The Predicaments of the Indian Mental Health System

The MHCA (Mental Health Care Act) of 2017 guarantees every affected person access to mental healthcare and treatment from services run or funded by the government, and promises that the government shall make sufficient provisions as may be necessary, for the range of services required. One of its main objectives is also to enable inclusion and rehabilitation of mentally ill persons into society, along with the elimination of the stigma attached to mental illness.

According to a study by the Indian Journal of Psychiatry, the conservative annual estimated cost on the government to implement the Mental Healthcare Act, 2017 would be Rs 94,073 crore. However, the actual current spending is not even a fraction of the figure.

What lies at the root of this problem is the shortage of funds allocated to mental health in India. The average percentage of the total healthcare budget allocated to mental health in developed countries is at least 5 percent. In India, the budget allocated to the National Mental Health Programme (NMHP) in 2019 was brought down to Rs 40 crore from Rs 50 crore. The funds spent were only about Rs 5 crore each during the years 2018 and 2019. The 2020 budget has not increased the allocation for NMHP, even though the total healthcare budget saw a 7 percent increase. The budget allocated for mental health is 0.05 percent of the total healthcare budget, which in itself is a little above 1% of India's GDP. A person having mental health conditions may not be fit or able to get employment, which ultimately leads to productivity loss. The morbidity cost incurred by the government due to such productivity loss is actually more than it would have to spend to kickstart the mental health sector, according to an Indian Journal of Psychiatry study.

The need of the hour is significant public or private sector investment in improving mental health services at the level of primary health centers, training and employment of psychologists, and creating awareness about psychological illnesses. The abysmally low investment in training mental health professionals and building facilities in all parts of the country has further contributed to the treatment gap.

In government wellness centers, the medication requested by the psychiatry department for primary mental health treatment doesn't fall under the ambit of free medication provided by the government and the lack of response gets the treatment stuck. The paucity of mental health professionals has resulted in medication being used as a first step instead of counseling and sensitization. There is an inadequate representation of psychologists in the proposed Allied and Healthcare Council of India. Their exclusion would lead to a singular focus on medical and related specialties and neglect of students and practitioners from the ‘Behavioural Health Sciences’ category. The longstanding demand of an independent, statutory National Psychology Council to oversee and regulate the education, training, and practice of psychology in India is yet to be seen. A recommendation to establish such authority was also made by UGC Expert Committee on Model Courses in Psychology in 2016. For better effectiveness and to make the sector a priority of the government, a Minister of State in the Ministry of Health and Family Welfare should preferably be in-charge of mental health matters.