Finance Minister Nirmala Sitharaman in Budget 2022 has thrown a delightful surprise by announcing 23 tele mental health centres, with National Institute of Mental Health and Neurosciences (NIMHANS) as the nodal centre and International Institute of Information Technology, Bangalore (IIIT-B) offering tech support. Many mental health professionals feel this is too less to address the mammoth mental health issues, further complicated by the COVID-19 pandemic. Yet it is a decent beginning that needs to be capitalised by all the stakeholders to build a mental health movement around it. Will this initiative lead to that, time will only tell.
Following are some steps that governments both at the Centre and states can implement.
Bridging the Digital Divide
‘Social cohesion erosion’, ‘livelihood crisis’ and ‘mental health deterioration’ are three of the five risks that have exacerbated the most globally through the pandemic. Digital inequality is seen as an imminent threat to the world as 3 billion people remain offline (Global Risk Reports 2022: World Economic Forum).
Around 78 per cent of schools in India had no Internet facilities and more than 61 per cent had no computers, as per Uniform District Information System for Education (UDISE) data for 2019-20. Therefore, instead of reaching out to individuals or single families, community centres catering to a group of people will help enhance connectivity to raise awareness about mental health; this could be on the lines of a ‘Mann ki Baat’, where large number of people listen to a programme together. This looks utopian but is possible.
Digital Buzz Can Snowball into a Movement
The digital buzz needs to be complemented by mental health interventions on the ground in all the states. The Centre will transfer Rs 4176.84 crore to the states for wellness centres, critical care hospitals and public health labs for districts with a population of more than 5 lakh. Last year, the allocation was only Rs 595 crore. States need to empower the health workers and the Asha workers to identify those distressed and ill for early interventions. This intervention needs to be linked to primary health care centres, district mental health programmes and hospitals.
Those who have ‘fever’ reach out to a health facility whereas those mentally ill rarely do. The National Family Health Survey in India revealed that the prevalence of major depression in India was 2.7 per cent whereas the treatment gap was 85.2 per cent. This gap needs to be bridged. Poor awareness of psychological disorders and the stigma attached to mental health lead to low identification of risk cases with disastrous consequences.
If health workers can work for malaria eradication campaign successfully, they can also be trained to identify and provide early access to mental healthcare. The National Framework for Malaria Elimination (NFME) outlines India’s strategy for elimination of the disease by 2030. We need to be as focused towards mental health as we are with malaria or TB. The NCRB figures for death due to suicides has jumped by 10 per cent in 2020 and the country is crying for a Suicide Prevention Policy. The Mental Health Policy 2014 for India needs to be made actionable. It needs swift wheels and strong teeth to impact mental health in India positively.
Beware of Over-medicalisation
As NIMHANS director Dr Pratima Murthy recently shared in an interview, “This programme will be useful to identify mild forms of mental illness, which may not require medication or in patient care.” The tele mental health centres need to integrate indigenous care into the system. Interventions that are culture-sensitive should be incorporated along with the rich wisdom of Yoga, Vipassana and others. Care should be taken to ensure that medication for psychiatric illness and psychotherapies are appropriately used when indicated. Myths around them need to be shattered. Medication needs to be appropriately located and not demonised. An army of mental health soldiers need to be trained to assist the mental health revolution. They can be the eyes and ears of the mental health apparatus. Needless to say, states and the Centre should increase the institutes dedicated to training mental health professionals, just like newer IITs and IIMs have come up across the country.
Go Beyond AIIMS and NIMHANS
The Centre needs to look beyond AIIMS and NIMHANS. Just like in cricket where we have five cricket zones, we need to similarly decentralise the nodal agencies for healthcare. Overburdening AIIMS and NIMHANS is not fair. During the pandemic most of the top politicians got themselves treated at big private hospitals. More than 80 per cent of mentally ill patients around the country are treated outside government hospital set-ups. Public-private-NGO partnerships are a must, right from the inception stage, to herald effective mental health programmes across the country. Spiritual groups can also be enrolled carefully.
Our Finance Minister Nirmala Sitharaman has shown the torch to all the ministries to be activated, both at the central and state level, to join the mental health revolution. We need a people-based Mental Health Movement as big as the Swachh Bharat Abhiyan or the Jal Jeevan Mission. Institutes can assist them and not vice-versa.
The WHO estimates that for $1 spent on treatment of depression and anxiety, the yield can be as high as $4 in health and productivity. It is time we look at mental health in a holistic manner.
Dr Harish Shetty is a Psychiatrist at Dr L.H. Hiranandani Hospital and has extensive experience in Community Mental Health. The views expressed in this article are those of the author and do not represent the stand of this publication.
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