Making Mental Health A Priority- Thoughts for the budget

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This is the preamble of the constitution of the World Health Organization, which has remained unchanged since 1948. And yet, when it comes to the budget and spending on healthcare, the mental health component, which is so crucial to well-being, seems to be not get its due importance year after year.

Depression alone is the leading cause of disability worldwide, having surpassed heart diseases a few years back, with over 264 million people from all over the world afflicted by it. Estimates indicate that approximately 10 – 13% of India’s population suffer from a mental illness and yet India’s spending on mental health care has not exceeded 50 crores. To put that in perspective, India spends approximately 1% of it’s entire budget on healthcare; 0.06% of that healthcare budget is utilized for mental health. Compared to global estimates, while high income countries utilize about 5.1% of all government health spending on mental health, even low-income countries on average spend approximately 0.5% of their healthcare budget on mental healthcare.

The Mental Health Act of 2017 holds promise to pave the way for the rights of patients with mental health concerns. However, at the forefront, there is an acute shortage of mental health professionals and facilities available in the country. We need more hospital beds dedicated to mental health. At present there are just about 60,000 public psychiatric beds available. The requirement on the other hand – 6.5 lakhs!

And it’s the same story with mental health care practitioners. Global norms suggest a ratio of 1 mental health professional per 10,000 population. India at present has approximately 9,000 psychiatrists and 1,000 clinical psychologists. Considering that the general population and mental health professionals remain constant, it would take just about 171 years to bridge the gap in the number of psychiatrists required to provide sufficient care. To add to that, most mental healthcare professionals are clustered in larger cities – it’s not unusual to find patients and caregivers travelling hundreds of kilometers and waiting in hour long queues for a 15-minute psychiatry consultation.

We simply do not have enough institutes in India at present to train the required number of psychologists and psychiatrists. There needs to be a strong impetus to training and

education by setting-up more colleges and educational institutes dedicated to mental health.

Following a multi-pronged approach, the training of mental health practitioners must also be paralleled with creating provisions for equipping other professionals such as primary healthcare practitioners and anganvadi workers in rural areas to bridge the regional disparity. Investing in digital healthcare promoting tele-psychiatry and tele-counselling can also go a long way in this respect, given that it’s efficacy has been well-established.

Preventive mental health is another key area that needs to be brought in focus – we require sustained campaigns, both on ground and digitally, to promote life-skills education and inculcate mental health literacy to fight against stigma and ignorance.

Affordability has also been a concern that has worried patients and families of those suffering from mental health concerns – psychiatric ailments are not covered by medical insurance. But the mind-body connection is a lot stronger than what one may be initially inclined to believe. There is ample research indicating that mental health problems impact physical health also. In fact, depression is linked with an increased risk for cardiovascular illnesses, stroke, diabetes and rheumatoid arthritis. From a long-term perspective, therefore, providing insurance for the treatment of mental health problems may assuage the need for more intensive, invasive and expensive medical procedures.

The rationale for increased spending on mental health is not only humanitarian, it impacts the economy too. Recent studies have estimated that more than 12 billion days of productivity are lost due to depression and anxiety every year – that’s equivalent to more than 50 million years of work. The global economic loss of these two illnesses alone is one trillion US dollars every year. On the flip side, every one dollar invested in scaling up treatment for these illnesses leads to a four times greater return in better health and ability to work.

The numbers are there for us all to see. It’s time we give mental health the same importance as physical health. It’s time the government takes cognizance – we need to make mental health a priority and to give it the attention, the resources and the budget it calls for.

The article is written by Dr Samir Parikh, Director, Department of Mental Health and Behavioural Sciences, Fortis National Mental Health Program.