When will we prioritize our mental health system? – The science of yarn


Union Finance Minister Nirmala Sitharaman speaking at Lok Sabha, March 14, 2022. Photo: PTI

  • Of the Rs 670 crore allocated for mental health, 94% has been allocated to just two centrally funded mental health facilities.
  • On the other hand, the expenditure budget allocated to tertiary level activities under the national mental health program is only Rs 40 crore – or 6% of direct mental health expenditure.
  • This low allocation stems from a vicious circle of misuse of previously allocated funds, which can be attributed to several operational and administrative bottlenecks.

As 2022 dawns, India is still reeling from the psychological and socio-economic consequences of the ongoing COVID-19 pandemic. There has been a significant increase in emotional distress due to unemployment, depleted savings and financial insecurity. Children have been unable to access school for nearly two years, which for many has affected learning outcomes, social development and the loss of a nutritious daily meal.

Increases in prevalence of domestic violence and other forms of social discrimination have become pervasive. The National Crime Records Bureau reported a 10% increase suicides in 2020 compared to 2019.

The 2022 EU budget has provided an opportunity to tackle these challenges head-on. Unfortunately, budgetary allocations for mental health and other social protection and safety schemes have remained a low priority.

A study 2017 estimates that 197 million people in India – one in seven – live with some form of mental disorder. Yet there is a treatment gap of around 83%, where most people with a mental health condition cannot access good quality mental health care.

However, an abysmal 0.78% or Rs 670 crore of the total direct expenditure budget allocated by the Union Department of Health was spent on mental health. This misallocation exists despite the WHO estimate that the burden of mental health problems in India is 2,443 disability adjusted life years per 100,000 population, and that the economic loss due to mental health problems, between 2012 and 2030, is expected to be Rs 75, 84 lakh crore.

Going deeper, out of the Rs 670 crore allocated for mental health, 94% (Rs 630 crore) was allocated to two centrally funded mental health institutions: National Institute of Mental Health and Neurosciences (NIMHANS ), Bengaluru, who received Rs 560 crore. , and the Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, which received Rs 70 crore.

On the other hand, the expenditure budget allocated for tertiary level activities under the National Mental Health Program (NMHP) is only Rs 40 crore or 6% of direct expenditure on mental health. These tertiary activities include the establishment of ‘centres of excellence’, the upgrading of existing psychiatry departments and capacity building through the appointment of psychiatrists, clinical psychologists, psychiatric nurses, etc. in all the countries.

The low allocation to tertiary activities of the NMHP stems from a vicious cycle of misuse of previously allocated funds, which were only 4% in 2018-2019 (see table below). This below average utilization can be attributed to several operational and administrative bottlenecks, including inadequate planning of NMHP activities and poor coordination between disbursing and implementing authorities.

Table: Estimated budget, actual expenditure and percentage utilization for NMHP tertiary level activities for 2018-2019, 2019-2020 and 2021-2022.

While budgetary allocations for mental health facilities and human resources are important, to make mental health services and treatment more accessible, we need to strengthen the delivery of mental health services at the national level. primary and community different levels, through a “community model” of service delivery.

The District Mental Health Program (DMHP) is the key service delivery component under the NMHP, to integrate mental health care with general health services at primary and district levels. The allocation for the DMHP is made under the “flexi-pool” mechanism for non-communicable diseases, a program under the National Health Mission.

Responding to a question posed in Parliament on February 4, 2022, the Minister of Health said that the ministry is disbursing up to Rs 83.2 lakh per district per year to DMHP, in 704 districts.

On February 9, 2022, in response to another question in Parliament, the Home Office revealed that an alarming 25,000 people died by suicide due to unemployment, debt and bankruptcy in 2020. He mentioned DMHP as an intervention to solve this problem by his suicide. prevention services. However, the budget allocation to the DMHP suggests the opposite, that it is not a priority for the government.

So many suicides due to social, economic and cultural factors underscore that mental health and well-being must be understood in a broader sense, intersectoral context – affected by employment status, gender, caste, religion and several other markers of identity. Axiomatically, a robust and responsive mental health system recognizes and addresses these crucial determinants of health and well-being.

In India, social protection and rights programs such as the National Rural Employment Guarantee Program Mahatma Gandhi, Prime Minister Garib Kalyan Yojana, PM POSHAN (midday meal scheme) and others are essential because they are a crucial lifeline for many marginalized and vulnerable groups. . Given the negative impact of COVID-19 on social and financial security, overall budget expenditures for the social sector and social protection schemes should have been higher, but have actually experienced a decline in real terms.

Nevertheless, there were some initiatives in the area of ​​mental health in this year’s budget. The first is the announcement of a national tele-mental health program. Under this program, the Ministry of Health will launch 23 tele-mental health centers under the authority of NIMHANS. The aim of these centers will be to improve access to mental health services by developing digital capacities and reaching more people in need in remote areas.

Program operationalization plans should consider and address the “digital divide” and issues of accessibility in low-resource settings, data privacy and ethics in maintaining patient confidentiality as well as psychosocial needs of individuals beyond the prescription of drugs. Currently, the exact expenditures for this newly announced program are unknown.

Another important announcement in the budget speech was tax relief for parents or guardians of people with disabilities. Previously, a tax relief on the sum received under life insurance was granted after the death of the parent or guardian of a disabled person. With the new announcement, the payment of an annuity or a lump sum to the disabled person may now be available during the lifetime of the parents or guardians when they reach the age of 60. This change has been made to allow people with disabilities to collect the sum during the lifetime of their parents or guardian himself.

Even before the COVID-19 pandemic, mental health care had long been neglected in India. According to WHO, about 20% of India’s population is likely to suffer from some form of mental illness, but little has been done to scale up efforts to strengthen mental health systems. Budgetary allocations for mental health services should not be limited to a few facilities in urban centres. Instad, you have to invest in communities to ensure last mile service delivery through programs like DMHP.

In addition, state and central governments need to address usage bottlenecks to ensure better allocations in the future. Finally, funding for mental health care should reflect the cross-sectoral, rights-based principles and priorities of the National Mental Health Policy 2014 and the Mental Health Care Act 2017, thereby ensuring overall well-being – psychological, social and economic – for all.

Sayali Mahashur and Tanya Nicole Fernandes are Research Associates at the Center for Mental Health Law & Policy, Indian Law Society, Pune.


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