* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.
In October 2014, the Government of India adopted a national mental health policy calling for an increase in funds for mental health care in the country. Though progressive and radical, critics believe it will be quite tough to implement.
Despite the prevalence of mental health problems in India, recently estimated at 20 percent, and the highest suicide rate in the world, the government allocatesless than a tenth of a percent of its health budget – already among the lowest globally as a percentage of GDP – on mental health.
The country also has an acute shortage of mental health professionals. For a population of 1.2 billion, India has only 3,500 psychiatrists – one for every 343,000 people.
As early as 1982, India was one of the first countries in the developing world to formulate a National Mental Health Programme (NMHP), followed by the District Mental Health Programme (DMHP), its flagship mental health delivery initiative.
The DMHP takes a decentralized community-based approach to mental health care. It was launched in 1996 in four districts, one each in the states of Andhra Pradesh, Assam, Rajasthan and Tamil Nadu. By the end of 2012, the program was said to cover 123 districts.
The Indian government has effected three significant policy developments in mental health: the roll out of the NMHP/DMHP, the reformulation of the Mental Health Act, and the recent adoption of the National Mental Health Policy. Yet these developments haven’t had an impact on the ground. Very little has changed for those affected by mental illness.
In December 2014 the government of India announced cuts to the health budget of nearly 20 percent. This has alarmed health activists and citizens alike, given that the public health system in the country is already ineffective.
Where will this leave mental health? How will it affect the DMHP and the implementation of the National Mental Health Policy? Not surprisingly, given that mental health is sorely neglected, no one is asking these questions.
It is possible that states that have already been running DMHPs may continue to fund them from the state health budget, after using up the initial start-up funds already released from the central Ministry of Health. However, these budget cuts could mean that no new DMHPs will be launched, even if they were planned by state governments.
Even now reluctant state governments have to be coaxed to set up DMHPs in their states. Budget cuts will offer them a ready excuse for inaction. The cuts could also affect evaluations of existing DMHPs, which are critical to ensure that programs are meeting the needs of people affected by mental illness.
The Mental Health Act, 1987 was revised and reformulated after much debate. Cuts to the health budget could seriously hamper the passage of the new mental health bill that is pending in parliament. Even if the bill does get passed it would remain a toothless piece of legislation if there are no funds to back it up.
In India there are few private and non-profit initiatives working in community-based mental health. Programs such as those run by BasicNeeds (in partnership with NBJK, GASS) and by PRIME are making concerted efforts to collaborate with state governments to strengthen the DMHP in Jharkhand, Bihar, Karnataka and Madhya Pradesh. Slashing funds available to these states could push back the progress made over the years.
India’s aspirations and ambitions run high. However growth and development will remain mere rhetoric without addressing the mental wellbeing of the population. That can come only when policy commitment to mental health also brings with it consistent and assured funding.
Chris Underhill is the founder and director of BasicNeeds. Shoba Raja and Natasha Abraham of BasicNeeds also contributed to this article.
