India’s budget for mental health leaves a lot to be desired

A majority of the funds being given to centrally controlled institutes like NIMHANS also adds to the lack of decentralisation of mental healthcare

The Union Budget 2021-22, announced on February 1, proposes a corpus of INR 712.69 billion for Ministry of Health and Family Welfare. This also includes the budget for mental healthcare – a total of INR 5.97 billion. One would have expected that a good chunk of this would be for the National Mental Health Programme (NMHP), which is a nationwide government scheme, as it is applicable and accessible – at least in theory – countrywide.

However, only 7 pc of the mental health budget has been allocated for the NMHP; while a majority of it has been set aside for two institutions: INR 5 billion for Karnataka’s capital Bengaluru based National Institute of Mental Health and Sciences (NIMHANS) and INR 570 million for Lokpriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur, Assam.

For Financial Year 22 (FY22), Finance Minister Nirmala Sitharaman said that health and wellbeing are one of the key pillars of an Atmanirbhar Bharat (self-reliant India). However, experts say that proposing only INR 400 million for NMHP will leave India unprepared and unable to deal with the requirements of the population, especially with the added impact and fallout of the Covid-19 pandemic on mental health globally.

Resilience building with diversity will be hit

Dr Edmond Fernandes, a physician and CEO of the CHD Group, a public health organisation in Mangalore, Karnataka says that giving a big chunk of funds to selected institutions will definitely strengthen the institutional capacity, but it will paralyse resilience building with diversity.

“In a post Covid-19 world, mental health is the next pandemic with increasing social isolation, work from home, and a stronger e-presence over emotional presence that drives our lives. The budget should be inspired to combat the next pandemic – mental health. In this context, the approach to mental health needs to assume a preventive role and not a curative positioning alone. Mental health financing is one thing, but mental health management is entirely different,” Dr Fernandes tells Media India Group.

Paras Sharma, a psychologist and founder of The Alternative Story, a Bengaluru based organisation that also offers therapy services with a sliding pay scale, points out that prioritising national mental health institutes over the NMHP impacts diverse approaches to mental health. “This ensures that only mental health practitioners (MHP) who subscribe to certain models have an advantage because they are from these big institutions that are regulated by the state,” he adds.

Experts also say that it is less likely that mental health professionals from big institutes will go to public health centre (PHC) level or community level programmes, and are more likely to set up private practices in cities, which adds to inaccessibility of mental healthcare for the common people.

The lack of decentralisation

Paras points out that there has always been a trend of allocating big funds for big institutions rather than looking at mental health at the block level and the PHC level.

“The problem is that whatever little budget does come at the state level for PHCs for mental health, because there is not enough awareness, push, and there is a scarcity of mental health professionals. There is just one general practitioner at the PHC, who may, in some cases, ask a patient to go to a district-level hospital for mental health concerns because there is no mental health professional at the local level. But the dropout rate becomes high when one is asked to go from the PHC to the district hospital. Hence, the government thinks there is no demand because there is little caseload, and so, it does not allocate money in the next budget,” he explains.

A majority of the funds being given to centrally controlled institutes like NIMHANS also adds to the lack of decentralisation of mental healthcare.

“Because places like NIMHANS keep coming up with one ambitious programme after the other, utilisation is there to show. This leads other states to want to set up the same model – set up one big multispecialty, flashy institute to get the funds. But this is a cost-heavy model; it will be far more effective and accessible and to set up mental healthcare infrastructure at PHC level,” says Sharma.

Even the existing NMHP needs to engage further with the private as well as the non-governmental sector to improve accessibility, says Dr Edmond. “Above all, we must build a dedicated cadre of community health physicians and public health professionals skilled in mental health to address it with a multi-pronged approach.”

Dr Edmond adds that it is not merely enough to increase budgets unless it is accompanied by engagement with grass-root level mental healthcare. “Setting up of counselling centres, driving aggressive promotional health campaigns where people are encouraged to consult with psychiatrists and psychologists in a traditional society that thinks otherwise; investing in community health physicians and public health professionals to strengthen mental health epidemiology as well and engagement in preventive care is crucial,” he adds.

An inadequate mental healthcare system

Inadequacy in India’s mental healthcare system had several lacunae even before the pandemic, and the situation has been exacerbated by the pandemic. One of the issues is that mental health is still seen as a ‘non-communicable disease’ by the Indian government, and not as the public health crisis that it is, states Sharma of Alternative Story organisation. This, experts say, is reflected in the Union Budget as well.

A senior official with the state Mental Health Authority in Karnataka, set up under the Mental Health Act, also admits that more funding is needed in mental healthcare. He argues that while funding institutes like NIMHANS is important to promote robust research and utilise the resources that it has, the government should remember that good mental health is needed to improve the health of the entire population.

“While the focus on it has been more of late, more funding is required, even to the states. The authorities also need to remember that implementation of the Mental Health Act also requires money for disbursing salaries,” he adds.

Analysts believe it would help if state governments modify their definition of mental health professional. As of now, only the Rehabilitation Council of India, a statutory body, can license clinical psychologists and rehabilitation psychologists.

“In a resource-poor country like India, if a person has a master’s degree in psychology, they will not necessarily be recognised by the government. One needs to be a minimum of an M Phil holder for an institute such as NIMHANS to be certified. Unless we start recognising and including psychiatrists and practising psychologists as mental health professionals in the countries and open up positions in districts to them, our needs will not be met,” he says.

Practitioners also say that the government urgently needs to set up bodies that recognise NGOs and community level organisations working in the mental health space. “There are so many NGOs and community level programmes run by common people and even state-level organisations. The government should perhaps look at funding them so that they can continue their work. Mass awareness programmes – such as the equivalent of pulse polio awareness – also need to be undertaken,” Dr Edmond says.