STATE OF MENTAL HEALTH CARE IN INDIA
MENTAL HEALTH: MEANING
The World Health Organization defines mental health as ‘a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.
A mental illness is a health problem that significantly affects how a person thinks, behaves and interacts with other people.
In India, 2-3 per cent (13 million people) adults suffer from depression. Yet, only about 4.3 per cent access mental care and nearly 90 per cent do not.
WHO predicts that 20% of India’s population will suffer from some form of mental illness by the year 2020. We are woefully under-equipped to handle mental health issues on such a large scale.
ISSUES IN MENTAL HEALTHCARE IN INDIA
*LACK OF INFRASTRUCTURE: NIMHANS estimates that currently, at least 35 lakh Indians need hospitalisation on account of mental illnesses. But the country has only 40 institutions and less than 26,000 hospital beds.
*LOWER BUDGETARY ALLOCATION: Barely 1-2% of the health budget is dedicated to mental health, in comparison to 10 –12% in developed countries.
*LACK OF FAMILY SUPPORT: Not everyone can afford to stay-at-home and look after their ill relative 24×7. Given the huge stigma, the extended family, neighbours are often unsupportive.
*SOCIAL STIGMA “HIDDEN EMERGENCY” : And given the huge stigma associated with any psychiatric illness, the vast majority continues to live with mental illness in the shadows, away from public view. That’s why WHO calls it the “hidden emergency”, one that the world has royally ignored.
*DEPLORABLE CONDITION OF HEALTH CENTRES: The few treatment centres (read: mental institutions) that exist in big cities have deplorable conditions with little regard to patient well-being and human rights. They are over-crowded, unhygienic and treat patients forcefully in a manner worse than animals with electric shocks.
STATUS OF DISTRICT MENTAL HEALTH PROGRAMME:
In India, the District Mental Health Programme (DMHP) covers 200 districts so far. The effectiveness of the programme varies across states because of restricted funding, shortages of human resource, and low motivation among service providers at all levels.
In practice, DMHP is largely limited to psychiatric outreach clinics in a few primary healthcare centres, and more than 60 per cent of people with mental disorders access care directly at a district hospital, rather than the primary healthcare centres.
Access to mental health services in India continues to be a major challenge as up to 40 per cent of patients travel more than 10 km to access DMHP services.
ROLE OF NGOs:
NGOs that provide mental health services are also concentrated in the southern and western regions of the country.
NATIONAL MENTAL HEALTH POLICY:
The National Mental Health Policy, announced in 2014, is based, inter-alia, on the values and principles of equity, justice, integrated and evidence based care, quality, participatory and holistic approach to mental health.
Its goals and objectives include the following:
• to reduce distress, disability, exclusion, morbidity and premature mortality associated with mental health problems across life-span of a person,
• to enhance understanding of mental health in the country,
• to provide universal access to mental health care,
• to increase access to mental health services for vulnerable groups,
• to reduce risk and incidence of suicide and attempted suicide,
• to ensure respect for rights and protection from harm of persons with mental health problems, and reduce stigma associated with mental health problems
• to enhance availability and distribution of skilled human resources for mental health.
The Government has approved the continued implementation of the National Mental Health Programme during the 12th Five Year Plan period with additional components.
With the objective to address the shortage of mental health professionals in the country, 15 Centres of Excellence in Mental Health and 35 PG training departments in mental health specialties to increase the PG training capacity in mental health as well as improving the tertiary care treatment facility have been funded.
Sufficient financial assistance is also provided to the three Central Institutions viz. National Institute of Mental Health And Neuro Sciences, Bangalore, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur and Central Institute of Psychiatry, Ranchi.
MENTAL HEALTH CARE BILL,2013:
On 8 August, 2016, the Mental Health Care Bill, 2013 was passed in the Rajya Sabha. The new bill will replace the rather outdated Mental Health Act of 1987, and when compared to the existing law, it is definitely reformist.
Features of the Bill:
-The definition of mental illness is broader and more inclusive.
-It decriminalises the attempt to suicide.The new law actually recognises suicide as a cry for help, and stresses on the immediate need to reach out and help the person overcome their issues. It does not treat the person as a criminal.
-Introduction of advance directives – this gives people suffering from a mental illness the right to choose their mode of treatment, and by nominating representatives who will ensure that their choices are carried out.
-The bill identifies inhuman and degrading treatment of the mentally ill as a crime.
Issues with the Bill:
Implementation of the Act will also pose to be a problem. There is a shortage of mental health professionals in our country. The bill provides facilities to the mentally ill, but how far does it address the stigma and discrimination a person with a diagnostic label is forced to endure?
CONCLUSION: As the number of people with mental health issues increase, the need for addressing their issues also rises. Role of Family, NGOs & Administration will be vital in this regard.