The past two years of the COVID-19 pandemic have highlighted the importance of mental health issues in our communities. A global study published in The Lancet in October 2021 estimated a 35 per cent increase in mental health problems in India, while a UNICEF survey found that nearly 14 per cent of adolescents reported feeling depressed. The government’s own report on suicides, published by the National Crime Records Bureau, showed suicides increased by 10 per cent in 2020.
The mental health sector, therefore, had reasons to be hopeful that the 2022 Union Budget would address the shortage of public mental health services by allocating more funds to the sector. The Finance Minister in her Budget speech also mentioned the setting up of a National Tele-Mental Health programme, under which 23 tele-mental health centres are to be launched. However, the exact budgetary outlay for this new programme is not known. It is unclear whether this Tele-Mental Health programme will be funded with new money or whether it will be funded from existing allocations to different mental health programmes.
Ministers' Rhetoric Doesn't Match Action
But a look at the detailed budgetary provision for mental health suggests that these hopes are dashed. An amount of Rs 670 crore has been allocated to mental health in the Ministry of Health and Family Welfare’s budget of Rs 83,000 crore – that is 0.8 per cent of the health budget, which is like the previous years. Mental health issues, even during pre-COVID years, accounted for almost 10 per cent of the total health morbidity; the National Mental Health Survey in 2016 found that nearly 70-80 per cent of people with mental illness received no treatment.
Things have only got worse during the pandemic, and it is, therefore, disappointing to see that rhetoric and words by Ministers about providing mental health support are not backed by increased funding.
Furthermore, nearly 93 per cent of Rs 630 crore is for funding two institutions run by the Central government, namely NIMHANS (Rs 560 crore) in Bangalore and LGBRI (Rs 70 crore) in Tezpur. The remaining Rs 40 crore (same as last year) is for funding the establishment of centres of excellence and strengthening the departments of psychiatry in medical colleges across the country.
Just Rs 83 Lakh for Each District
So, where is the money for public mental health services in different districts of the country? The government funds the District Mental Health Programme (DMHP) in 704 districts. However, there is no increase in the allocation for each district, which has remained a meagre Rs 83 lakh (the maximum amount for an entire district) for the past many years.
Furthermore, this is funded out of the Flexipool of the National Health Mission. But a detailed breakdown of the Flexipool is not provided in the Budget, and hence, it is not possible to discern how much of this Flexipool money is used for mental health.
Funding Priorities Brushed Aside
That sums up all about mental health in the Budget document. No funding for suicide prevention despite the enormous rise in suicides, especially amongst children (suicides amongst young people under 18 years were up by 21 per cent in 2020); no funding for adolescent mental health services despite the UNICEF survey showing that one out of seven young people aged between 15 and 24 years experienced depression in 2021. Ignoring mental health problems, particularly among children, is going to result in even more problems in the future as they reach adulthood. There is also no funding for education and training to increase the number of mental health professionals, despite the enormous shortage of trained mental health staff. These are just a few examples of funding priorities that have not been addressed in the Budget.
In its defence, the Union Government can point out that health is primarily a state subject, and so, the responsibility lies on state governments. But given the precarious situation with most states’ finances, that is unlikely to happen soon.
Mental Health & Poverty
The government has left people with mental health problems to fend for themselves. Given the two-way linkage between poverty and mental health, it means more people with mental health problems will slide into poverty and the poor with mental health problems will be unable to access even basic mental health care.
As part of the Sustainable Development Goals, India is committed to reducing its suicide rate by one-third in 2030. On the contrary, the suicide rate increased by 8.6 per cent in 2020 and is likely to increase further in the coming years as the economic impact of COVID-19 plays out over time.
What does the mental health sector need to do to get the government’s attention to the mental health crisis in our communities?
(Dr Soumitra Pathare is a Consultant Psychiatrist and Director of the Centre for Mental Health Law and Policy at Indian Law Society, Pune. He can be reached on Twitter @netshrink. This is an opinion article and the views expressed are the author's own. The Quint neither endorses nor is responsible for them.)