Finance Minister Nirmala Sitharaman in Budget 2022 launched a pleasant surprise by announcing 23 telemental health centers, with the National Institute of Mental Health and Neurosciences (NIMHANS) as the nodal center and the International Institute of Information Technology, Bangalore (IIIT-B) that offers technology support. Many mental health professionals feel that this is too little to address the gigantic mental health problems further complicated by the COVID-19 pandemic. However, it is a decent start that should be capitalized on by all stakeholders to build a mental health movement around it. Will this initiative lead to that? Only time will tell.
The following are some steps that both Central and State governments can implement.
Bridge the digital divide
‘Erosion of social cohesion’, ‘livelihoods crisis’ and ‘deterioration of mental health’ are three of the five risks that have been most exacerbated globally during the pandemic. Digital inequality is seen as an imminent threat to the world, with 3 billion people remaining offline (Global Risk Reports 2022: World Economic Forum).
Some 78 per cent of schools in India did not have internet facilities and more than 61 per cent did not have computers, according to data from the Uniform District Information System for Education (UDISE) for 2019-20. Therefore, rather than reaching individual individuals or families, community centers serving a group of people will help improve connectivity to raise awareness of mental health; this could be along the lines of a ‘Mann ki Baat’, where a large number of people listen to a program together. This seems utopian but it is possible.
Digital buzz can snowball in one move
The digital buzz needs to be supplemented by on-the-ground mental health interventions in every state. The Center will transfer Rs 4176.84 crore to the states for wellness centers, intensive care hospitals and public health laboratories for districts with a population of more than 5 lakh. Last year, the allocation was just Rs 595 crore. States must empower health workers and Asha workers to identify distressed and sick people for early interventions. This intervention should be linked to primary health care centers, district mental health programs, and hospitals.
Those with a ‘fever’ go to a health facility, while the mentally ill rarely do. The National Family Health Survey in India revealed that the prevalence of major depression in India was 2.7 per cent, while the treatment gap was 85.2 per cent. This gap must be closed. The little knowledge of psychological disorders and the stigma associated with mental health lead to a low identification of risk cases with disastrous consequences.
If health workers can successfully work on the malaria eradication campaign, they can also be trained to identify and provide early access to mental health care. The National Framework for Malaria Elimination (NFME) outlines India’s strategy for eliminating the disease by 2030. We need to be as focused on mental health as we are on malaria or tuberculosis . The NCRB suicide death figures are up 10 percent in 2020, and the country is crying out for a suicide prevention policy. The 2014 Mental Health Policy for India must be actionable. It needs fast wheels and strong teeth to positively impact mental health in India.
Beware of overmedicalization
As NIMHANS director Dr. Pratima Murthy recently shared in an interview, “This program will be helpful in identifying mild forms of mental illness, which may not require medication or patient care.” Telemental health centers need to integrate indigenous care into the system. Interventions that are culturally sensitive must be incorporated alongside the rich wisdom of Yoga, Vipassana, and others. Care must be taken to ensure that medication for psychiatric illnesses and psychotherapies are used appropriately when indicated. The myths that surround them must be destroyed. Medications must be located appropriately and not demonized. It takes training an army of mental health soldiers to help the mental health revolution. They can be the eyes and ears of the mental health apparatus. It goes without saying that the states and the Center should increase institutes dedicated to training mental health professionals, just as new IITs and IIMs have sprung up across the country.
Go beyond AIIMS and NIMHANS
The Center needs to look beyond AIIMS and NIMHANS. Just like in cricket, where we have five cricket zones, we need to similarly decentralize the nodal agencies for healthcare. Overloading AIIMS and NIMHANS is not fair. During the pandemic, most top politicians were treated in large private hospitals. More than 80 percent of mentally ill patients across the country are treated outside of government hospitals. Public-private-NGO partnerships are essential, from the initial stage, to announce effective mental health programs throughout the country. Spiritual groups can also be carefully enrolled.
Our Finance Minister, Nirmala Sitharaman, has held out the torch to all ministries to be activated, both at the central and state levels, to join the mental health revolution. We need a people-based Mental Health Movement as big as the Swachh Bharat Abhiyan or the Jal Jeevan Mission. The institutes can assist them and not the other way around.
The WHO estimates that $1 spent on treating depression and anxiety can yield as much as $4 in health and productivity. It’s time we look at mental health in a holistic way.
Dr. Harish Shetty is a psychiatrist at Dr LH Hiranandani Hospital and has extensive experience in community mental health. The opinions expressed in this article are those of the author and do not represent the endorsement of this publication.
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