Deprioritizing Mental Health - Indian Union Budget 2021: The Reality
With the ever-increasing talks around mental health, India is slowly coming out of the derogatory and orthodox norms of viewing mental illnesses as a myth or a ‘problem’. However, the same is not noticeably visible at the administrative level. Read further to know what is India's budget stance on India's mental health.
With the ever-increasing talks around mental health, India is slowly coming out of the derogatory and orthodox norms of viewing mental illnesses as a myth or a ‘problem’. However, the same is not noticeably visible at the administrative level.
Ever since the establishment of the first Indian Government, less has been the focus around mental health. Even in the year 2021, when not only celebrities but the youth has aggressively come forward to talk about it – it is not a status of concern for the legislative authorities.
Ms. Nirmala Sitharaman, Minister Of Finance of the Government of India, presented the union budget for the year 2021-2022 on 1st February 2021.
The citizens of India were eagerly waiting for the announcement of the Mental Health Budget this year, which has been less than Rs. 1 per person per year for over decades now. However, only Rs. 597 crores were given to the mental healthcare, out of which only a small sum of Rs. 40 crore was proposed for the National Mental Health Program, about 7 per cent of the total mental healthcare budget. This figure has been the same for quite a few years now. Rs. 500 crores out of the budget were given to the National Institute Of Mental Health And Neuro Sciences.
Even though India managed to pass a comparatively progressive and robust mental healthcare act in 2017, most of its policies have still not been implemented. The need for quality healthcare is not overstated and is an outright requirement now.
The number of people suffering from mental health issues in India has grown from 125 million in 1990 to 197 million in 2017.
For the financial year 2022, our honourable finance minister said that health and well-being are the key pillars of a self-sufficient Bharat. However, with just Rs. 40 crores to serve a population of 137 crores, the statement seems far distant from the truth. Experts also believe that the proposed budget will leave India absolutely unprepared and unable to deal with the population's requirements, especially after the addition of the mental trauma and health after the fallout of the COVID 19 pandemic.
The pandemic hit the Indian population quite hard, leaving millions jobless and several homeless. An estimated 12.2 crore citizens of India lost their jobs amidst the pandemic, nearly 9 per cent of the workforce.
Most of the youth has been locked inside their homes, with little to no social interaction. This has been a conspicuous situation of the increasing mental health issues in people as young as 15 or 16 years old.
Värnik claims that India's adjusted annual suicide rate is 10.5 per 1,00,000, against the world's rate of 11.6 per 1,00,000. According to a 2017 study in Lancet Psychiatry, 14.3% (197.3 million people) of the Indian population suffered from mental illnesses.
8 million people around the world die every year due to some or the other mental illness. This is how crucial it is for us to identify the seriousness of the matter.
When the Government fails to identify it, allocating less than Rs. 1 per person per year for their mental health stability, it clarifies how significant this aspect is to the authorities. The Indian Government spends 0.05% of the total healthcare budget on mental health, whereas other developed countries spend at least 4%-5% annually. This is one of the primary reasons why India is still coming to terms with the fact that mental issues are real and absolutely normal, even in the 21st century. We have started accepting it, but not acting on it.
Despite the productivity loss caused due to mental problems and a shortage of doctors and agencies to suffice the need for a proper mental healthcare mechanism, the budget does not seem to increase at all. In fact, the first time the mental health funding was brought down instead of adding onto it, was in the year 2011. Since 1982, India, as a part of its yearly Union Budget, spent more than Rs. 100 crores on the NMHP. In 2020, the actual spending was less than Rs. 5 crore on the same. Additionally, In FY2019, the funding was dropped to Rs. 40 crore from Rs. 50 crore in the financial year of 2018.
It would be right to say that the Indian Government is slowly and silently deprioritising mental health, and now it is evident more than ever.
If we calculate the exact cost required to fulfil the mental healthcare positions and issues in India, it comes down to a whopping Rs. 94,073 crores, according to the Indian Journal of Psychiatry. As in front of us, the actual current spending is not even a mere fraction of this amount.
The Mental Health Care Act guarantees every affected person access to mental healthcare and treatment funded by the Government. The Government is said to make sufficient provisions for a range of services required. However, one does not need to be a mathematician to do the simple math here. The Government's budget for mental healthcare is Rs. 40 crores, on an average of about 197 million people (as stated above) are going through some mental illness. The amount is certainly not even enough for 20% of the said population. From doctor consultations, medications, tests, to whatnot – mental healthcare check-up is a routine which the Indian citizens do not even get to follow regularly. No wonder what the allocated budget is going to do, for it will never even reach a maximum of the population in need of the same.
Dr Devraj Sinha, a top player in the category of Psychiatrists in Mumbai, expressed the system's attitude towards mental health by citing an example that is definitely an eye-opener. "If the cardiology department, for instance, asks for funds for a transplant, they get cleared the next day. However, suppose the psychiatry department asks even for medication. In that case, that does not fall under the ambit of the Government's free medication, and there is no response for days. How will the patient afford this medication, the treatment then gets stuck." said the doctor. This one statement tells a lot about the system's attitude, and the importance it has been giving to sensitive issues like that of mental health.
Numerous individuals and multifarious organisations in India have been coming up as registered establishments for mental health, trying to help as many people as possible. Nevertheless, to reach out to a population as diverse and as large as ours, spread in a land size of 3.287 million km², without the authority’s and system's support is more like feeding a bird, when in reality you want to feed the entire biodiversity.
What the Government is also failing to do is create awareness. Only 2 out of 10 affected people actually seek medical help when suffering from a mental illness. There are no campaigns, centres, or counsellors that the Government provides for its citizens who can actually come forward and educate the unaware, about what is the thing which has been acting as a toll in their lives.
"There is a shortage of doctors for the already affected patients; to expect trained paramedical staff and social workers to spread awareness and provide counselling seems far-fetched," added Dr Sinha. There is an absolute paucity of trained human resource for all the mental health arenas, and even after several calls from the public, there has not been much change.
This lack of professional human resource to carry out tasks like understanding the patient, counselling the patient, talking to the patient; leads to a mental health system which is incomplete within its roots, in India. Medication is preferred over counselling and sensitisation, making the problem grow deeper.
This gap in budget allocating and budget spending has led to non-stop fundamental issues related to improving mental health and citizens coming forward for the same but being overshadowed every single time, by the immediate measures of 'more medication, less sensitisation.
To understand where we are going wrong as a nation, here is another little addition to our knowledge on the budget. The 2021 budget also mentioned a grant of Rs. 300 cores to the Goa Government for their diamond jubilee celebrations on the occasion of Liberation Day. As much of an important day it is for the people of Goa; the Government initially sought just Rs. 100 cores from the central Government. Rs. 200 crores were allocated for the celebration purpose in excess, whereas the Mental Health budget lacks Rs. 94,000 crore. As a student of economics and a citizen of India who prioritises mental health of each citizen, it is not only astonishing but confusing to see such less significance given to something as big as the well-being of the country-men. If a celebration deserves Rs. 300 crores, why does a health condition not?
This entire scenario that processes the low level of spending on mental health is exacerbated through an underutilisation of the government funds, which are actually the citizens' funds in the end. Low prioritisation of mental health by the centre and the Indian states and low coverage of health insurance for mental, neurological, and substance use disorder states the authorities' realisation about the matter as grave as this. The COVID 19 pandemic witnessed numerous suicide cases by not just commoners but even celebrities. Celebrities, who generally have access to luxuries and an easier approach to almost everything, lost their battle against mental suffering. The COVID 19 pandemic has only increased the need for additional financing of mental health services worldwide, but especially in our nation. The focus has to be on increased mobilisation and effective allocation of finances to address priority needs like immediate counselling, therapy sessions, agencies to support these sessions and qualified doctors. With a. budget as low as that proposed, the goal does not only seem far-fetched but next to impossible.
In a country with most of its population in the working stage, the youth, where there should be a heavy focus on their mental health to promote the nation's development, productivity and growth; the Government has not been paying attention to an issue that is now out here in public. All it needs is the authorities to take over and take it seriously, by not just addressing it but acting on it. The idea of a budget that 100% fulfils the criteria of India's mental healthcare system seems truly implausible, and nothing until the next budget can be said or done, unfortunately. These are the times of crises, and what we need the most is our minds to be stable and healthy and in a position of anything but dismay. However, as down on one’s luck as it may sound, this has not been the case. There is no shame in admitting that we, as the citizens of India, had high expectations from the Union Budget 2021, especially in the Mental Healthcare Act category. Now that it is clear that we are not going anywhere with this budget, all we can do is wait and hope for a better amendment in the years to come. This ground reality of the mental healthcare system in our country is genuinely agonising yet petrifying.
"A change of attitude towards mental health, an investment push, government-backed awareness campaigns, primary mental health treatment in government's wellness centres and sanctioning of more psychiatry seats in government colleges are some of the immediate steps that can be taken to start solving the issue," said Dr. Mundada, a senior specialist consultant in Mumbai.
To end my thoughts on the part of the National Mental Health Program in India's Union Budget and its priority setting, India seems like a country with no mental health at all, today, or tomorrow. There is a blind eye turned towards something affecting a large share of the population, the consequences of which will be visible in the coming years.
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