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The challenge of mental illness

Mental illness is deeply stigmatising. It cruelly deprives a large number of people of a socially satisfying and economically productive life. Advances in medicine have helped in the management of some conditions with a fair degree of success, but social prejudices remain strong. Evolving a comprehensive government-mediated care programme for an estimated 60 million Indians with moderate to severe mental health problems represents a big challenge. Despite greater awareness of treatment possibilities, mental health continues to enjoy low priority in the national budgeting exercise. Even the grisly spectacle of chained patients perishing in a fire in an asylum in Tamil Nadu four years ago failed to bring about far-reaching policy changes. National spending on mental health as a proportion of the total health budget remains abysmally low at 2.05 per cent despite a large proportion of patients needing a continuum of care and year-round medication. In the absence of a supportive public health system, several families with a mentally ill member have perforce to seek the assistance of non-governmental organisations. Many of these outfits have no strong care-providing credentials based in psychiatric practice. Invariably, the mentally ill have to depend on family support, and, where there is none, are left to wander the streets. These trends are an indictment of the continued failure of health policy to recognise medical care as a basic entitlement.

Bringing about a qualitative change requires active intervention by both the public health system and the private sector. The Schizophrenia Research Foundation in Chennai, which has been studying the stigma associated with the disease, recommends that preventive efforts should involve the general practitioner, who is the first point of contact for most people. The Centre must see the wisdom in this advice, especially in a situation where psychiatrists are in short supply. In more than half the districts of the country, there were no psychiatric facilities of any kind at the start of the Tenth Plan. The outlook for the mentally ill will improve if the revamped National Mental Health Programme launched in 2002 with an enhanced Plan outlay can be sincerely implemented. The Health Ministry must abide by the spirit of the programme and the budgetary support needs to be stepped up significantly. Governments need to launch campaigns in association with the private medical sector to remove stigma, prevent suicides, curb abuse of substances that can induce psychological problems, and rehabilitate patients. The public health system can help detect early signs of psychiatric conditions, provide shelter where necessary, and offer treatment. Quackery has to be tackled with a firm hand. A progressive approach that recognises the need for trained medical personnel and essential drugs at primary health centres and in taluk and district hospitals can make a big difference.

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