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Improving mental health

In its call to governments on World Suicide Prevention Day this year, the World Health Organisation emphasised, among other strategies, the need to expand access to mental health services. Many countries spend a small fraction of their meagre health budgets on mental health although they can afford to do a lot more. The WHO has pointed out that efficient interventions to treat the most common mental disorders are as cost-effective as those for other chronic, non-communicab le diseases. It is disappointing, therefore, that only a minority of patients has access to proper treatment in the low-income and middle-income countries, India included. Even where medical facilities are available, the majority of patients incur heavy out-of-pocket expenditure because of weak pre-paid mechanisms for health care in general and mental health in particular. Voluntary health insurance policies available from even public sector companies in India generally exclude, along with chronic diseases, all psychiatric and psychosomatic disorders.

A combination of community-level and hospital-based services may be the most effective system for mental health care. While India made a beginning in community-level interventions through the District Mental Health Programme a decade ago, it has not been able to scale it up adequately. At present, it serves only a fraction of the population. The Centre now has the responsibility to take the agenda forward and ensure that adequate funding and human resources are available in the Eleventh Plan and that the States deliver on care. Quite appropriately, the Planning Commission views the need for a comprehensive national mental health programme as part of the ‘unfinished agenda’ that includes expanding care for cancer, and cardiovascular and renal diseases. It is important to remember that poverty, violence, insecurity, and unemployment are correlated with mental disorders. These are endemic factors in India and require sustained, multi-pronged interventions. Support services for youth, students, and vulnerable women are necessary to prevent many heart-rending suicide attempts. There is also the challenge of removing stigma and discrimination. In a global overview of mental health published on September 8, The Lancet found that in India, psychiatrists are the least preferred option for people seeking help for mental illness, owing to fear of stigma. That must change. As former WHO Director-General Gro Harlem Brundtland wrote in the 2001 World Health Report, the present generation must be the last that “allows shame and stigma to rule over science and reason.”

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