The Global Burden of Disease Study shows that in 2013, 50% of all disease burden in India was caused by non-communicable diseases, while mental disorders accounted for about 6% of the total disease burden.
The Mental Healthcare Bill, 2016, which was passed in the Lok Sabha on March 27, 2017, has been hailed as a momentous reform.
The ground reality, however, suggests that these objectives are not just overambitious but an overkill .
What are major issues in mental healthcare?
Whether legislation help overcome supply and demand barriers seems highly unlikely, as the root causes lie in pervasive negative attitudes, massive neglect of mental health care, rampant abuse and unchecked inhuman practices, and weak redressal and enforcement mechanisms.
There are only 43 government-run mental hospitals across all of India to provide services to more than 70 million people living with mental disorders.
There are 0.30 psychiatrists, 0.17 nurses, and 0.05 psychologists per 1,00,000 mentally ill patients in the country.
At the macro level, the proposed health expenditure of 1.2% of GDP in the Budget for 2017-18 is among the lowest in the world. Of the total health budget, a mere 1-2% is spent on mental health.
Underlying this abysmal quality, is a perception that those with mental illnesses are pathological/criminal. Hence they do not deserve the type of rehabilitation given to those with physical ailments.
Besides, the treatment gap is widened because of the social stigma attached to such illnesses.
Women typically face larger treatment gaps as they are vulnerable to violence, sexual abuse and inhuman treatment.
Ethnographic evidence from the Human Rights Watch Report 2014 relating to women inpatients is gruesome.
Women and girls in institutions are often subject to not just physical and verbal abuse but also sexual violence.
What could be done?
An emphatic case could be made for shifting from institutional care to community-based care for people suffering from mental disorders.
A study published in The Lancet Psychiatry, 2017 offers corroborative evidence from VISHRAM, which is a community-based mental health initiative.
The reduction in the treatment gap was due to increased supply of mental health services through front-line workers and their collaborative linkage with the physicians and psychiatrists in the facilities
The demand can be increased for mental health services due to improved mental health literacy.
The substantial reduction in the median cost of care resulted from availability of general as well as specialist services in the village itself.
What is the way forward?
The Bill seeks to address major lacunae in mental health care and is thus an important step forward.
However, its implementation will require larger public resources and restructuring of mental healthcare services with a key role for the community in their provision, rapid expansion of mental health literacy, effective monitoring and enforcement of the objectives envisioned in it.
