OPINION: India has taken a much-needed step towards mental health reforms, but it will be crucial how it builds on the momentum

By Charu Sehgal and Harsh Kapoor

Mental health issues have been on the rise globally and the issue has been further exacerbated to almost worrying proportions driven by the impact of COVID-19 on the socio-economic environment. Many developing and developed economies recognised this alarming trend and swiftly acted by enhancing their mental health budget significantly last year. For instance, Chile announced an over 300% increase in the mental health budget in 2021 and Canada announced a $1 billion fund allocation for mental health in its Budget 2021.

The Indian government has also recognised the pandemic’s impact on people’s mental health and wellbeing and has placed its priority on mental health in the 2022 Union Budget. The push towards digital health and the investments in a national tele-mental health programme to improve access to care is a welcome move and shows that mental health is now on the government’s agenda.

However, despite a 16.6% increase in the total healthcare allocation in this year’s budget, the year-on-year increase in funds allocated to mental health was only 12.22% (approx ₹670 crore vs approx ₹597 crore) with its proportion in healthcare budget dropping from around 0.8% to around 0.77%. Moreover, entire increased mental health funding has been directed towards the centrally funded mental health institutes with no increase in allocation to the government’s National Mental Health Programme (NMHP).

Given, India shoulders around 15% of the total mental health burden of the world, much more needs to be done to combat the challenge, and its efforts need to be matched vis-à-vis the scale of the problem. There is a need to capitalise on this momentum that has been generated and concentrate on actionable policy initiatives focused on meeting short term requirements and building long-term capabilities.

In the short-term, there needs to be a stronger focus on enhancing awareness and mitigating the stigma associated with mental health. This can be achieved through a country-wide mental health literacy campaign that can be implemented by government bodies. It is vital that the campaign focus on educating not only the masses, but also, other healthcare professionals, including those treating non-communicable disease cases, to ensure timely recognition of symptoms and that cross-referrals are conducted. For example, in the UK, the anti-stigma campaign (“Time to Change”) runs activities throughout the year and has led to significant shifts in attitudes towards mental health, as recorded during evaluation surveys. The government has had great success in the past with public campaigns (such as polio immunisation, sanitation) aimed at addressing social issues and serving as a call to action for its citizens, and can use learnings from them to develop a national mental health awareness campaign.

In addition, mental health programmes must seek to incorporate learnings from other successful government programs across the globe and introduce relevant policy changes. One notable example of a successful mental healthcare model focused on deinstitutionalisation can be found in Australia. The Australian National Mental Health Strategy focuses more on community-based care rather than institutional level of care thereby successfully reducing the need for in-patient care requirements in recent years. In India, we continue to have a shortage of qualified mental health care providers, with only 0.3 psychiatrists per 100,000 population available as compared to the corresponding figure of 12.7 in high income countries. The national tele-mental health programme launched in this year’s budget is a welcome move as digital solutions can be a great way to achieve scale and improve access. However, in light of the missing awareness of mental health issues as well as lacking access to digital treatment for a significant share of the population, there is a need to complement the tele-mental health programme with a community-based delivery model with necessary funds allocated at the grassroot level. Moreover, the government must use this as a foundation to build more dedicated and decentralised training programmes to cover the expansive network of front line health workers and general physicians at PHC and CHC levels spanning the country.

Mental health cannot be viewed and solved in a silo. There is an increasing realisation that a wide variety of actors across sectors impact mental health, and correspondingly, the economic impact of mental ill-health is also felt across sectors in the form of loss of productivity, absenteeism, decline in quality of work, etc. Hence, mental wellness must be viewed in an integrated manner, particularly in terms of service delivery and outcomes. A multi-sectoral approach for solving mental health challenges, with non-health sectors prioritising mental health agenda and developing policies and ways of working, has been gaining momentum. Several countries have adopted this cross-sectoral approach where multiple ministries apart from health such as education, employment, social affairs, and families develop a dedicated mental health plan and budget. India must consider adopting a similar integrated multi-sectoral approach to enhance the effectiveness of NMHP, including encouraging collaboration among various ecosystem stakeholders beyond healthcare professionals. Employers need to build mental health in their HR policies and provide awareness, counselling and other support including leave where necessary. Additionally, schools should provide mental health education to ensure an early understanding and early detection of mental health issues. A well-functioning ecosystem needs to be created with clear incentives provided for solutions, tools and services directed at treating mental health issues.

Insurance Regulatory and Development Authority’s (IRDAI) directive to ensure that mental health enjoys coverage under universal health insurance was a step in the right direction. However, insurers typically offer coverage for in-patient care and exclude out-patient services such as psychological counseling services and non-hospitalisation treatments for mental health. There needs to be a focus on introducing reforms and ensuring enforcement, so that most patients can afford the counseling and care that they require.

Moreover, we must continue to build our pool of mental health professionals and enhance care standards to cater to the growing needs of the population. Development of relevant infrastructure, research and technological advancements related to mental health has been on-going, albeit at an insufficient rate. Moving forward, we must ensure future-readiness by earmarking sufficient budgets for medical colleges and research grants, as a part of a larger five or ten-year mental health enhancement vision.

As per the World Health Organization (WHO), for every $1 put into scaled up treatment for common mental disorders, there is a return of $4 in improved health and productivity – hence investment in mental health will not just have improved health outcomes, but significant economic outcomes as well. The government has taken a much-needed step towards mental health reforms, it will be crucial to build on this momentum and galvanise mental health care reforms and support them with adequate financial aid in the budgets to come.

Charu Sehgal is Partner and Lifesciences and Healthcare Leader, Deloitte India; and Harsh Kapoor is Partner, Deloitte India

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