Mental Health, not a priority, fiscally

In the run to World Mental Health Day, the WHO announced that 2020 will mark a year of greater investment in mental health as COVID-19 has reminded us of its importance. On the contrary, India’s 2020 Union Budget, further reduced the allocation of funds to the National Mental Health Program, continuing the neglect of mental health.

COVID-19 has heightened awareness about mental health like never before. Google Trends shows a surge in searches related to managing mental well-being and accessing mental health services during the lockdown, and new phrases like “coronavirus loneliness” and “coronavirus mental health” have emerged in search tool suggestions.

In the run-up to World Mental Health Day observed on 10 October, the World Health Organization urged leaders to consider 2020 the “opportunity to kick-start a massive scale-up in investment in mental health”, launching a formal campaign – “Move for mental health: let’s invest”.

In his address, Dr. Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization stated, “We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social, and economic consequences will be far-reaching.”

Prevalence of mental illness in India

Mental Illnesses have historically been ascribed a low priority status in health expenditure, arguably a reflection of society, wherein mental health conditions are only recently being acknowledged as legitimate physiological conditions that can be addressed through prevention and treatment.

In India, mental illnesses contribute to ~4% of the number of years lost due to ill health, disability, or early death. The Global Burden of Disease Study in 2017 estimates that 14.3% of Indians are diagnosed with a mental disorder. When calculated by the number of years of life lost, Depressive and Anxiety orders cause the largest drop in productive years (33.8% and 19% percentage DALYs respectively), more so for women who are disproportionately affected by these illnesses.

Suicides on the rise

As of 2019, 1 in every 10,000 Indians dies of suicide, an increase of ~ 0.25% every year since 2017. 17.1% of suicides were attributed to illness, which was the second most prevalent cause of suicide after family problems.

The National Mental Health Programme is the Government of India’s sole centrally-sponsored scheme for mental health. The programme was launched in 1984 to build mental health treatment facilities, enable citizens to access mental health care services at Primary Health care centres, district and state hospitals, and create community awareness about mental health and well-being.

In 1996, the District Mental Health Programme was introduced under the National Mental Health Programme to further the up-gradation of mental health facilities and outreach activities to enable early detection and prevention.

The programme, however, remains heavily underfunded, and the union budget allocation only gets smaller every year.

Budget allocations for the programme that already constituted a small percentage of the total budget allocated to MoHFW are being reduced even further. In 2010, the programme’s budget was 0.44% of the total budget allocated to MoHFW. In 2020, it is 0.06%.

The programme receives major cuts in revised budget estimates

The National Mental Health Programme has seen substantial cuts in revised budget estimates. In 2018-2019, the 50 crores allocated was slashed to 5.5 crores in revised estimates. Similarly, in 2019-2020, 40 crores were brought down to 5 crores in revised budget estimates.

Actual spending on the decline since 2018

The percentage of revised allocations spent also declined in 2018, uncharacteristic of the years prior. Until 2018, over 95% of the funds allocated were spent. In 2018, only 37% of the 5.5 crores allocated in the revised budget was spent.

Do state budgets prioritize mental health?

The National Mental Health Survey conducted in 2015-2016  found that state budgets allocated less than 1% towards mental health. Most states did not even have separate budget health for mental health, making it impossible to decipher if any money was spent at all.

The report states, “The financing of mental health care is in a state of total disarray, amidst the lack of clarity and shared responsibilities between central and state governments and several departments at the state level. Most states were unable to utilise even the available funds due to lack of clear mechanisms and guidelines.”

Will COVID-19 be an inflection point in government spending on mental health? The data shows little hope.

1 in 20 are suffering from depression, there are only 47 psychiatric institutions in the country and one psychiatrist for every two lakh person, but mental health is not a priority, at least fiscally.