While presenting the Union Budget 2022, Finance Minister Nirmala Sitharaman acknowledged the increase in mental-health problems in people across age groups in the wake of COVID-19 pandemic. To address the concerns, the Union minister announced 23 tele-mental health centres to be launched with the National Institute of Mental Health and Neuro Sciences (NIMHANS) as the nodal centre. The boost to the mental-health sector in last year’s Budget was welcomed by mental-health experts. In 2023, when most of the country’s workforce is back in office, experts feel it is still important to keep a tab on our mental well-being, especially with the threat of another COVID wave looming over us. Here are some of the key mental-health areas which the experts feel this year’s Budget should focus on:
Affordable therapy and subsidised medicines
In India, therapy sessions cost anywhere between Rs 1,000-4,500 on an average depending upon where one lives. Those who are recommended by their psychiatrist to seek therapy are sceptical because of the high cost. Dr Neerja Birla, founder and chairperson, Mpower and Aditya Birla Education Trust, says, the cost is the tip of the iceberg. “Mental-health issues do not go away with one or two sessions. At Rs 1,000-1,500 per session, an average person cannot afford 10-20 sessions that are required to put him or her firmly on the path of recovery."
Second, out-of-pocket expenses for travel and mental-health medications can be an additional Rs 5,000-10,000 a month, which is again beyond the means of so many people. Reducing the cost of consultations and sessions isn’t enough, the medications need to get heavily subsidised as well.”
Priya Hiranandani-Vandrevala, co-founder, Vandrevala Foundation, recommends allowing up to Rs 50 lakh of annual mental-health cover for families belonging to lower-income groups who have a member who is disabled and suffering from mental illness. “This will prevent homelessness of such people and encourage society to pay for carers who take care of such people. Those with diagnosed mental illnesses (not severe and those who can take work but not very well) can be given a lifetime corpus of Rs 20 lakh worth of treatment to allow them to function in society, get treatment, etc., and be productive members of society.” While many health-insurance policies include certain mental-health issues, according to a Policy Baazar report, hospital admissions related to self-inflicted injury, suicide attempt and psychological disorders resulting from alcohol abuse are not included. Moreover, many insurance policies do not cover mental illnesses from the first day and consider it as a pre-existing condition. “Health-insurance companies should be mandated to provide diagnosis and treatment for mental illnesses just as they do for physical illnesses," says Hiranandani-Vandrevala.
Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) provides at least 100 days of guaranteed wage employment in a financial year to every rural household. “An additional 50 days of jobs, through a separate budgetary allocation, should be given to families, who have one or more disabled in the family so that they can take care of disabled members of their family,” recommends Hiranandani-Vandrevala. Dr Suprakash Chaudhary, professor and HOD, department of psychiatry, Dr DY Patil Medical College recommends the government to increase psychiatric OPD services at all hospitals with adequate psychiatrists so affordable mental-health care is available to the poorest of the poor.
Dr Chaudhary says, having free-of-cost deaddiction and rehabilitation units for those struggling with substance abuse will also help. “Short-term facilities are needed for the victims of domestic, sexual and emotional abuse. In addition, sheltered housing and protective services should be arranged for nomads, migrants and wanderers who are often diagnosed with mental illnesses.”
On the insurance front, Dr Chaudhary opines that the American model of health insurance is flawed. “The main profits of insurance in American healthcare are, first, the companies, then medical personnel, though they also run the risks. The patient does not benefit. We should take a look at the British/continental model as an alternative.”
Lack of mental-health professionals
According to a report by the Union Ministry of Health and Family Welfare, there is one psychiatrist for every two lakh people in India. The ideal ratio for the population is 1:8,000. To tackle the issue, Dr Chaudhary recommends converting all state mental hospitals into teaching institutes. “In addition to this, one autonomous psychiatric institute in every state should be started by the government that will train psychiatrists and other mental-health professionals, and also provide comprehensive psychiatric care to poor people. This will, over time, address the shortage of mental-health professionals in the country.” Dr Birla says, funds alone cannot stop the problem of lack of mental-health professionals in India. “This is where a push and grants by the government will make the difference. Mental-health studies need to be considered a stream and given more importance in our medical colleges. Funds need to be allocated with a clear-cut directive to make this happen with a sense of urgency,” Dr Birla says.