Ayushman Bharat health and wellness centres start delivering services but mental health yet to get its due

A just released report assessing Ayushman Bharat Health & Wellness Centres (HWCs) across 18 states shows that the government’s efforts to address the challenges of mental health issues beyond metros remain inadequate.

Of all the sub health centres and primary health centres that have been upgraded into HWCs since 2018, very few offer primary consultation to patients approaching them with mental health issues, says the report.

The report was released by Union health minister Mansukh Mandaviya on May 17.

The assessment, which was carried out by the community medicine department of the All India Institute of Medical Sciences and independent organisations GRAAM and Jhpiego, an international health body affiliated with Johns Hopkins University, showed that while just 48 percent of HWCs at the sub-health centre level offered consultation on mental health in 2020-21.

This figure was only a tad better at HWCs at the primary health centre level, at 65 percent.

In contrast, 99 percent of HWCs in both categories are already offering screening for non-communicable diseases such as diabetes, cancers and hypertension.

Lack of trained personnel for mental health

Experts pointed out that the performance of HWCs in offering basic mental health services was disappointing but not entirely unexpected.

Also read I In Depth | Rajasthan shows the way with first Right to Health draft bill; may have lessons for the country

“Historically, mental health awareness has been poor, partly due to the stigma attached and perception of people towards mental illness,” pointed out Dr Santosh Bangar, senior consultant psychiatrist with Global Hospital in Mumbai.

He added that the awareness of mental health continues to improve with time and more and more people are now coming forward to accept professional help.

“Also, there is a lack of trained mental health professionals in our country, which further adds to the void of specialist services for the needy. To address these, more training of health workers to deliver mental health first-aid by identifying signs and symptoms of common mental health illness is needed,” Bangar added.

Ayushman Bharat—Health and wellness centres

The government has decided to upgrade sub-health centres and primary health centres across the country into HWCs in an attempt to move from selective healthcare to deliver a comprehensive range of services across all ages. The Centre has targeted upgrading 1.5 lakh AB-HWCs across India by the end of 2022.

The implementation of AB-HWC entailed a set of multiple reforms, spanning all aspects of health systems, such as service delivery, human resources, financing, access to medicines and diagnostics, community participation and ownership, accountability and governance to ensure that all the three dimensions of universal health coverage are addressed.

The first AB-HWC was launched in Chhattisgarh in 2018 and by the end of February this year, nearly 90,808 centres were functional across states, as per government records.

Apart from primary consultation for various ailments across 12 categories, a total of 105 free and essential medicines at sub health centre HWCs and 172 medicines at primary health centre-HWCs are also to be provided free of cost.

In addition, while sub health centres are supposed to provide 14 diagnostic tests, the number of tests promised at primary health-HWCs is 63.

The assessment report said that overall, there has been an improvement in equity in access, despite existing constraints such as infrastructure availability and status of peripheral health facilities.

However, it also noted that “mental health and elderly and palliative services were the least rolled out services,” adding that many states said that training for these services has not yet been held.

The latest report underlined that the availability of an expanded range of services, beyond NCDs, was a work in progress and the national guidelines for these are just being released, to be followed by training. It, however, noted that during the survey preparedness for rollout was to be assessed.

Bangar stressed that a periodic review of the mental health services at HWCs is crucial to identify the unmet needs of people with mental health illness.

“Mental and physical illnesses must be considered together in every individual,” he said. “A change in perception by the common person can be brought about by increasing awareness, which should reduce the stigma around mental health”.

India’s mental health burden

The Global Burden of Disease Study (1990–2017) states that one in seven Indians was affected by mental disorders of varying severity in 2017 and the proportional contribution of mental disorders to the total disease burden in India had almost doubled since 1990.

Some studies indicated that mental health issues in the majority of Indians has been exacerbated since the COVID-19 pandemic owing to isolation and financial difficulties.  The growing number of suicides in India, among both men and women, is yet another example of the deepening mental health crisis in the country.

Dr Milan Balakrishnan, a consulting psychiatrist with Masina hospital in Mumbai, pointed out that the prevalence of mental health issues is estimated to be as high as 1 in 5 people.

‘Lack of priority’

“If you are sitting around a dinner table it’s likely that at least one of you is suffering (a mental health issue),” said Balakrishnan.

Also read I Coming soon:  India’s first hypertension management guidelines

Despite this the lack of priority may continue unless politicians and bureaucrats are made aware and have a deeper understanding of mental health issues, he said.

Balakrishnan, however, notes that the Mental Healthcare Act of 2017 has put pressure on governments at the central and state levels to allocate funds for mental health review boards, as well as services for people with mental illness, including admission facilities, halfway homes and day-care services.