Last year, Google Search trends for words like stress, anxiety, and relaxation reached their highest recorded levels in the search engine’s history. This was a direct impact of the COVID-19 crisis that bropught along with it another silent epidemic that has ravaged many – Mental Health issues.
Over the years, the mental health of a population has come to be recognized as an important public health problem, but the stigma associated with it still make it difficult for people to come forward and seek help.
The World Mental Health Day is commemorated every year on 10th October and this year’s theme is “Mental Health in an Unequal World” – an apt theme considering the growing disparity between 'haves' and 'have nots'.
Marginalized communities like sexual minorities, people with disabilities, the elderly, the poor, etc, face mental health problems just like everyone else but their problems are exacerbated due to the prejudice, stigma and discrimination they face. Often, they are not able to afford or access quality mental healthcare.
Various research studies have shown elevated rates of major depression, anxiety disorders, Post Traumatic Stress Disorder (PTSD), and the resultant substance use and abuse among these communities.
With the adoption of the 2030 Agenda for the Sustainable Development Goals (SDGs), UN Member States pledged to ensure “no one will be left behind” and to “endeavor to reach the furthest behind first”. This is well reflected in the World Mental Health Day theme for this year which envisages making mental healthcare a reality for everyone.
Mental Health Care in India
While mental health care in India has been available since the 18th Century, rapid improvement has been seen in this field in the last 30 years, with active involvement of the Judiciary and the National Human Rights Commission (NHRC) in monitoring the availability of infrastructure and human resources for mental health care.
However, the availability of human resources for mental health for the population remains a challenge. In 2019, there were 0.3 psychiatrists per 1,00,000 people in India compared to 2.2 in China and 10.5 in the United States, and 0.8 mental health nurses per 100,000 people in India compared to 5.4 in China and 4.3 in the US.
The National Mental Health Programme (NMHP) was started in 1982 with the objective of developing community-based mental healthcare in India. The NMHP has evolved over the years and is working to provide basic mental health services at the community level through multiple strategies like out-patient and in-patient services at Community Health Care (CHC) and Primary Health Care (PHC) centers, satellite outreach clinics, Public-Private Partnership (PPP) model services with financial support to NGOs, technical and financial support to day care centers and residential centers, etc.
The Government of India bolstered efforts in mainstreaming mental health by passing the Mental Healthcare Act, 2017, which protects the rights of persons with mental illness including the Right to Mental Healthcare. The Act also clearly spells out that mental healthcare should be provided to all without any discrimination and in a manner that is acceptable to persons with mental illness and their families and caregivers.
Mental Healthcare of Marginalized Communities
People belonging to marginalized communities have their own unique challenges in accessing Mental Healthcare. Many among them belong to the lower socio-economic strata which affect their accessibility and affordability of mental healthcare. The provision of mental healthcare to these communities will require developing focus strategies to reach them and provide them quality mental healthcare.
For people with disabilities, Mental Health services may be provided through PPP mode with NGOs (a model already being used under NMHP) that already work with this group. Further, the Public Health facilities (CHC, PHC) should make efforts for creating a stigma and discrimination-free enabling environment for these communities to access services.
Similarly, for sexual minorities the Targeted Intervention Model (TI-NGO) used under the National AIDS Control Programme (NACP) may be useful to reach out to the communities. Recently, Integrated Transgender Clinics are also being set up under this programme and mental healthcare can be part of the service package.
UNDP India is also working with NIMHANS to develop holistic psychosocial support training modules on LGBTQIA+ community mental health for services providers. Apart from the Public Healthcare System, affordability is a major issue in the private sector. Therefore, medical insurance should cover mental illnesses as it covers physical illness. Section 21(4)A of the Mental Healthcare Act, 2017 mentions this and it is slowly being implemented.
Further, convergence with other relevant programmes e.g., Tribal Health Programme will be essential. Reaching the unreached communities with quality mental healthcare is critical to achieve Universal Health Coverage and to reach SDG 3 - Good Health and Well-being - by 2030.
Dr. Jayakumar C is Associate Professor, Center for Psychosocial Support in Disaster Management, NIMHANS, Bengaluru
Dr. Chiranjeev Bhattacharjya is National Programme Manager at Health & Governance Unit, UNDP India