Budget 2020 & India’s Mental Health Crisis: Gaps and Expectations
What does budget 2020 need to promise for India’s mental healthcare?
As we await the upcoming budget and all that it will hold for the country of billions, there are particular sectors that are especially concerned and hopeful. Healthcare, and within it, mental healthcare, deserves a special mention.
The mental health expenditure by the Union Government is less than 0.5% of its total health budget, which itself is marginally above 1% of India’s Gross Domestic Product.
To get this into perspective, compare the 1.15 percent health budget with some international numbers. The U.S. spends 17.5 percent of its GDP on healthcare, while Switzerland follows with a close second of 12.25 percent. France and Germany spend 11.45 and 11.27 percent respectively.
So the question that naturally follows: Is India spending enough on healthcare, and in particular, mental healthcare?
1 in 7 People in India Suffer From Mental Disorders
In 2017, 197.3 million Indians (14.3% of the total population) were suffering from mental illnesses. Of these, 45.7 million had depression and 44.9 million had anxiety disorders, according to a study published in Lancet Psychiatry.
The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990.
This rising proportion has, unfortunately, not been accompanied by a parallel rise in the budget allocation for mental illnesses.
For the fiscal year 2019-20, former Finance Minister Piyush Goyal had announced a Rs 61,398 crore budget for the health sector — a 16 percent increase from 2018-19’s Rs 52,800 crore. This was also the highest in the previous two financial years.
But did mental healthcare experience the same trend? On the contrary, the National Mental Health Programme saw a reduced allocation from Rs 50 crore the previous year to Rs 40 crore for 2019-20.
What We Have V/S What We Need
The Mental Healthcare Act (MHCA) passed by the government in 2017 was seen as a welcome step in the direction of catering to the millions of Indians needing assistance. It looks to protect, promote, fulfil the rights of persons with mental illness (PMI) and puts the onus on the state to provide affordable mental healthcare to its citizens.
A review article ‘Cost estimation for the implementation of the Mental Healthcare Act 2017’, published in the Indian Journal of Psychiatry, estimated the conservative annual estimated cost on the government to implement MHCA to be Rs 94,073 crore rupees.
Rs 94,073 crore compared to the allocated Rs 40 crore.
The stark contrast is alarming, and the fact that the budget allocation has seen a reduction from 2018 to 2019 suggests a worrying trend.
But the National Academy of Psychology India (NAoP) is hopeful. In its statement on budget 2020, it calls upon the government to increase the expenditure on mental health to Rs 50,000 crore. Ajay Gulzar, member of the social policy committee at NAOP, told FIT, “While this is still not the amount we truly need, starting with Rs 50,000 crores is a step closer.”
The statement mentions several gaps that need to be filled in India’s mental healthcare space — substantiating the need to raise the allocated amount to a considerable extent.
- The abysmally low investment in training of mental health professionals and building facilities in all parts of the country has led to an enormous treatment gap of over 90%.
- There is an immediate necessity of a significant public sector investment in improving mental health services at the level of primary health centres, training and employment of psychologists, and creating awareness about psychological illnesses.
- For better effectiveness and to make the sector a priority of the government, a Minister of State in the Ministry of Health and Family Welfare should be in-charge of the mental health matters.
- The longstanding demand of an independent, statutory National Psychology Council to oversee and regulate the education, training, and practice of psychology in India. A recommendation to establish such an authority was also made by UGC Expert Committee on Model Courses in Psychology in 2016.
- The need for adequate representation of psychologists in the proposed Allied and Healthcare Council of India. Their exclusion would lead to a singular focus on medical and related specialties and neglect of students and practitioners from ‘Behavioural Health Sciences’ category.
- While speaking to FIT, Gulzar adds the requirement of focusing and investing more in the research and development of psychology and mental health.
“Therefore, it is the need of the hour that the Government outlay on mental health grows multi-fold from a miniscule Rs 40 crore allocation to National Mental Health Programme in Budget 2019-20”, the statement reads.
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