Its that time of the year again when the Honourable Finance Minister presents the Union Government’s spending and fund-raising plans for the coming financial year – popularly known as the
Even prior to the pandemic, there was an acute paucity of mental health services in India. The National Mental Health Survey in 2016 reported that nearly 70-80 per cent of those with mental illness in India received no treatment. This has probably exacerbated in during the pandemic.
Funding for mental health has traditionally been neglected in our health budgets. Over years, mental health sector received hardly 1 per cent of the funds allocated to the health sector, even though mental health problems probably account for almost 10 per cent of health-related morbidity and healthy years of lives lost to disease. Analysis of last year’s Union Budget by my Centre showed Rs 932 crores allocated to mental health, Rs 597 crores through direct funding to
In all fairness, the Finance Ministry can point out to the abysmal utilization of even the meagre funds allocated to the National Mental Health program (see Figure 1 below). Nearly 95 per cent of this meagre amount was returned unspent in the years 2018-2020. The revised estimates for 2020-21 were reduced by 30 per cent, presumably due to lack of uptake by the Health Ministry. It points to a serious implementation problem in the Health Ministry. Unless these are addressed, additional fund allocations are not going to result in an improvement in mental health services availability across the country. We also need to remember that Health is primarily a state subject and the States need to step up and increase funding for mental health in their State health budgets.
So what can the Finance Minister do? In the short term, the lack of absorptive capacity of the Health Ministry to utilize funds allocated to mental health presents a serious challenge. A sudden bolus of increased funding for mental health to the Health Ministry will not result in an improvement in mental health services tomorrow and will actually be counter-productive as the funds will be returned unspent as we have seen in the previous years.
The Finance Minister needs to take a more medium-term view and announce a plan of graduated increases in funding in the coming three to five years. Along with this, there is a need to build administrative capacity of the Health Ministry to utilize the funds. Over the next five years, the Finance Minister should ensure atleast 10 per cent of the Health Ministry allocation is spent on mental health (from the current 0.8 per cent). This can be easily done without cutting existing budgets for other health areas, by mandating a larger proportion of future health funding increases to go to mental health. The Finance Minister needs to also keep in mind the Mental Healthcare Act, 2017 which was legislated by this Government, has provisions for right to access mental healthcare from government health services and mandates Government to increase funding for mental health services.
In the immediate short term, many civil society organizations are actually better placed to provide mental health services in the community, as shown by programs run by Banyan, Ishwar Sankalpa, and my own organization in different parts of the country including Tamil Nadu, West Bengal and Gujarat. These programs have been highlighted by the World Health Organization (WHO) amongst 25 most innovative community programs in the world and work at the grassroot level. There is an opportunity to scale up these programs by exploring public-private partnerships with civil society organizations.
The Finance Minister should also look at areas where no additional funding is required but can dramatically improve the availability of affordable mental health services. For example, Ayushman Bharat scheme has 13 packages of care for mental health, but they are currently only available in public health hospitals, unlike other health packages which can also be delivered by private health providers. Expanding the coverage of these mental health packages to private mental health providers will increase access, without additional mental health fund allocation, as this could dip into the existing Ayushman Bharat funding pool.
Similarly, with children’s mental health, an additional thrust to mental health in the existing programs such as the Rashtriya Kishor Swasthya Karyakram (RKSK) might yield immediate dividends rather than setting up a separate child mental health program. Mental health is one of the 7 focus areas for community health workers at the Health and Wellness Centres (AB-HWC) and increasing allocations for the training of these community workers to provide effective mental health services can improve the accessibility of mental health services in rural areas.
(Dr Soumitra Pathare, is a psychiatrist by training and Director of the Centre for Mental Health Law and Policy at the Indian Law Society, Pune India. He was a member of the Policy Group which drafted India’s first mental health policy in 2014. His work spans the areas of mental health policy, scaling up community-based mental health services, suicide prevention and mental health legislation)