Only on a Thursday afternoon will you find the department of psychiatry in the basement of Mumbai’s Cooper Hospital empty. On a normal weekday, Dr Devraj Sinha, the HOD and the only permanent doctor in the department is occupied dealing with 80-100 patients in a span of 4-5 hours.

"I’m the only one handling the OPD (Outpatient Department). Recently, I recruited a lady doctor on contract basis because the hospital is not filling the vacant positions in the department," said Sinha, after his weekly round of the in-patient ward, which can only happen on Thursdays due to the volume of patients he has to attend to on other days of the week.

It's no different in the city’s other public hospitals, namely, KEM Hospital, JJ Hospital, GT and Sion Hospital. “Where there should be ten doctors for 100 patients, there are only two doctors. This situation is not just in public set-ups of the city but across the country,” says psychiatrist Dr Sagar Mundada, who has been a part of the city’s top public medical institutions and now runs a private facility.

Lack of funding

What lies at the root of this problem is the shortage of funds allocated to mental health in India. In the financial year 2019, the budget allocated to the National Mental Health Programme (NMHP) was brought down to Rs 40 crore from Rs 50 crore in FY18. And the funds actually spent were only about Rs 5 crore each during the years.

Budget 2020 has not increased the allocation for NMHP, even though the total healthcare budget saw a 7 per cent increase. “The budget allocated for mental health is 0.05 per cent of the total healthcare budget. The average percentage of the total healthcare budget allocated to mental health in developed countries is at least 5 per cent," said Dr Mundada.

The conservative annual estimated cost on the government to implement the Mental Healthcare Act, 2017 would be Rs 94,073 crore, according to a study by the Indian Journal of Psychiatry . However, the actual current spending is not even a fraction of the figure.

Sector outlook

The MHCA (Mental Health Care Act) guarantees every affected person access to mental healthcare and treatment from services run or funded by the government, and the government shall make sufficient provisions as may be necessary, for a range of services required.

One of its main objectives is also to make inclusion and rehabilitation of mentally ill persons into the society and elimination of the stigma attached to mental illness. Dr Devraj Sinha expressed the system's attitude towards mental health by citing an example. If the cardiology department, for instance, asks for funds for a transplant, they get cleared the next day. However, if the psychiatry department asks even for medication, that does not fall under the ambit of the free medication provided by the government and there is no response for days. “How will the patient afford this medication, the treatment then gets stuck.”

There is a lack of awareness of mental health related issues in India. According to a study, only two out of every 10 affected people actually seek medical help. "There is a shortage of doctors for the already affected patients; to expect trained paramedical staff and social workers to spread awareness and provide counselling seems far-fetched," said Dr Sinha. The sensitisation of patients and their families to the mental condition also requires trained human resources.

Morbidity costs

“The most common mental health and related issues like depression, anxiety and addiction are the highest contributors to productivity loss. It might not cause immediate death but it leads to morbidity,” said Dr Mundada. A person having mental health conditions may not be fit or able to get employment, which ultimately leads to productivity loss. The cost incurred by the government due to such productivity loss is actually more than it would have to spend to kickstart the mental health sector, according to an Indian Journal of Psychiatry study.

Due to the gap in the Budget allocation and the actual spending on the sector, the fundamental issues related to improving mental health in a the country are overshadowed by the immediate measures to solve the problem. Where there should be counselling and sensitisation as the first steps, medication is used; this is due to the lack of mental health professionals to carry out these tasks.

“A change of attitude towards mental health, an investment push, government backed awareness campaigns, primary mental health treatment in government’s wellness centres and sanctioning of more psychiatry seats in government colleges are some of the immediate steps that can be taken to start solving the issue,” said Dr Mundada.

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