Several investigations have revealed a deterioration of mental health concerns among people of all ages since the commencement of the Covid-19 epidemic. Michele Mary Bernadine investigates the situation of mental health in India, the economic burden of the mental health problem, and the extent to which legislation and current State capability are ready to manage this issue in this post.
In 2017, India’s President, Ram Nath Kovind, declared that the country was “on the verge of a mental health crisis.” According to one research, 14 percent of India’s population suffered from mental health problems in the same year, with 45.7 million suffering from depressive disorders and 49 million suffering from anxiety disorders.
The Covid-19 epidemic has exacerbated this mental health catastrophe, with reports from throughout the world indicating that the Virus and accompanying lockdowns were having a severe impact on the populace — particularly on young people.
LEGISLATION AND CONSTRUCTION CAPABILITY OF THE STATE
The Mental Healthcare Act of 2017 has numerous clauses aimed at improving India’s mental health. The Mental Healthcare Act of 1987 is repealed by this Act, which was criticised for failing to recognise the rights and agency of persons suffering from mental illness (Mishra and Galhotra 2018). This involves establishing Central and State Mental Health Authorities (SMHA), which would focus on constructing solid infrastructure, including the registration of mental health practitioners and the implementation of service-delivery guidelines. Although the Act requires states to establish an SMHA within nine months of the Act’s passage, only 19 of the 28 states had done so as of 2019.
In accordance with WHO recommendations, the National Mental Health Programme (NMHP)2 was established in 1982 to provide mental health treatments as part of the general healthcare system. Although the initiative has been effective in increasing community access to mental health treatment, resource restrictions and a lack of infrastructure have restricted its impact (Gupta and Sagar 2018).
Only a few states had a specific line item in their budgets for mental health infrastructure as of 2021. 3 Budget projections for the NMHP increased from Rs. 3.5 million in 2017-18 to Rs. 5 million in 2018-19 after the Act was passed in 2017. This number, however, was cut to Rs. 4 million in 2019-20 and has stayed at the same level in succeeding years – even in 2021-22, when various studies have suggested a worsening of mental health difficulties amid the Covid-19 epidemic. Emerging evidence suggests that during the Covid-19 pandemic, women have higher levels of psychological stress than the urban poor (Afridi et al. 2020), and households with migrant workers in rural areas – who were particularly hard hit by the lockdown restrictions – have a higher incidence of mental health issues than those without migrants (Sarin et al. 2021). The lockdowns also had a significant impact on students, who had to adjust to a new learning medium and setting, as well as raised fears about their future prospects. During the epidemic, the government launched ‘Manodarpan,’ an online portal featuring an interactive online chat option, a list of mental health practitioners, and a hotline number to give psychological assistance to students.
Developed nations spend 5-18% of their yearly healthcare expenditure on mental health, while India spends just 0.05%. (Organization for Economic Co-operation and Development, 2014). The yearly budget for 2018 and 2019 included funding for the National Institute of Mental Health Rehabilitation. The institution was established in 2018 with the goal of increasing human resource capacity and doing research in the field of mental health. Furthermore, the government yearly sponsors the Lokopriya Gopinath Borolo Regional Institute of Mental Health and NIMHANS, all of which are under the Ministry of Health and Family Welfare. Although NIMHANS claims to offer inexpensive and accessible mental healthcare to all individuals in need, these efforts remain regionally isolated because the organisation is based in a single city (Bengaluru). Initiatives like the NIMHANS Centre for Well Being, which offers low-cost therapy sessions from experienced experts, would be a big help if they were spread to additional regions around the country, but their influence is now restricted to an urban metropolis.
After the implementation of the Act, the Economic Survey of India has yet to address mental health in a substantive manner, with the only mention of mental health in this period being a cursory reference in the context of information asymmetry in healthcare and changes in the approach to medicine during the Covid-19 pandemic (Economic Survey 2020-21). In contrast to the President’s remark in 2017, the administration has recently refused to accept the severity of mental health illnesses in India as approaching a “pandemic.” Questions in parliament about efforts to improve mental health for specific demographic groups (for example, the elderly) elicit a standard response – referring to NIMHANS initiatives to improve general mental health and the NMHP/DMHP – with no mention of any targeted interventions or plans to do so. Recognizing the scope of the problem would be the first step in addressing the country’s mental health crisis. According to an Indian Psychiatry Society poll, 20 percent more individuals have suffered from poor mental health since the start of the Covid-19 epidemic.