It has taken long in coming, but the union health ministry finally released India’s first official National Mental Health Policy last week. The policy, which is to be followed by a "Mental Health Action Plan 365" for implementation, has been hailed as progressive and radical for a country that has for long had a poor record on mental health.
In India, where general public health services are often insufficient, inaccessible and of low quality, mental health has been particularly sidelined. According to the World Health Organisation’s Mental Health Atlas of 2011, India spends less than 1% of its total health budget on mental health. It also faces a severe shortage of mental health professionals, with one psychiatrist for every 3.4 lakh people.
In this context, the National Mental Health Policy is far-sighted and ambitious in its objectives and approach.
1) It emphasises the need for greater funding While making a case for expanding mental health budgets, the policy states, “Spending on health by the government is not expenditure but a social investment and a social right.” It also recognises the fact that mental health is linked to many other aspects of life, and thus recommends allocation of funds not just to the government’s health department but also to other sectors such as social welfare, school education and women and child development.
2) It identifies vulnerable groups The policy acknowledges that some populations are especially vulnerable to mental health ailments, and must not be discriminated against in the provision of services. The policy document contains a comprehensive list of these different groups, which include the poor (who are linked with mental illnesses in a “negative vicious cycle”), the homeless (who have “no provision for care and support”), persons in custodial institutions (who face a “deprivation of personal liberty”), orphans, children, the elderly and people affected by emergencies and various natural or man-made disasters.
Notably, the policy also lists as vulnerable people who are “internally displaced” – migrants from rural to urban areas who work in the unorganised sector – and people from marginalised groups like sexual minorities, sex workers or victims of human trafficking.
3) It puts the focus on care-givers Acknowledging that family members are the main care-givers of the mentally ill in India, the policy aims to give families access to information and guided access to special services. “Families bear the direct financial costs of treatment as well as associated indirect costs such as loss of wages,” it states. “The emotional and social costs of providing care for a family member with mental illness cannot be quantified but exacts a huge toll on families.”
4) It focuses on the promotion of mental health In addition to the treatment of mental illnesses, the policy also stresses the need to prevent such problems and promote mental health. It places the onus of such promotion on early childhood care itself, by targeting anganwadi centres for children below six years of age.
The policy aims to train anganwadi workers and school teachers to help parents and care-givers understand the “physical and emotional needs of children to facilitate and affirmative and positive environment” for their growth. It also proposes teaching mandatory life skills education in schools and colleges that, among other things, includes discussions on issues of gender and social exclusion.
5) It seeks to decriminalise suicide: To bring down rates of suicide in India, the policy talks of setting up crisis intervention centres, training community leaders to recognise risk factors, restricting access to means of suicide and also framing guidelines for responsible media reporting of the issue. More importantly, however, the policy officially aims to decriminalise attempted suicide, which is currently a much-debated punishable offence in India.
For mental health professionals across the country, the policy is welcome step towards improving treatment of mental ailments in India. “The crucial thing now is implementation, and the Action Plan to be announced by the government will add value to the policy,” said Dr. Nimesh Desai, director of the Institute of Human Behaviour and Allied Sciences in Delhi.
Desai believes it is commendable that the policy goes beyond treatment of mental illness to prevention and promotion of mental health, but hopes that the Action Plan keeps Indian cultural contexts in mind while implementing policies for prevention and promotion. “While talking about policies for treatment of mental ailments, there is reasonable uniformity in approach,” said Desai. “But when it comes to personality development and seeking happiness, the Action Plan must keep cultural aspects in mind.”
In India, where general public health services are often insufficient, inaccessible and of low quality, mental health has been particularly sidelined. According to the World Health Organisation’s Mental Health Atlas of 2011, India spends less than 1% of its total health budget on mental health. It also faces a severe shortage of mental health professionals, with one psychiatrist for every 3.4 lakh people.
In this context, the National Mental Health Policy is far-sighted and ambitious in its objectives and approach.
1) It emphasises the need for greater funding While making a case for expanding mental health budgets, the policy states, “Spending on health by the government is not expenditure but a social investment and a social right.” It also recognises the fact that mental health is linked to many other aspects of life, and thus recommends allocation of funds not just to the government’s health department but also to other sectors such as social welfare, school education and women and child development.
2) It identifies vulnerable groups The policy acknowledges that some populations are especially vulnerable to mental health ailments, and must not be discriminated against in the provision of services. The policy document contains a comprehensive list of these different groups, which include the poor (who are linked with mental illnesses in a “negative vicious cycle”), the homeless (who have “no provision for care and support”), persons in custodial institutions (who face a “deprivation of personal liberty”), orphans, children, the elderly and people affected by emergencies and various natural or man-made disasters.
Notably, the policy also lists as vulnerable people who are “internally displaced” – migrants from rural to urban areas who work in the unorganised sector – and people from marginalised groups like sexual minorities, sex workers or victims of human trafficking.
3) It puts the focus on care-givers Acknowledging that family members are the main care-givers of the mentally ill in India, the policy aims to give families access to information and guided access to special services. “Families bear the direct financial costs of treatment as well as associated indirect costs such as loss of wages,” it states. “The emotional and social costs of providing care for a family member with mental illness cannot be quantified but exacts a huge toll on families.”
4) It focuses on the promotion of mental health In addition to the treatment of mental illnesses, the policy also stresses the need to prevent such problems and promote mental health. It places the onus of such promotion on early childhood care itself, by targeting anganwadi centres for children below six years of age.
The policy aims to train anganwadi workers and school teachers to help parents and care-givers understand the “physical and emotional needs of children to facilitate and affirmative and positive environment” for their growth. It also proposes teaching mandatory life skills education in schools and colleges that, among other things, includes discussions on issues of gender and social exclusion.
5) It seeks to decriminalise suicide: To bring down rates of suicide in India, the policy talks of setting up crisis intervention centres, training community leaders to recognise risk factors, restricting access to means of suicide and also framing guidelines for responsible media reporting of the issue. More importantly, however, the policy officially aims to decriminalise attempted suicide, which is currently a much-debated punishable offence in India.
For mental health professionals across the country, the policy is welcome step towards improving treatment of mental ailments in India. “The crucial thing now is implementation, and the Action Plan to be announced by the government will add value to the policy,” said Dr. Nimesh Desai, director of the Institute of Human Behaviour and Allied Sciences in Delhi.
Desai believes it is commendable that the policy goes beyond treatment of mental illness to prevention and promotion of mental health, but hopes that the Action Plan keeps Indian cultural contexts in mind while implementing policies for prevention and promotion. “While talking about policies for treatment of mental ailments, there is reasonable uniformity in approach,” said Desai. “But when it comes to personality development and seeking happiness, the Action Plan must keep cultural aspects in mind.”
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