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India's mental health policy

IBEF, Knowledge Centre

Jan 21, 2021 19:42

Overview

Mental wellness is a major health concern worldwide. Mental health includes a person’s emotional, psychological and social well-being. It encompasses a wide range of issues, from clinically diagnosed mental disorders to substance abuse and addiction. Globally, ~800,000 people die by suicide each year (1 death in every 40 seconds), while over 264 million people (of all ages) suffer from depression.

Months of fighting a pandemic has drawn attention to the importance of mental health and India’s approach towards an often-ignored health issue. According to the WHO, at least 57 million people in India are depressed—the highest in the world. By 2030, the mental health crisis is estimated to cost India a trillion dollars in productivity losses. There are huge gaps in the preventive and curative care of these mental disorders. For instance, in India, mental health workforce comprises <4,000 psychiatrists. While the total healthcare budget increased by 7% in 2020, there was none in the budget for the National Mental Health Programme (the allocated amount is only 0.05% of the total healthcare budget). Current spending on implementing provisions of the Mental Healthcare Act, 2017, is a small proportion of the conservative estimate of 94,073 crore.

Mental Healthcare Act, 2017
The Mental Healthcare Act was passed in April 2017 and implemented from May 2018. The act effectively decriminalised attempted suicide, which was punishable under Section 309 of the Indian Penal Code. The law was described in its opening paragraph as an act to provide for mental healthcare and services for people with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto." This act superseded the former Mental Health Act, 1987.

The act ensures healthcare for people suffering from mental illnesses through government-funded health services. It decriminalises suicide, disallows sterilisation and solitary confinement of mentally unwell patients. The act entails setting up the Central and State Mental Health Authorities for training medical professionals. It also mandates insurance companies to provide mental health insurance.

Innovative Mental Health Programmes
In the last few decades, innovations have helped address gaps in the mental health service delivery in India. The innovative approach not only makes mental health services more accessible and affordable, but also empowers by encouraging community members in early detection & prevention of mental illnesses and appropriate treatment referrals. Most innovations can be broadly categorised into the following:

 

Categories

Innovations

Quality improvement in mental health programmes

Use of WHOQR tool in Gujarat

WHO's mhGAP in Kashmir

Mental healthcare pilots in Gujarat

Early interventions for psychosis in Tamil Nadu

Integration of mental healthcare models with primary and community care

Community-based mental health programmes

A community-based rehabilitation programme for psychotic disorders in Madhya Pradesh

Community mental health initiative in Tamil Nadu

Community-based mental health intervention for women in Karnataka

Community-based intervention for people with schizophrenia and their caregivers

Community mental health development projects in India

Dava–Dua project in Gujarat

Non-specialist mental health programme

Atmiyata Intervention in Maharashtra

Low-cost model for improving healthcare services in Kashmir

Health Activity Programme delivery by lay health counsellor in Goa

Lay health counsellor for brief psychological intervention in Goa

Programme for Improving Mental Healthcare (PRIME) in Madhya Pradesh (India) and four other countries

Mobile technology-based mental health programmes

Mh2: Mobile for mental health in Gujarat

Systematic Medical Appraisal, Referral and Treatment (SMART) mental health project in Andhra Pradesh

Digital technology (text and phone) for treating and preventing mental disorders in LMIC (including India)

Tele-mental health programmes

Tele-psychiatry in Chennai, Tamil Nadu

Mobile tele-psychiatry in Pudukkottai, Tamil Nadu

Tele-mentoring programme—NIMHANS ECHO in Chhattisgarh

 

Corporate Scenario
The pandemic has also brought mental well-being to the forefront, even at workplaces in India. However, only 1,000 companies are estimated to have a structured employee assistance programme (EAP) for mental health, out of 1.1 million active registered companies, according to Optum Health International (a leading EAP service provider under the Minnesota-based UnitedHealth Group).

An EAP typically includes both preventive (workshops & awareness programmes on mental health) and counselling services (telephonic, face-to-face or online chat) for employees and their families.

Mental health disorders have a significant impact not only on the health of individuals and communities, but also pose economic challenges for corporates in terms of productivity losses. The WHO points out that for every $1 invested in treating common mental disorders, there is a $4 return in improved health and productivity; hence, it makes sense for corporates to foster employee mental wellness—not just from an ethical perspective, but also economical.

With a sizable population working from home, some corporates are making efforts to create a safe environment for employees to freely talk about their worries and anxieties. Many of them offer free counselling services through tie-ups with external service providers. Corporate houses such as JSW Group, Capgemini India and Mahindra & Mahindra have EAPs including free counselling to employees and their families. Oyo, Uber, Google, Mondelez, American Express and Panasonic are a few companies in India providing similar services. According to Optum Health International, the number of companies seeking EAP or mental health programmes has increased by 45–55% YoY.

Preventive measures that can be taken by corporates:

  • Protect Work–Life Balance
    Policies for flexible hours, teleworking, care leave and last-minute day off can help ease the combination of working and caring. Beyond these policies, promotion of work life–balance in an organisational culture: respect regular working hours and safeguard leisure and family time.
  • Combat Stigma
    Promote a workspace that encourages positive mental health and has zero tolerance for stigmatisation. Train HR personnel and managers on how to promote mental health in the workplace.
  • Celebrate Awareness Days
    Share a message on days such as World Schizophrenia Day, World Mental Health Day and World Suicide Prevention Day to support colleagues dealing with mental health issues in their daily lives.
  • Start the Conversation
    Do not wait till awareness days to start a conversation about mental health. Speaking up about your own story related to mental health sends the strongest message that it’s safe for others to open up too.
  • Communication is the Key
    Regularly inform your employees on services available for them. Do you have someone in HR for emergency mental health calls? Does your company’s health insurance plan cover access to services and care? Let them know.

The Road Ahead…
Given the rising incidences of mental health issues, corporates must have mental health policies. Only a few companies are found to be practicing it at present. Such policies should entail creating awareness or reducing stigma around mental health as well as providing access to mental health services. Interventions should be designed as part of an integrated health and well-being strategy including prevention, early identification, support and rehabilitation. Corporates should foster healthy lifestyle practices including exercise, proper nutrition, work–life balance and yoga & meditation that are known to improve mental health.

India is gradually moving towards the mental health epidemic; hence, it is important for corporates to support employees and invest in programmes for emotional well-being. Corporates will play a crucial role in our society’s overall mental well-being as much of our time and energy is spent in the workplace. The workplace is often the source of stress, but it can also be the source of solution.

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