By Siddhartha Mitra
Mental health remains a major issue in India, especially since the focus on it has increased after the Covid-19 pandemic outbreak and its subsequent impacts. What are the challenges ahead of improving mental health in India?
In recent years there have been some salutary changes in regard to mental health policy in India. In 2018 the Mental Health Act was passed. This legislation decriminalized suicide and thereby paved the way for effective rehabilitation of those whose emotional distress causes them to attempt suicide. It also proscribed discrimination at the workplace against those suffering from mental disorders. Further, mental illness came under the ambit of medical insurance for the first time and an intention was declared to tackle the stigma associated with mental illness.
However, some important challenges remain. First, the treatment of mental illness is usually associated with expenses that are destabilizing for most households. Consider the recent study by Jeetendra Yadav, Shaziya Allarakha, Denny John and other authors on the impoverishment caused by mental illness in India. The study uses data from the 76th round of the National Sample Survey, held in 2018, in which 6,679 households each self-reported a person with mental illness.
The study found that the average amount spent by such a household on healthcare was Rs. 2,115 a month, a fifth of the average household expenditure. These constitute the direct cost of mental illness: the amount spent on treatment, medication and travel to hospitals. There are also significant indirect costs: monetary loss due to loss of productivity and psychic costs in terms of stress and stigma.
Due to the significant direct costs of mental illness, the study reported that about 21% of the affected households dropped below the poverty line. The literature on the economics of mental health reports a strong association between poverty and common mental disorders (CMD). CMDs refer to depressive and anxiety disorders. According to the WHO, around 8% of the world’s population suffers from these disorders.
The association may be explained as follows: Poverty is often associated with emotional distress and leads to CMDs. On the other hand, CMDs are associated with productivity loss and high healthcare expenditures which plunge households into poverty. Once people fall below the poverty line the synergy between poverty and emotional distress can keep people both afflicted and poor.
How do we tackle this simultaneous occurrence of impoverishment and mental distress? Self-help groups that involve the participation of CMD patients and get credit from the banking sector can alleviate poverty as well as make CMD patients feel better by contributing to the income of households through their productive efforts.
The government can help in the early identification of CMDs by expanding the infrastructure for the treatment of mental illness. Note that the National Mental Health Programme has a budget allocation of only Rs. 40 crores. Private sector provision of mental healthcare is also not sufficient. There are only 9000 practicing psychiatrists in India according to the Indian Psychiatric Society. This translates to only 0.75 psychiatrists per lakh of the population instead of the recommended 3. Thus, the country needs at least 27,000 more psychiatrists.
Increased government participation in the mental wellness sector is not just required from a social justice perspective. It will also be rewarding from an economic viewpoint: those who are afflicted with mental disorders but are self-employed will earn more due to higher productivity and reduced absenteeism at work; employees in various enterprises who get afflicted will be able to perform better at work, thus enhancing the income of enterprises. Thus, government investment in the mental health sector will be characterized by a healthy return in terms of enhanced gross domestic product and will result in an increase in tax revenues.
To put the whole issue in perspective, we need to look at the overall magnitude of the mental health problem in India. According to the National Mental Health Survey of 2016, 14% of the population suffers from mental disorders and 70-80% of the suffering population receives no care. Once the mental healthcare infrastructure is expanded, early identification and treatment of mental disorders can be greatly facilitated, thus greatly reducing costs arising out of delayed treatment and those borne by the economy in terms of person-days lost.