Mental Health Emergency Amid COVID Is Not On India's Priority List, Budget Is An Example

In September 2020, nearly 8 months after India reported its first case of COVID-19 in Kerala, the country launched the 24x7 Toll-Free Mental Health Rehabilitation Helpline KIRAN (1800-599-0019), the first mental health helpline. The helpline, available in 13 different languages, aims to provide relief and support to persons with mental illness in view of the growing incidence of mental illness, particularly in the wake of the pandemic.

This toll-free helpline is operational 24 hours a day, seven days a week with the support of national and state institutions, and is backed by 660 clinical/rehabilitation psychologists and 668 psychiatrists. The 13 languages covered in the helpline are: Hindi, Assamese, Tamil, Marathi, Odia, Telugu, Malayalam, Gujarati, Punjabi, Kannada, Bengali, Urdu, and English.

The helpline is aimed at providing mental health support to people who are facing anxiety, stress, depression, suicidal thoughts or have any other mental health concerns.

The majority of callers ¨C around 75 percent ¨C were made by people between the age of 15 to 40 years and around 18 percent were made by people between the age of 41 to 60 years. 40.32 percent of calls came from North India while 27.08 percent of the calls were from Western India. Southern India made 16.99 percent of the calls followed by 11.28 percent of calls from the East and 4.33 percent from the North East.

The report also states that 65.9 percent had milder nature of distress while 26.5 percent were moderately distressed and 7.6 percent were severely distressed. There is no information on how these distinctions were made and how does one measures the state of the distress exhibited by a person.

From the calls that were made to the helpline, around 32 percent of the callers were students while 15.2 percent were self-employed, 27.1 percent were employed, 23.3 percent were unemployed, 1.4 percent were home-makers and 0.7 percent did not reveal their employment status.

Operators were told not to ask callers for their name or any identification details and calls into question how this information was available to be collated.

Nearly 78 per cent of calls were made to help themselves, some calls were made to find out how the callers could help their family members and others.

Seeking mental health services

Between September 2020 to January 2021, India's KIRAN helpline received 13,550 calls, of which 70 per cent were men between the age of 15-40, with nearly 32 per cent of them being students.

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Speaking to Indiatimes, a young entrepreneur, who wishes to remain anonymous, said that the calls he made to the national mental health helpline remained unanswered. "After calling the helpline a couple of times and no one answering the call, I turned to private professional help, which is burning a hole in my pocket, but I also cannot ignore my mental health."

He added that some of his acquaintances did receive help from government toll-free helplines and actually benefitted from it. "I was among the unlucky ones," he adds.

A 39-year-old chef, who wishes to remain anonymous, told Indiatimes that she finds private professional help more reliable while being expensive. The woman, who lives in Mumbai with her mother, was quite distressed after her father passed away during COVID. "My father's death hit me hard. My mother is old and it sometimes feels difficult to manage work and household, but I'm not complaining. I try to give my mother as much support as she needs, but I have experienced my mental health dipping over the course of the pandemic. I sought private help while knowing that free mental health services also exist," she says.

"I believe it's more hassle-free, since seeking mental health help is a long process and change is not seen overnight. It is a commitment. There has to be a connection between your therapist and you. Anyone can't be your therapist, you need to know them ad they need to know you to be able to help you," she adds.

India's mental health budget over the years

Mental illness can affect one¡¯s emotional, psychological, and social well-being. Seeking help is a positive step, it enhances health, well-being, and happiness. India has one of the world¡¯s highest suicide rates, and it only got a national helpline just a little over one year ago.

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, according to a report by The Hindu.

Budget 2020 did not increase the allocation for NMHP, even though the total healthcare budget saw a 7 per cent increase. The budget allocated for mental health was only 0.05 per cent of the total healthcare budget -- this was India in its first year of the pandemic. The average percentage of the total healthcare budget allocated to mental health in developed countries is at least 5 per cent.

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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.

The Budget 2021-22, proposed a corpus of Rs 71,269 crore for the Ministry of Health and Family Welfare. This included the budget for mental healthcare ¨C a total of Rs 597 crore.

However, only seven percent of the mental health budget was allocated for the NMHP; while a majority of it had been set aside for two institutions: Rs 500 crore for the Bengaluru-based National Institute of Mental Health and Sciences (NIMHANS) and Rs 57 crore for Lokpriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur.

Overall, the budget for the NMHP had remained the same as 2020 ¨C Rs 40 crore.

The government announced the Tele Mental Health Policy -- taking into account the severe impact of coronavirus pandemic on mental health, as it enters the third year of the pandemic -- on February 1, 2022.

In 2022-23, the budget estimate for the health sector is Rs 86,200.65 crore ¡ª a 16.59 per cent increase compared to 2021-22 budget estimate.

This year¡¯s budget takes forward the announcements made last year in the backdrop of the strain on health systems experienced during the pandemic.

The development comes in the backdrop of growing scientific evidence that mental health sequels post-coronavirus infection.

Significantly, the national digital health mission has been allocated Rs 200 crore, compared to just Rs 30 crore allocated in the previous Budget.

Lurking under the shadows, the mental health pandemic in India

Amid an ongoing battle against the coronavirus pandemic, the importance of mental health is quickly being accentuated and spoken of. It has exacerbated mental health issues in the country. The physical isolation to which the population has been subjected, added to the fear of the immediate effects of the virus on health, has been two of the main triggers.

Economic woes, COVID misinformation, and distressing news around COVID have also contributed to worsening mental health.

In October 2021, a study in Lancet reported a 35 per cent increase in mental health problems in India.

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In the same month, a UNICEF survey found that ¡°around 14 per cent of 15 to 24-year-olds in India, or 1 in 7, reported often feeling depressed or having little interest in doing things¡±, exacerbated, among other things, by the ongoing school and college closures.

In November 2021, the government's National Crime Record Bureau (NCRB) annual report showed suicides in India increased by an alarming 10 per cent in 2020 during the pandemic ¨C nearly 400 Indians died by suicide each day in 2020.

Even before the pandemic, there was an acute shortage of mental health services in India. The National Mental Health Survey in 2016 reported that nearly 70-80 per cent of those with mental illness in India received no treatment.

Considering the existing conditions, mental health in India is an often-ignored subject, one that is also surrounded by massive stigma.

Mental health is only now widely talked about but there¡¯s a long way to go to give the attention it deserves. And with the pandemic still wreaking havoc, the crisis is only getting wider and deeper. Mental health services are only going to grow as more and more people understand mental health and are ready to seek help.

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