A plea to set up a medical wing dedicated to mental health care either in Trichy Central Prison or Madurai Central Prison recently prompted the Madras High Court to voice concern over the prioritisation of mental health in India (KR Raju v. State of Tamil Nadu and ors).
Noting the negligible budget allocation of mental health, the low ratio of psychiatrists, and statistics indicating that one in seven people suffer from mental illness in India, the Bench of Justices N Kirubakaran and B Pugalendhi impleaded various ministries to respond on whether there is a need to increase the mental health infrastructure in the country.
There is no sufficient budgetary allocation for the mental healthcare which is required to be increased as one among seven persons is suffering from mental health disorders.
Madras High Court
“It is shocking to note that India is the most depressed country in the world”, the Court observed on Friday, adding that the prevalence of mental illness is said to have doubled in the past ten years.
“When such is the given situation on the mental health front, only a very negligible amount is being allotted and spent towards mental health”, the Court added.
The Bench further took note that India’s mental health care budget in 2018 was stated to be around 500 million rupees, which was reduced to 400 million rupees the following year. Media reports indicated that only 50 million rupees was actually spent on mental health, it was observed.
“The amount spent on mental health comes to 33 paisa for mental health patient, given the number of 150 Million people requiring urgent care. It is reported in Parliament in March 2020 that a sum of 48 Crores Rupees only has been spent on mental health in the year 2018-2019, which approximately comes to Rs.2.40/- per patient in a year or approximately, 20 paisa per month per patient”, the Court remarked further.
Added to this, only 9,000 psychiatrists or one psychiatrist for every 1 lakh people were said to be available, while three for every 1 lakh were required. There is a shortage of 18,000 mental health doctors or psychiatrists, the Court observed, adding that India requires about 2700 new psychiatrists every year.
“That apart, only 49 child psychiatrists take care of children of the entire country”, the order notes.
Despite the enactment of the Mental Healthcare Act, 2017, sufficient awareness programmes have not been conducted, the Court opined. The taboo/social stigma attached to persons with mental illness prevents people from receiving proper treatment as well, it stated.
“The people should be sensitised that mental disorder is like any other normal disease which is required to be treated, failing which, dangerous consequences would follow.”
Further, only physical health is taken care of under medical insurance, the Bench voiced concern.
Moreover, it was highlighted that there was only one mental health research centre in the country i.e. the National Institute of Mental Health and Neuro Sciences (NIMHANS). The Court opined,
“Every zone should have an institution like, NIMHANS. Similarly, psychiatry is not a subject in all the medical colleges and hence, psychiatry should be introduced in every medical college as the requirement of psychiatrists is more. Similarly, only a negligible number of mental hospitals are stated to be functioning in the country and for 130 Crore of population, more number of mental health care centres have to be established by the Central Government as well as by all the State Governments… In regular intervals, surveys of the prevalence of mental disorders across India have to be conducted and appropriate remedial measures have to be taken.”
It is the need of the hour to have a Psychiatry Department in every District Headquarters Hospital and a Psychiatrist in every Taluk Level Hospital.
Madras High Court
Given that rehabilitation is an essential component in psychiatric treatment, the Court also suggested that community-based rehabilitation should be encouraged in India.
The Court has now called for responses to various queries on these issues, including, among others, the following:
- Does the Government conduct mental health surveys? If so, when was the last survey conducted?
- Are there enough mental health hospitals are available in India?
- Whether the Government should increase the number of Institutes offering psychiatry/psychology in higher studies?
- Is it a fact that only 50 million rupees have been spent for mental healthcare in 2019?
- Why shouldn’t the Central Government increase the allocation of funds towards mental health, especially, when one in seven persons of the population of the country is stated to be suffering from mental illness?
- What are the steps the Government has taken to establish the rehabilitation services?
- What is the status of insurance coverage of mental illnesses?
Questions have also been asked regarding the prevalence of mental health issues in the country and for the setting up of NIMHANS in all four zones of the country.
Why not the Central Government establish premier Institutes, like, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, in each Zone of the country, namely, North, East, West and Central?
Madras High Court
Notice was issued to the Union Ministries of Finance and Health, the Medical Council of India, the University Grants Commission, NIMHANS and the Indian Psychiatric Society.
The matter is expected to come up next on December 12.