The Hollowness of “Reach Out To A Mental Health Professional” Advice In India
The advice is infructuous in a nation which has only 5% of the required clinical psychologists.
Medium
The tragic death of young actor Sushant Singh Rajput has once again brought into public attention — even if it is for a few days — the importance of mental health. Everyone was understandably shocked by the tragedy, which resulted in outpouring of tributes and sharing of his memories. Almost immediately, people started talking about mental health and urged others to seek help in case of psychological struggles. Two important messages were often repeated: (a) talk to someone and (b) reach out to a mental health professional. I am focusing on the latter one here in this article since without trained professionals, a healthcare system and a healthy society simply do not exist.
The advice to seek a mental health professional is a vital one and needs to be repeated as much as possible, especially in a country like India where psychological issues come with stigma and awareness regarding them remains abysmally low. However, I would like to humbly submit that in India, more often than not, the suggestion to consult a professional is at best ignorant and at worst tone-deaf. I say so for two reasons:
(a) there is an acute shortage of mental health professionals in the country, rendering the suggestion infructuous as one doesn’t have a professional to go to, and
(b) where available, counseling, therapy and medicines are expensive. A single factor lies at the heart of both the reasons: our governments’ expenditure on mental health is negligible.
The Government of India runs a National Mental Health Programme (NMHP) “to ensure the availability and accessibility of minimum mental healthcare for all” with a particular focus on “the most vulnerable and underprivileged sections of the population.” However, the expenditure under NMHP is so little that Harshita Rathore, in an article in The Diplomat, wrote that “the amount spent is comparable with what Indian billionaire Mukesh Ambani makes in just 3 hours, or a day’s expense of a trip abroad by Indian Prime Minister Narendra Modi, or barely the cost of a Rolls Royce car. It is also almost half the one-day cost of running a parliament session, or one-100th of what the government has spent on promoting the Clean India Mission.” In case you are still wondering, the allocation was Rs 5 crore only (2019–20 Revised Estimates). For a population of 1.38 billion!
With mental health expenditure by Union Government being less than 0.5% of its total health budget, a huge part of burden is shared by non-governmental organizations, individual professionals and patients themselves. Even during the CoViD-19 pandemic, hundreds of mental health professionals and many organizations have come forward to provide their services free of cost to those facing psychological problems. Moreover, the insignificant public spend has resulted in the severe scarcity of mental health workforce with an enormous demand-supply gap. Considering a conservative desirable number of three clinical psychologists per one lakh population, we need about 41,400 such professionals to cater to 1.38 billion Indians. In reality, there are fewer than 2,000 clinical psychologists in the country and only about 328 seats for aspirants this year (with more than 40% of them in the private sector). With the demand and number of seats staying unchanged and with the zero percent attrition rate of psychologists, it would take 120 years to fill in the gap between demand and supply! Similarly, there are only 9,000 psychiatrists in India against the required number of 36,000, whereas annual seats in psychiatry are only around 700.
While the shortage of mental health professionals ensures that the treatment remains inaccessible for over 90% of Indians, it is prohibitively expensive for most of those who can find a psychologist or psychiatrist near them. A few sessions with a psychologist, consultation with a psychiatrist and the high cost of medicines can easily set someone back by thousands of rupees each month. In a country, where the per capita income is only Rs 11,254, very few people can afford the cost of the treatment. Although the Mental Healthcare Act, 2017 mandates that the insurance companies cover mental illness on the same basis as physical illness, the provision is mired in confusions and has not been implemented properly. Moreover, as it is almost impossible to find a right professional to seek help, there is no point having insurance for something for which the treatment is not easily accessible.
Therefore, the fundamental requirement of the hour is a significant government investment to improve mental health services at the level of primary health centres, to train and employ psychologists, conduct more research, and create awareness about psychological issues. In a statement (drafted by this author) released before presentation of 2020 Union Budget, the National Academy of Psychology (NAoP) had demanded “to increase the expenditure on mental health to Rs fifty thousand crore” during the current financial year, but the allocation was again a minuscule Rs 40 crore under National Mental Health Programme.
Hence, it is vital that for “reach out to a mental health professional” advice to become a reality for everyone and not just remain a privilege for the selected few, we must demand that our governments enhance expenditure on our mental health substantially. This is something which should become an election issue. From the NAoP statement quoted earlier, I reiterate that “for better effectiveness and to make the [mental health] sector a priority of the Government, a Minister of State in the Ministry of Health and Family Welfare should be in-charge of the mental health matters.”
While it is appreciated that many of the mental health professionals and organizations are offering free counselling and therapy services nowadays, it is also a fact that Indians should not have to depend on the kindness of a psychologist to seek treatment free of cost. It should be guaranteed by our governments.
If you have suicidal thoughts or need mental health assistance, you may contact BMC mental health helpline 022–24131212 (24×7); iCall (TISS): 022–25521111 (8 a.m. to 10 p.m., Monday to Saturday); Indian Association of Clinical Psychologists: 08047192224 ((9 a.m. to 9 p.m.); Vandrevala Foundation: 18602662345/ 18002333330 (24×7); and The Samaritans Mumbai: 8422984528/ 8422984529/ 8422984530 (3 p.m.- 9 p.m. all days). For more state wise helpline numbers, please visit http://aasra.info/helpline.html.
Ajay Gulzar currently works with a member of Parliament and is a former LAMP Fellow.