Mental Health in Union Budget and Election Manifestoes: Two Petitions

The Government and political parties should give mental health due importance in next year's budget and legislative assembly elections.

It was World Mental Health Day a few days ago, which, among other things, served as an opportunity to repeat several truths which have become clichés. One of the clichés is that Indian governments do not fund the mental healthcare sector adequately. Another is that our governments do not even fully spend the minuscule budget allocations. The Union government repeatedly saying ‘there is no data’ to any question has become another truism. There is another platitude that we do not have adequate mental health professionals, infrastructure, and affordable and accessible mental healthcare services in our country. 

World Mental Health Day was introduced in 1992. Two years later, World Federation for Mental Health commemorated it with a specific theme for the first time: ‘Improving the Quality of Mental Health Services throughout the World.’ Twenty-five more themes later, our concern remains the same: how to improve the quality of mental health services? Actually, in India, we have to go one level down: how to provide mental health services of any quality at all? Because more than one hundred crore — a number so large that you won’t even bother reading it correctly: 1000000000 — Indians do not have affordable access to any mental health service. Therefore, along with quality, it is a quantity issue. 

The Union Ministry of Finance has started the process of preparation of the 2022-23 Budget. Moreover, the legislative assembly elections are going to be held in five states — Goa, Manipur, Punjab, Uttar Pradesh, and Uttarakhand — in February/March next year. They present us with two opportunities: lobby with the Government to increase the budget allocations for the mental health sector and ask the political parties to include mental health in their election manifestoes.

I am starting two petitions: one to the Government of India to increase expenditure on mental health and another to political parties to include mental health promises in their manifestoes for upcoming legislative assembly elections. Following is the text of these petitions:

Increase the allocation for mental health in the upcoming Union Budget 2022-23

The Government of India should increase the expenditure on mental health to at least Rupees ten thousand crores in the Union Budget 2022-23. While the Government has brought multiple progressive laws, including the Mental Healthcare Act 2017, the abysmally low public investment in mental health has led to an acute shortage of mental health professionals and an enormous treatment gap of over 90%. The mental health expenditure by the Union Government is less than 1% of its total health budget, which itself is marginally above 1% of India’s Gross Domestic Product.

The Global Burden of Disease Study estimated that about twenty crore Indians suffer from mental disorders, i.e., one in every seven persons. A budget of Rupees ten thousand crores would amount to Rs 500 for every person living with mental illness, or at the population level, it would be Rs 71 for every Indian. Not a huge amount, but it would be a significant improvement from the current budget of about Rs 7 per Indian.

Improving psychological wellness is also an objective of the United Nations Sustainable Development Goals (SDGs). The SDG Target 3.4 seeks to “reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being” by 2030. Target 3.5 aims to “strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.”

The meagre government spending on mental health in India has led to a shortage of services for people with psychological disorders. There is an immediate necessity of significant public investment for improving mental health services at the level of primary health centres, construction of infrastructure, adequate training of mental health professionals including increasing the number of seats, hiring mental health professionals at every level, enhancing funding for research, creating awareness about mental illnesses, and implementation of the Mental Healthcare Act 2017 and the National Commission for Allied and Healthcare Professions Act 2021. Therefore, the government outlay on mental health must grow multi-fold. Moreover, for better effectiveness and to make the sector a priority of the Government, a Minister of State in the Ministry of Health and Family Welfare should be made in charge of the mental health matters.

In her 2021-22 Budget address, Finance Minister Nirmala Sitharaman spoke about nutrition, water supply, Swachh Bharat, clean air, and even vehicle scrapping policy under ‘health and wellbeing’ but did not mention mental health at all. Let us hope that in 2022, our mental health will become as important as old vehicles.

You can sign this petition here.

Political parties should include mental health provisions in election manifestoes

While the Parliament has passed several laws related to mental health, the primary responsibility of implementation falls on the state governments. The Global Burden of Disease Study estimated that about twenty crore Indians suffer from mental disorders, i.e., one in every seven persons. Despite good laws, we lack access to affordable, acceptable, and quality mental health care. The rights-based approach enacted on paper has to be followed by evidence-based implementation.  

The proposals which a government executes usually originate in an election manifesto. Five states — Goa, Manipur, Punjab, Uttar Pradesh, and Uttarakhand — are holding legislative assembly elections in February/March next year. Therefore, it is an opportunity for all political parties to include mental health provisions in their manifestoes and convey that our mental health matters. As a beginning, the following points are being suggested for inclusion in the manifestoes:

1.     Allocation of at least ten percent of the state’s health budget to the mental health sector every year

2.     Implementation of the National Mental Health Policy 2014 in letter and spirit

3.     Implementation of the Mental Healthcare Act 2017, including the establishment and operationalisation of State Mental Health Authority and Mental Health Review Boards

4.     Implementation of the Rights of Persons with Disabilities Act 2016, including the simplification of the disability assessment and certification process, adequate disability pension, job reservation & opportunities, and access to specialized work training

5.     Recruitment of registered mental health professionals in Primary Health Centres, Community Health Centres, and Civil Hospitals

6.     Increase seats and provide training programs for mental health professionals in all state medical colleges

7.     Ensure 100% expenditure of allocations under Government of India’s District Mental Health Programme, and

8.     Address social inequalities to reduce the risk of mental health issues

You can sign this petition here.

Mental health is a profession of a few rays of hope in vast swathes of darkness. Every year, we hope that finally, the Government of India will pay attention to mental health in this budget. Every year, the government disappoints, and the cycle continues. Let us see if our governments and political parties would listen to us this time or old cars would remain more important than our mental health.

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