Mental Healthcare in Union Budgets
An analysis in light of the interim Union Budget 2024-25
The article for Tuesday is being published now, as the presentation of the interim Union budget was scheduled for today.
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It is a cliché that the governments do not make major announcements in an interim budget presentation. The interim budgets usually represent the continuity of the government’s ongoing schemes and priorities. As such, the common wisdom dictates that not much should be expected from an interim budget nor should it be analysed with as much scrutiny as the general budgets.
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However, if the budgets are vision documents of a government, then the interim budgets, as they come before the general elections, provide us with an opportunity to investigate how that vision was implemented during its term. So in this article, I will briefly analyse the budget allocations and expenditure under Indian government’s programmes related to mental health since 2019.
A not-much-discussed data point of the budget is the actual expenditure. The news providers often focus on the funds allocated for the next year, but skip the discussion about how much of the funds allocated in earlier budgets for the same schemes were actually spent by the government.
One reason for this phenomenon may be that the actual expenditure figures come two years later. For instance, the data for the budget allocations made in 2022 has been published in 2024. The expenditure details of announcements made in the 2024 budget will be provided in 2026, and on that day, as expected, the news providers will focus on the announcements made in the new budget.
But for better policymaking and implementation of programmes, it is important to scrutinise the actual expenditure data, along with the latest announcements.
For this analysis, I have taken data from the Financial Year (FY) 2019-20 through the current FY.
The Union government does not have a single, dedicated programme for mental healthcare. Rather, the allocations are made under different departments in different ministries. Hence, it can be difficult, sometimes impossible, to identify and track the funds allocated and spent on mental healthcare.
The major identifiable line items are the National Institute of Mental Health and Neuro-Sciences, Bengaluru (NIMHANS), Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur (LGBRIMH), Deendayal Disabled Rehabilitation Scheme (DDRS), Scheme for Implementation of Persons with Disability Act 2016 (SIPDA), National Action Plan for Drug Demand Reduction (NAPDDR), the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation [why do we still have this phrase?] and Multiple Disabilities, and National Tele Mental Health Program.
Before we dive in, let us define a few terms:
Budget Estimates (BE): the funds allocated to a department/ministry/scheme at the time of budget presentation (on February 1 every year)
Revised Estimates (RE): the allocation amount arrived after mid-year review, after taking into account the trend of expenditure, new requirements, etc
Actual Expenditure (AE): the funds actually spent by the government (figures usually available two years after the BE announcement)
Let us analyse these now:
Ministry of Health and Family Welfare
The following allocations have been made under the Ministry of Health and Family Welfare.
National Institute of Mental Health and Neuro-Sciences, Bengaluru (NIMHANS)
Leading mental healthcare institution of the country, NIMHANS has been allocated Rs 850 crores in the interim budget, up 17.87% from last year’s Rs 721.15 crores. Since 2019, the BE for NIMHANS has gone from Rs 450 crores to Rs 850 crores, showing an enhancement of 88.89%.
NIMHANS has consistently utilised all the funds allocated in the budget and even received more money from the government during all the last five years. Its RE and AE have always been higher than the BE during this period. During FY 2021-22, the actual expenditure of NIMHANS surpassed even the revised estimates.
In case you did not know, NIMHANS is currently undertaking the second National Mental Health Survey in all the states and UTs of the country. Check out the Survey website here.
Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur (LGBRIMH)
One of the oldest mental healthcare institutions in India, LGBRIMH is located in Tezpur town of Assam.
In the interim budget, it has been allotted Rs 60 crores, down 5.75% from last year’s Rs 63.66 crores. Despite increasing BE, RE and AE in between, its FY 2024-25 allocation of Rs 60 crores is still equal to that of FY 2019-20. It does not bode well for an institution to have the same amount of budget allocation even after five years.
On utilisation front too, LGBRIMH’s record does not inspire confidence. It actual expenditure has always been less than the budget estimates except for FY 2021-22.
Given the LGBRIMH’s standing as a premier institution of mental healthcare in India’s North East, the government should not only enhance its budget, but also encourage the institution authorities to fully utilise the allocated funds.
National Tele Mental Health Program (T-MANAS)
Announced in the Union Budget 2022-23, the T-MANAS was launched on 10 October, 2022 (World Mental Health Day). A toll-free, 24/7 helpline number 14416 has been set up under this scheme. NIMHANS is the nodal centre with T-MANAS cells set up in various states of the country.
The budget allocation for this programme for the FY 2024-25 is Rs 100 crores, down 25.22% from last year’s BE of Rs 133.73 crores.
Compared to budget allocations, the utilisation of funds under T-MANAS is quite little. In FY 2022-23, the utilisation percentage stood at mere 54.12%. The last year’s allocation of Rs 133.73 crores has also been revised down to Rs 65 crores, a decrease of 51.39%.
The government needs to look into the reasons for such high underutilisation of funds in T-MANAS and should take steps to ensure 100% actual expenditure.
Earlier, the government used to provide separate figures for the National Mental Health Programme (NMHP), but now it has been subsumed under the Tertiary Care Programme. It should be noted that the track record of fund utilisation under the NMHP and District Mental Health Programme has been extremely poor, which might be one of the reasons for removing the NMHP as a separate line item from the budget documents.
Moreover, the government does not provide allocations and expenditure data for the Central Institute of Psychiatry, Ranchi separately. These are part of the Establishment Expenditure of the Centre under line item Other Hospitals/Institutions.
Ministry of Social Justice and Empowerment
The following mental healthcare related allocations have been made under the Ministry of Social Justice and Empowerment.
Deendayal Disabled Rehabilitation Scheme (DDRS)
The Government of India runs a National Program for the Welfare of Persons with Disabilities including several schemes. Some of these are Deendayal Disabled Rehabilitation Scheme (DDRS), Scheme for Implementation of Persons with Disability Act 2016 (SIPDA), and the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. Although funds are spent on mental healthcare through these schemes, their exact amounts cannot be determined from the available data.
The Department of Empowerment of Persons with Disabilities runs the Deendayal Disabled Rehabilitation Scheme for, inter alia, the rehabilitation of the persons of persons with mental illness. It includes establishing half way homes, providing vocational training, reskilling, and counselling beneficiaries and families to facilitate integration into families and society/community.
For FY 2024-25, Rs 165 crores has been allocated for the DDRS, up 26.92% from Rs 130 crores last year.
The utilisation of funds under the DDRS has ranged from 63.98% to 91.75%, except for the FY 2019-20, when it peaked at 135.48%.
Scheme for Implementation of Persons with Disability Act 2016 (SIPDA)
Under this scheme, the Union government provides financial assistance to various bodies to, inter alia, provide barrier free environment for the persons with disabilities (PwDs), make government websites accessible to PwDs, establish skill development centres, run awareness campaigns, organise camps for issuance of disability certificates, provide pre-school training for children with disabilities, promote research and development activities in disability rehabilitation, organise sports events, and establish early diagnostic and intervention centres.
In the interim budget, the government has allocated Rs 135.33 crores for the Scheme for Implementation of Persons with Disability Act 2016, down 9.78% from the FY 2023-24 BE of Rs 150 crores.
The budget allocations for this scheme have consistently declined since 2019. The FY 2019-20 BE for SIPDA stood at Rs 315 crores, which has now come down to Rs 135.33 crores, amounting to a decrease of 57.04%.
SIPDA is also plagued by acute underutilisation of funds. The actual expenditure, as compared to the budget estimates, has ranged from a mere 27.28% in FY 2022-23 to 68.99% in FY 2019-20. Forget budget estimates, the actual expenditure under this scheme has never matched even the revised estimates.
The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities
The National Trust “works towards providing opportunities for capacity development of Persons with Disability and their families, fulfilling their rights, facilitating and promoting the creation of an enabling environment and an inclusive society.”
For FY 2024-25, the BE for the National Trust is Rs 25 crores, down 28.57% from the last year’s BE of Rs 35 crores. Over the last five years, the allocations have declined twice, increased twice and stayed the same once.
The utilisation of funds has ranged from 75.44% to 100%.
National Action Plan for Drug Demand Reduction (NAPDDR)
The NAPDDR has been started from the FY 2020-21 by subsuming two schemes National Policy for Prevention of Alcoholism and Substance (Drugs) Abuse, and Scheme for Prevention of Alcoholism and Substance (Drugs) Abuse. For comparison purpose, I have combined the data for both the earlier schemes for FYs before 2020.
The NAPDDR has the following objectives:
a) Drug demand reduction in the country by focusing on preventive education, awareness generation, identification, counseling, treatment and rehabilitation of drug dependent persons, training and capacity building of the service providers through collaborative efforts of the Central and State Governments and non-governmental organisations; and
b) Create awareness and educate people about the ill-effects of drugs abuse on the individual, family, workplace and the society at large and reduce stigmatisation of and discrimination against, groups and individuals dependent on drugs in order to integrate them back into the society.
In the interim budget, the government has allocated Rs 314 crores for the NAPDDR, almost same as the year’s BE of Rs 311.
However, this scheme is also marred by consistent underutilisation of resources. It’s AE, as compared to the BE, has ranged from just 34.97% in FY 2021-22 to 48.76% in FY 2022-23 to 56.08% in FY 2019-20.
Probably due to such low use of funds, the budget allocations for the NAPDDR (or the earlier equivalent schemes) declined between FY 2019-20 and FY 2022-23.
Other allocations related to mental healthcare also exist such as those to the Ministry of AYUSH, Rehabilitation Council of India, National Institute of Public Cooperation and Child Development (NIPCCD), and various health institutions with psychiatry and psychology departments. However, the data for the mental healthcare component is not available in such allocations and expenditures.
As much as the focus of the government should be on enhancing budget allocations for various schemes, emphasis should also be placed on the complete utilisation of the funds. Even new schemes like T-MANAS started with much fanfare are not fully utilising their allocations. A country with a treatment gap as high as 92% cannot afford underutilisation of even one percent.
The government should prioritise the implementation of the National Mental Health Policy 2014, the Mental Healthcare Act 2017 and the National Suicide Prevention Strategy 2022 by allocating adequate dedicated funds for them. Even after a decade, the goals of the 2014 Policy are at the starting point. Last year, the Parliamentary Standing Committee on Health and Family Welfare pointed out that most of the issues highlighted by the NMHS 2015-16 remained almost the same even in 2023.
The government does not provide sufficient data for many schemes related to mental healthcare. Mental healthcare sector has to deal with the hellish trinity of low budget allocations, gross underutilisation of funds and non-availability of required data. For ensuring the proper implementation and effectiveness of the schemes, the government should collect adequate data and make it available to the public for scrutiny and analysis.
A few institutions such as the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities, and the Rehabilitation Council of India are in need of urgent reforms. Even the legislations founding them need to be examined and revised.
As I have written elsewhere, a Minister of State in the Ministry of Health and Family Welfare should be made in charge of mental healthcare sector for the effective implementation of the schemes and programmes.
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