Mental health: Multi-stakeholder ecosystem of Philanthropies, civil society and public sector required
If we are to move towards better mental health outcomes in India, it will not be possible without a multi-stakeholder approach. Ideally, such an approach should include varied actors, including the government, civil society and philanthropy
The National Mental Health Survey (NMHS) 2016 stated that 150 million Indians were in need of active intervention for mental health issues. This roughly constitutes 15% of all adults in the country. Yet! Alarmingly, less than 30 million had ever sought mental health care.
A further analysis of the data shows us that approximately 80% of those living with psychosocial distress or mental health issues remain without support due to lack of access.
Additionally, the majority of the state-led mental health programs and activities are fragmented, disorganised, and suffer from low implementation priority. These findings present a grim picture of not just the magnitude of the issue, but also, the inability of the existing ecosystem to provide access to reliable and affordable mental health care for all.
Multi-stakeholder approach necessary
If we are to move towards better mental health outcomes in India, it will not be possible without a multi-stakeholder approach. Ideally, such an approach should include varied actors, including the government, civil society and philanthropy.
The Union Budget for 2021-22 had only allocated ‘0.81% of the budget for the Ministry of Health & Family Welfare (MoHFW) directly for mental health.’ The existing allocation of funds towards mental health is grossly insufficient considering the magnitude of the issue at hand. These gaps in funding can in part be filled by philanthropic initiatives in the country.
Philanthropists should build their understanding on mental health beyond conversations on stigma and discrimination while entering the domain. This is because provision of mental health services is as important as creating awareness and encouraging conversations on mental health.
Whether a philanthropic initiative works in education, livelihood generation, water sanitation & hygiene (WASH), care for the elderly, climate justice, and more; they can include a component of mental health service delivery in their existing projects.
While philanthropy can play a role, responsibilities of duty-bearers cannot be forgotten. The MoHFW needs to implement the Mental Healthcare Act (MHCA) 2017 effectively and in its full spirit.
For example, according to the MHCA, every state should have a State Mental Health Authority (SMHA); yet in reality, only some states have set these bodies up. Poor implementation of programmes such as the District Mental Health Programme (DHMP) set up as part of the National Mental Health Programme to decentralise mental health care provisions leads to fewer trainings of relevant officials including law enforcement and mental health, on implementation of the Act, as well as, lack of supervision over mental health establishments and lack of grievance redressal in provision of services.
The NMHS (2016) ‘found a majority of the states surveyed had less than 50% of their population covered by the DMHP’. Additionally, since its inception there have been no mechanisms in place for ‘service users and caregivers to participate in the design of the DMHP or governance, delivery or monitoring and evaluation.’
As a result there are no spaces for the community to question inadequate or improper functioning of the DMHP.
The state governments should urgently address this gap to create participatory processes to make room for inputs from the community as well as civil society organisations working in these areas.
CBOs (Community- Based Organisations) and NGOs are a vital link in this ecosystem of provision of mental health care. They have strong linkages with the communities they serve and are best placed to understand the unique stressors of the members of the community.
For instance, lack of/poor access to education, health, sanitation services, poverty, climate-induced displacement, livelihood insecurity all contribute to mental health issues in communities.
Given these relationships, they need to also prioritise building a perspective on mental health care and include mental health service delivery within their own focus areas/projects. The mental health component of their work should comprise of services that centre the needs of the community members and are provided with a rights-based approach.
The service delivery should be conducted in a sensitive and empathetic manner keeping in mind cultural appropriateness and creating a safe space for all.
Building a robust and inclusive mental health ecosystem is a marathon, not a sprint. It requires sustained periods of investment, effective implementation of existing policies and laws as well as creation of community-based mental health services that are culturally appropriate, accessible and sustainable.
The author is lead of New Initiatives, Mariwala Health Initiative
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