Decrepit structure

The country has much ground to cover in caring for the mentally ill and urgently needs to upgrade its infrastructure in order to ensure universal access.

HYDERABAD, 30/12/2011: An attender taking mental challenged person into the high-security psychiatric ward of the Institute of Mental Health in Hyderabad on December 30, 2011. Police are on high alert after six prisoners from Cherlapally Central Prison undergoing treatment escaped after breaking through a window in the early hours. Photo: Mohammed Yousuf

FOR two decades now, India has been touted as the next big superpower and a sleeping giant that would shake up the world when it finally wakes up to its true potential. However, in the rush to achieve growth in gross domestic product (GDP) and wealth creation, many sectors that have a direct impact on public well-being have suffered from persistent state neglect. Mental health is one such. Thus, it is encouraging to see the government take proactive steps to remedy the situation, first by mooting the Mental Health Care Bill, 2013, which was passed by the Rajya Sabha recently. However, statistics from the World Health Organisation (WHO) and the National Sample Survey Organisation (NSSO) indicate that the country has a lot of ground to cover in terms of infrastructure, number of professionals and overall spending on health before it can guarantee universal access to mental health care.

For instance, India’s total expenditure on health as a percentage of the GDP has barely grown, from 4.3 per cent in 2010 to 4.7 per cent in 2014. Compare this to the Organisation for Economic Co-operation and Development (OECD), a grouping of advanced nations, where the average is about 9 per cent and the highest is 16.9 per cent for the United States. There are at least 10 members whose spending is more than 10 per cent, according to OECD Health Statistics 2016.

Also, in India the proportion of private expenditure is greater than state spending by a huge margin. Private expenditure accounted for 72.9 per cent of all health expenditure in 2010 and had slightly reduced to 70 per cent in 2014.

The country also scores low in terms of professionals in the mental health sector and availability of facilities, according to a WHO report from 2011. The numbers of psychiatrists, psychologists, nurses or social workers are much below one per one lakh people each, and the numbers of those undergoing training in such professions is even lower. For a country where the number of mentally ill runs into millions, the infrastructure is woefully inadequate, with just 43 mental hospitals and fewer than 28,000 beds in general and mental hospitals combined. The report also estimates that 62 per cent of all patients require care for less than a year, 24 per cent between one and five years, and 14 per cent for more than five years.

The NSSO’s 71st Round (January-June 2014) found that among the cases of hospitalisation, there were an average of 200 cases relating to psychiatric and neurological problems for every one lakh persons, and the average combined number of cases of mental retardation and mental disorders was combined 35. These figures indicate the enormity of the problem.