Priyambada Kashyap
(priyambadakashyap.47@gmail.com)
As individuals, the well-being of both ourselves and our loved ones is a constant pri- ority in our lives. It doesn’t matter which age, ethnicity, race, class, or caste we belong to; we universally regard our health as the cornerstone of our existence. Therefore, when we face poor health, it can disrupt our ability to engage in everyday activities. It might prevent us from attending school or work, fulfilling our family obligations, or actively participating in our community.
Human rights are the compasses that guide us towards a more just and equitable society, and the right to health is a prominent human right. But despite evidence that there cannot be health without mental health, nowhere in the world does mental health enjoy parity with physical health in terms of budgeting, or medical education and practice. According to the World Health Organization, one in four people worldwide will experience a mental health condition in their lifetime. According to the ‘Global Burden of Disease Study 1990–2017,’ 19.73 crore Indians, or one in every seven, suffer from a variety of mental problems. The theme for this year’s World Mental Health Day is thus ‘Mental health is a universal human right’.
In a world that often measures progress in economic terms, we must remember that the true measure of a just society is how it cares for its most vulnerable members, including those struggling with mental health issues. Mental health is a human right because it is essential for our well-being and our ability to live full and productive lives. When we are mentally healthy, we can better cope with stress, manage our emotions, and make healthy decisions. We can also build strong relationships, contribute to our communities, and reach our full potential.
The right to mental health is enshrined in international agreements like the Universal Declaration of Human Rights. Article 25 of this declaration recognizes the right to health, including mental health, as a fundamental human right, the right to mental health includes the right to accessible and affordable mental health care, treatment with dignity and respect, freedom from discrimination and violence, participation in decision-making about one’s own care. Furthermore, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) explicitly acknowledges the rights of people with psychosocial disabilities. This includes the right to live independently, be included in the community, and access mental health services without discrimination.
However, the recent years, especially in the wake of a global pandemic has made us aware of just how crucial our mental health is to our overall wellbeing. India, like many nations, has started to realize the importance of mental health. However, we must also recognize the challenges that still exist, particularly in the context of insurance policies, budget allocations, and the treatment gap in mental healthcare.
Insurance policies in India, like those in many other countries, have traditionally treated mental health as a secondary concern. In the past, insurance providers often discriminated against individuals seeking coverage for mental health treatment, creating a financial barrier for those in need. Only a small percentage of the population has mental health insurance and those who do often have to pay high deductibles and out-of-pocket costs. This makes it difficult for many people to afford the care they need. Fortunately, there has been a positive shift in recent years, with regulations mandating that insurance policies include mental health coverage. This is a significant step forward, signaling the recognition of mental health as a human right.
The overall budget for mental health has increased by 14% in the 2023-24 financial year compared to 2022-23. The budgetary provisions for mental health services have witnessed a 16% rise in funding across the two centrally funded mental health institutions and the National Tele-Mental Health Programme (T-MANAS). The budget for mental health remains a fraction of the overall healthcare budget, even though mental health disorders are among the leading causes of disability worldwide. We must recognize that mental health is not a luxury; it’s a necessity.
Moreover, alongside these issues, we must also address the glaring treatment gap in mental healthcare in India. The treatment gap refers to the disparity between the number of people who need mental health services and those who actually receive them. In India, this gap is alarmingly wide. Millions of individuals suffering from mental health disorders are left without access to the care they desperately need. The treatment gap is a stark reminder that while we have made progress in recognizing mental health as a human right, much work must be done. We must expand mental health services, particularly in underserved areas, and work to reduce the stigma surrounding mental illness. We must ensure that mental health services are not only available but also culturally sensitive and inclusive, reaching even the most marginalized communities. Most of us don’t even know that we have certain rights when it comes to our mental health, and the state has the obligation to ensure that these rights are protected.
A comprehensive health care system does not include only physical but also mental health facilities. A primary health centre does not need only physicians but also psychologists and social workers. Tele Manas, the digital arm of the District Mental Health Programme launched in October 2022, has been a welcome step in bridging the treatment gap in the country. T-MANAS is a two-tier system that includes trained counsellors as first-line service providers at Tier 1 and mental health professionals at District Mental Health Programmes (DMHP) at Tier 2 to provide secondary-level specialist care. Referral services are also available for in-person or audio-visual consultations via e-Sanjeevani, the MoHFW’s national telemedicine initiative.
However, the number of mental health professionals in the country still remains glaringly low. India has 0.75 Psychiatrists per 100,000 population, while the desirable number is anything above three Psychiatrists per 100,000. Moreover, the Ministry of Health and Family Welfare reported to the Lok Sabha in 2018 that the country possesses a mere 898 clinical psychologists, which falls significantly short of the required number of 20,250. Similarly, the number of psychiatric nurses stands at a meagre 1,500, failing to meet the demand of 30,000.
In conclusion, mental health is a human right that must be upheld within the context of insurance policies, budget allocations, and the broader human rights framework. An important point to be noted is that we also need to take a more holistic approach to mental health care. This means addressing the social and economic determinants of mental health. Mental health is as much psychosocial as it is biological. Modern societies have led to newer psychosocial issues (and some older ones rebranding as new problems) like social isolation, work-life imbalance, climate change, social and political unrest, and rising inequality. We need to promote mental well-being by creating supportive communities and fostering resilience. By doing so, we not only improve the lives of individuals but also move closer to building a society that genuinely values the dignity and well-being of all its members. Mental health is not a privilege; it’s a human right, and it is time we treat it as such.