Conclusion First
This piece is the third piece of my trilogy on the state of mental health and its care in India on the eve of World Mental Health Day. I begin the concluding piece that is “An Open Letter to the Prime Minister Narendra Modi”, with my exhortation first-
“Dear Prime Minister, the time has arrived for India to have a separate fully empowered Ministry for Mental Health and Mental Well-Being. The time is now, and tomorrow will be too late.”
Make no mistake, the consequences of not doing it are truly horrendous and the result of the purposive action exemplary. It will enable the country to use the ‘whole mind of the nation’ for the first time and also take the country’s GDP closer to the cherished double digits.
I Rest My Case
Instead of re-establishing the case for why I say what I say, for the sake of brevity, dear Prime Minister sir, I will be grateful if you make the think tank in your office carefully scrutinise Part I and Part II of this trilogy ‘Rising Economic Cost of Mental Illness in India’ and ‘It is Time to Reboot Mental Health Care in India’ along with my earlier piece ‘Alzheimer’s: The Mind Stealer’.
It Will be the Culmination of Your Audacious Dream
Honourable Prime Minister, it is your government that on World Mental Health Day in 2014 unveiled India’s maiden National Mental Health Policy” And it was World Health Day in 2017 (April 7) whose campaign theme was depression, the President of India approved the enactment of audacious world best practices, rights-based Mental Health Care Act (MCHA), 2017 that was earlier passed by both Houses of Parliament unanimously. The provisions of the MCHA, 2017 were so revolutionary that it was lauded by the World Health Organisation (WHO) as a model statute worth emulating by the developed world and the reputed medical journal Lancet came out with a special editorial lauding it.
The establishment of a separate Ministry of Mental Health and Mental Well-Being, that too in the present term of your government, will be the next big step in the actualisation of your audacious dream that will change the lives of crores of mentally ill people of India. Else, I fear the National Mental Health Policy, 2014 and the Mental Health Care Act, 2017, may die prematurely in their infancy due to lack of implementation. They have already buckled on the altar of implantation.
It will be First Mover Advantage
By taking this bold step, Prime Minister Modi, you will put India on a high pedestal among with first mover countries in the world that today have a separate ministry to tackle mental illness. To put in perspective, Britain has Maria Caulfield as its Minister of State for Mental Health, in response to worrying figures on suicide, mental illnesses and social withdrawal, former Prime Minister of Japan, Yoshihide Suga appointed veteran politician, 71-year-old Tetsushi Sakamoto to the newly created post of ‘Minister of Loneliness’ in 2021 and in Australia, even the provinces have dedicated ministers in charge of mental health. Ireland also has Mary Butler, TD as Minister of State for Mental Health and Older People.
The Context is
It will not be out of context, Prime Minister, to mention here that the total number of mentally ill in India far exceeds the total population of the countries that already have dedicated ministries for Mental Health. Conservatively speaking, based on the pre-pandemic data of mentally ill in India cascaded to the present population, assuming that the incidence and severity of mental illness in the country has not gone up during and after the Covid-19 era, the total number of mentally ill in the country today is 20 crores. The number of our mentally ill is far higher than the total population of Japan, the UK, Australia and Ireland (12.57 crores, 6.73 crores, 2.57 crores and 50.3 lahks respectively), the countries which already have forged ahead with dedicated Ministry of Mental Health. Even our tiny Himalayan neighbour Bhutan has a Ministry of Happiness whose precise function is the mental wellness of its citizens.
Present Governance Paradigm Untenable
Honourable Prime Minister, I have had the fortune of being a member of Government of India Mental Health Policy Group that framed the maiden National Mental Health Policy, and have been involved in giving the final touches to the Mental Health Care Bill (that is now MCHA, 2017), have been an expert invitee to the panel that framed rules and regulations for MCHA, 2017 and was blessed to be an appointed non-official member of India’s first Central Mental Health Authority from 2019 to 2021.
The above-mentioned has given me a fair idea of the present official dispensation of mental health governance at the Government of India level. For the sake of brevity, I humbly posit that despite the humungous and fast-growing burden of mental illness in the country, the buck ends with a dedicated section officer in the Ministry of Health and Family Welfare. The ministry does not even have a dedicated joint secretary whose 24×7 job is mental health. The additional secretary who is the ex-officio chairman of the Central Mental Health Authority is so burdened with other responsibilities that he/she has no time to focus on this neglected subject. I as a Member of the Central Mental Health Authority was so disgusted at the complete nonfunctioning of the entity that I resigned from its membership in November 2021.
Prime Minister sir, the above-mentioned nonfunctional setup is sure recipe for disaster and in itself is reason enough that you create ‘Modi India Next Practices’ (India’s Next Practices was a term coined by Late Coimbatore Krishnarao Prahlad, world’s most reputed management guru after Peter F Drucker in his now classic speech India @75) to tame the beast thy name is Mental Illness in India.
Present Budgetary Allocation to Mental Health is Pittance
Ever since I became a student and researcher of mental health in the country, in the first decade of the current century, allocation to mental health in the union budget has never gone beyond one per cent of the total health budget and whatever the allocation is, it is largely distributed to the buildings and establishments of three mental health institutions run by the Central government NIMHANS, Bengaluru Central Institute of Psychiatry Ranchi and Lokpriya Gopinath Bordoloi Regional Institute of Mental Health Tejpur.
A case in point is the poor allocation of funds to the National Mental Health Program (NMHP) even in recent years. In the financial year 2019, the budget allocated to the NMHP was reduced from Rs 50 crore in FY18 to Rs 40 crore. In subsequent years, the total healthcare budget was increased by 7 per cent (FY20), 137 per cent (FY21) and FY222 and FY23 much more, but the funding for NMHP remained unchanged or marginally changed during budget and actually reduced during the final allotment. Prime Minister sir, I get shivers down to my marrows just thinking of how India, soon to be the world’s most populous country and the world’s third-largest economy, will solve one of its most pressing problems with such financial allocation.
Money not a Problem, Intent is
Honourable Prime Minister, however intractable the problem of mental illness, given the right intent, policies and focused action, I believe the money is going to be the least of the problems if the whole ‘mind of the Indian nation’ is put together.
If proof is needed, to my assertion, there are Tata Trusts which have already worked with NGOs and provided millions of dollars to change the lives and times of the mentally ill already. In recent years, the Mariwala Health Initiative has earmarked huge funds, especially with a particular focus on making mental health accessible to marginalised persons and communities. On April 1, 2023, social entrepreneur Rohini Nilekani, wife of Infosys Ltd co-founder Nandan Nilekani, gave a grant of Rs 100 crore to the ‘Centre for Brain and Mind’ at the National Institute of Mental Health and Neurosciences (NIMHANS) to speed up research and treatment into five major mental health disorders. Ajit Issac, chairman of Quess Corp, has donated Rs 105 crore to the Institute of Sciences (IISc) in Bengaluru for setting up a Centre for Public Health and Policy Research.
The Need for Financial Allocation is Huge But can be Met
The requirement of money on a recurrent basis to fight the menace of mental illness is huge but there is a tradeoff here, consensus estimate is that X$ investment in mental health brings 4X$ benefit to the national economy. And the above instances of corporate contribution to mental health need not be isolated cases. Trust me, Honorable Prime Minister, if you create a dedicated, non-fungible and non-lapsable ‘Prime Minister Mental Health Care Fund’, money will flow from all directions. When I was given the responsibility to raise money for India’s then flagship Konkan Railway project, ordinary citizens of the country gave money at Rs 1,000 per person.
Time to Move Mental Health to Concurrent List
While the Government of India in the last nine years has taken some salutary measures to combat the menace of mental health, unfortunately, health is part of List 2 State List, of the Seventh Schedule of the Constitution of India. And the performance of state governments whether in terms of allocation of resources or bringing desirable changes has been pathetic, to say the least. The magnitude of the problem is so huge that there is an immediate need to bring mental health to the Concurrent List and for the Government of India to give a performance-based allocation of resources to states on transparent parameters using carrot and stick policy. There is no easy way to wake up states from their deep slumber.
Postscript
Prime Minister sir, the creation of a separate Ministry of Mental Health is an inescapable first act. Mentally ill are India’s biggest, marginalised and most neglected and condemned minorities. Even today, the Constitution of India and most statutes “dub” severely mentally ill “persons of unsound mind” devoid of basic human rights. Notwithstanding the best practices Mental Health Care Act, 2017, the mentally ill in Indian society and most statutes remain “lunatics” and “insane” from whom the society has to be saved.
When will India, that is Bharat, Change Mr. Prime Minister? If you cannot bring the urgently needed chance and that too now, tomorrow will be too late and the generation next to the country will never forgive us. Let us get going and make the beginning with a separate Ministry of Mental Health and Mental Well-Being.
Akhileshwar Sahay is Principal Instigator of Whole Mind India Foundation dedicated to changing the life of mentally ill in India, Principal Instigator of Action Group-Mission Zero Suicide India. He was a member of Government of India’s Mental Health Policy Group and a past member of CMHA. Sahay has lived life with incurable mental health condition bipolar disorder. He works as President, Advisory Services of Consulting Company BARSYL. Views expressed in the above piece are personal and solely that of the author. They do not necessarily reflect News18’s views.
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