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Let’s make mental health equitable

Post by on Saturday, October 9, 2021

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If ever there was a need to affirm our commitment to mental health, it is today, on the 30th anniversary of mental health day. Thirty years back when Richard Hunter thought of telling the world that there is no health without mental health and he proclaimed 10th October as mental health day to focus the world’s attention on improved care for mental health issues.
The ongoing pandemic has exposed human’s fallibility and frailty in times when he truly thought he is on top of nature’s pyramid. He thought he has seen it all and conquered it all. The fiction of our times has become our reality. We are living in times when fiction has become real and reality has been redrawn.
But to our advantage, fear is as old as humans and perhaps this ‘emotion’ is
responsible for our survival on earth in face of dangers of death and devastation. To be fearful is normal and fear is universal this time, the most prevalent emotion at the moment and has been so for years immemorial in times of disaster. It helps us to calibrate our responses and survive. We should have it in appropriate doses to help us overcome this crisis as well. We, as culture, have faced such life-threatening situations innumerable times whether it was trauma of conflict, earthquake, floods, snowstorm etc.
By doing what we are doing at present, that is self-isolating, distancing socially, we are trying to survive with minimal mortality and morbidity and inshallah that will help us preserve our mental health as well. But there will be times when there will be people who will demand support from mental health services and the question is, is that at offer? Is that reachable? These are the questions we need to ask this mental health day.
This year’s theme – as announced by the World Federation for Mental Health (WFMH) is “Mental health in an Unequal World”.
This theme was chosen by a global vote including WFMH members, stakeholders and supporters because the world is increasingly polarized, with the very wealthy becoming wealthier, and the number of people living in poverty still far too high.  
This theme, chosen for 2021, will focus on the fact that access to mental health services remains off balance. Between 75% to 95% of people with mental disorders in low- and middle-income countries are unable to access mental health services, while access in high income countries is also not sufficient.
What contributes to the mental health treatment gap is the lack of investment in mental health disproportionate to the overall health budget.
The 2021 World Mental Health Day campaign ‘Mental Health in an Unequal World’ will enable us to take measures to reduce inequalities and encourage practitioners to share what they know about mental health inequality and practical ideas to confront and stop it.   
Many people with a mental illness do not receive the treatment that they are entitled to. They continue to experience stigma and discrimination. The gap between the ‘haves’ and the ‘have nots’ grows more extensive and there is continuing unmet need in the care of people with a mental health problem.
Research evidence shows that there is a deficiency in the caliber of care provided to people with a mental health problem. It can take up to 15 years before medical, social and psychological treatments for mental illness that have been shown to work in good quality research studies are delivered to the patients that need them in everyday practice.
The stigma and discrimination experienced by people who experience mental health issues not only affects that person’s physical and mental health, it also affects their educational opportunities, current and future earning and job prospects, and also affects their families and loved ones.  This inequality needs to be addressed and should not be allowed to continue. We all have a role to play to address these disparities and ensure that people with lived experience of mental health are fully integrated in all aspects of life. 
People who experience physical illness also often experience psychological distress and mental health difficulties. An example is visual impairment. Over 2.2 billion people have visual impairment worldwide, and the majority also experience anxiety and/ or depression and this is worsened for visually impaired people who experience adverse social and economic circumstances.
The Covid-19 pandemic has increased inequalities in human development, including dealing a double whammy to mental health by causing more incidence of mental disorders and disrupting already limited mental health services.
We need to act, and act imperatively.
The 2021 World Mental Health Day campaign ‘Mental Health in an Unequal World’ will enable us to focus on the issues that perpetuate mental health inequality locally and globally.
Given the magnitude of the challenge, our response is inadequate. India’s health budget is low and even lower budget line is earmarked for mental health.  The government’s total expenditure on mental health is about Rs 600 crore, including Rs 40 crore for flagship National Mental Health Programme (NMHP).
The low budgetary allocation is reflected in the state of our human resources. The total number of mental health professionals (government and non-government) is 25,312. The total number of mental health workers per 1,00,000 population is 1.93.  The mental health workforce (rate per 1,00,000 population) comprises  psychiatrists (0.29), other specialist doctors (0.15),  mental health nurses (0.80),  psychologists (0.07),  social workers (0.06),  occupational therapists (0.03) and other paid mental health workers (0.36).
Even these scarce resources are under increased pressure due to the pandemic. The disease, death of kith and kin, and loss of income have caused mental health conditions or aggravated pre-existing conditions, even in some cases causing a spike in substance abuse.
As far as UT of J&K is concerned, it has with the help of National Mental Health Programme worked on pyramid of care, at the apex of which is the erstwhile Government Psychiatric Diseases Hospital. This has been upgraded to Institute of mental health and Neurosciences Kashmir – Centre of Excellence under the scheme A of National Mental Health Programme and is currently the primary driving force behind the mental healthcare in the UT of J&K.
There has been an increase in the manpower in mental health over the period of last 20 years because of the establishment of MCI recognised department at Institute of mental health and Neurosciences which produced psychiatrists, clinical psychologists that not only served the department at IMHANS but percolated down to the other medical colleges and district hospitals of JK providing the necessary critical skill base for running the mental health services. 
However, there is a need for budget enhancement at the Institute of mental health and neurosciences, Kashmir with provisions for all new facilities including the general hospital Unit SMHS which houses the De-addiction centre, child psychiatry unit, consultation-liaison facility and General Psychiatry OPD.
There is a need for Phase B funding for the Institute of mental health and Neurosciences from the UT government as till now entire funding has been from the central government and the program period has ended in March 2021.
One of the best things which has happened is availability of a huge capital of mental health professionals whose expertise needs to be utilized and bridge the treatment gaps further with evidence-based intervention methods and measures.
While I think that we are firmly on way to better and equitable mental health care what we lack at this time is facilities providing long-term rehabilitative care as has been pointed by the Supreme Court as well. Lack of half way homes and long-term care facilities for addiction patients and homes providing Dementia care need to be set up at earliest 
Accessing Mental health is a basic right of all citizens let us work towards making mental available accessible and acceptable and foremost let us make it equitable.

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