New Delhi, September 13
Eight years after the macabre incident of Erwadi in Tamil Nadu, where 28 fettered mentally-ill inmates of a private asylum were charred to death on August 6, 2001, India is yet to learn its lessons, with mental health facilities in the government sector still painfully negligible.
In the latest National Mental Health Programme (NMHP) document which sets the tone for future strategy in the sector, government admits to a treatment gap of over 50 per cent in case of severe mental disorders. This gap increases to 90 per cent if common mental disorders are also included.
If that was less, 60 per cent of the districts in the country, by government’s admission, have no mental health treatment facility at all. “When we say there is no facility, we mean there is no hospital or mental health professional,” say health ministry sources.
The current human resource shortage in the sector is alarming - being a whopping 97 per cent for psychiatric social workers and 74 per cent for psychiatrists.
Where the country needs 11,500 trained psychiatrists for its mental health programme, it has only 3,000. Clinical psychologists are short by 9,000 and psychiatric social workers by 8,800.
The situation being that grim, there appears little political will to expand the programme at the district level. Enquiries made by The Tribune reveal that over 70 applications for district mental health programme from severely deficient districts have been pending for over a year for want of approval. The NMHP document makes a reference to the matter and says, “Applications for expansion of district mental health programme need to be cleared at the earliest.”
Urgency apart, the District Mental Health Programme expansion proposal has been pending for clearance for over a year now at the levels of the Planning Commission and Finance Ministry’s Expenditure Department.
It is learnt that last year the health ministry had forwarded to the Plan panel and Expenditure department a 1000-crore proposal for the expansion of mental health facilities in India. It had sought majority of the budget for district-level expansion and IEC component to create awareness.
The proposal was sent back to the ministry, with advice to cut down the IEC budget and get external evaluation of the existing District Mental Health programmes done before seeking fresh expansion.
Currently, 123 districts are covered under the mental health programme, with the health ministry seeking to cover 250 more under the new proposal.
“We have now sent the revised proposal to the Planning Commission and the Expenditure Department. We got external evaluation done. It took six months and concluded that district-level expansion was urgently needed. We are waiting for the comments of approving bodies,” said highly placed sources in the health ministry, who rued that IEC budgets for mental health should have been sought to be cut.
“Mental health disorders are not routine diseases. Their awareness generation is much more challenging. And in awareness lies the success of the programme. But we would have to do with reduced IEC budgets, it appears,” sources in the NMHP said.
The revised proposal sent by the health ministry is worth only Rs 475 crore - down by over half of what it had earlier sought. The reduction indeed reflects poorly on the willingness of a system to spend generously on a sector that has remained shut for years despite repeated insistence of the Supreme Court and National Human Rights Commission to open it up.
