As India observes World Mental Health Day today, a shocking revelation by a survey said that 80 per cent of Indians (of those surveyed) either did not have health insurance or thought mental health treatment was not covered by their insurance.
This was despite the fact that the Mental Healthcare Act 2017, which was implemented last year, directs every insurer offering health insurance products to cater to policyholders with mental illnesses the same way they cater to physical illnesses or injuries.
As says the Act, “Every person with mental illness will be treated as equal to persons with physical illness when it comes to healthcare, including health insurance.”
The survey was conducted by CIMBS, New Delhi in collaboration with the World Federation for Mental Health (WFMH), which announced “Mental Health Promotion and Suicide Prevention” as the theme for the World Mental Health Day this year. The study is also supported by the World Dignity Project.
The survey was conducted among 10,233 individuals in urban and rural regions conducted across seven states of North India, analysing factors like access to mental healthcare, awareness and attitudes.
Dr. Shobhana Mittal, Psychiatrist at CIMBS said, “Costs can be a significant deterrent to healthcare, especially in case of chronic illnesses. Only 26 per cent individuals in the study felt that government provided adequate support to those with mental illness. Despite this, there is lack of preparedness for mental health; only 8 per cent respondents were aware whether their health insurance covered mental health treatment costs, while 9 per cent were covered under a government scheme.”
Exploring the issue of lack of adequate facilities, Dr Sunil Mittal, Senior Psychiatrist and Director, WFMH added,” Although 43 per cent had knowledge of a person with mental illness within their family or friends, of them nearly 20 per cent reported no mental health facility or clinic even within a 50 km radius of their residence. Overall, only 49 per cent had a mental health facility within a 20 km radius. Similarly, while 48 per cent had a person with a known addiction in their family or friends, 59 per cent had no de addiction service near their house. Such distances are deterrents that contribute to a wide treatment gap.”
“There seems to be poor awareness of the Mental Healthcare Act, 2017 which directs insurance companies to provide coverage for mental health on equal basis as physical illnesses. Still, we see many patients delay treatment because they are unaware of this,” Dr Shobhana added.
“India’s suicide rate of 17.8 per 100,000 is significantly higher than the global average of 10.5 per 100,000. Every year 2.2 lakh lives are lost to suicide in India, and India contributes 28 per cent to all global suicides despite only 18 per cent of global population. For every suicide, it is estimated 25 more are attempted,” said Dr Shobhana Mittal. “Since a significant proportion of attempted suicides are not identified as a mental health issue, they are less likely to be met with intervention to address underlying mental health issues, “she added.
“The study adopted a ground-up approach seeking inputs from those it surveyed for strategies appropriate for improving access to mental healthcare in the respondents own regions. The data is detailed and interesting,” said Mitali Srivastava, Senior Psychologist at CIMBS.
This raises practical issues for caregivers facilitating treatment for persons with mental illnesses who feel there is disconnect between on-ground realities and governmental policies.
“The nature of the caregivers’ role is invisible and complex, much like mental illness itself. The entire journey is laden with fears, insecurities, trauma, isolation and dysfunctionality. To add to it, the new laws do not cater to the concerns and needs of caregivers and their voice,” she says.
Srishti Jaju, Clinical Psychologist at CIMBS commented, “Availability of facilities has been an issue, and an overwhelming 87 per cent individuals favoured use of technology to try to bridge this divide by using mobile-phones, apps, and tele-medicine.”
“The National Mental Health Programme was launched in 1982 to address inadequate mental health infrastructure and in 1996 a mental health service was planned inevery district. Yet, decades later, infrastructure remains inadequate,” said Mrinal Kanwar, a Supreme Court lawyer actively involved in mental health advocacy.
“There is a need for well-thought guidelines for a participatory approach to encourage non-governmental entities and addresses concerns regarding medico-legal issues in mental health service delivery, without which it is difficult to bridge the huge treatment gap that exists today. Similarly, innovation and adoption of technology like telemedicine need to be promoted”, added lawyer Mrinal Kanwar.
On misconceptions about mental health, Dr Sunil Mittal said, “Nearly 1 in 6 suffers from mental health issues, and it is amongst the most common chronic disorders. 49 per cent respondents felt mental health issues were not common, and 57 per cent individuals did not know of anyone with mental health issues, an indicator of difficulty in recognising symptoms in near and dear ones.”
“It was interesting to note that only 43 per cent felt that a person dealing with a mental health issue was likely to be taken to a hospital, while 44 per cent felt the person may be counselled by family members or taken to a local healer or a baba/ tantric,” said Mitali Srivastava.
Sixty one respondents felt laws should make it easier for patients (22 per cent) and caregivers (39 per cent) to get treatment. Such respondents include some who may be unfamiliar with legal provisions, and also others who have had difficult experiences.
The top three suggestions for promoting mental healthcare include, opening of more mental health facilities (37 per cent), easier process for caregivers to facilitate treatment for persons with mental illness (28 per cent) and public social campaigns (24 per cent).