In this contribution to IF’s Worldwide Intergenerational Fairness Blog Week, Aarthi Ratnam, a mental health campaigner, explains why India’s understanding of, and investment in, child mental health must change post-COVID-19
Child mental health
Being mentally healthy during childhood means reaching emotional and developmental milestones. It allows children to have a positive quality of life, maintain healthy relationships with others and themselves.
Mental health is not merely the absence of disease, but is the state of overall physical and social well-being. Mental disorders, on the other hand, act as a barrier, impacting the way children behave, learn and handle their emotions. Aside from psychological difficulties, untreated mental illness makes one vulnerable to various issues like poverty, violence, substance abuse and other deprivations.
In India there is a glaring gap in the mental healthcare system thereby further exacerbating the situation.
Stigma in India
One of the biggest challenges to addressing mental health is the widespread lack of knowledge and stigma. Stigma refers to societal disapproval or shaming of those suffering with a mental illness. The unwillingness to accept mental health as an important part of a person’s overall well-being, results in a high reluctance to seek help.
A lack of awareness, education, inappropriate labels, and fear of people with mental illness, aid stigmatization. This also results in insufficient resources and investment in mental healthcare facilities.
India performing poorly
According to a UNESCO report published in 2008, India stands at 132nd position out of 172 nations on the Human Development Index. 10 percent of 5–15 year-olds have a diagnosable mental health disorder. This equates to 20 million adolescents where nearly 90 percent are not receiving the necessary treatment.
Despite this, for every 100,000 people there is only one psychiatrist. Those who are more likely to seek help are largely in urban areas perched on top of the socio-economic ladder. The privilege of seeking aid is not extended to rural communities, let alone children. Thus, owing to the enormity of the issue, a participatory, comprehensive and integrated policy is required.
First and foremost, the policies set up should work towards mental health awareness. On a national level, this can be done by increasing investment in this sector. In the financial year 2019, the budget allocated to the National Mental Health Programme (NMHP) was reduced to Rs.40 crore from Rs.50 crore in 2018. In 2020, there has been no increase in allocation for NHMP, despite a 7 percent rise in the total healthcare budget.
Policies should be implemented to increase the budget allocation for this sector to tackle the problem at ground-level. Currently because of scarce resources, actual spending is limited to quick and immediate measures to solve the problem instead of addressing the fundamental issues. Limited numbers of healthcare professionals leads to generalized medication prescription instead of patient-centred diagnosis.
It is important to note that the mental healthcare system cannot work in isolation. Other social welfare sectors such as domestic violence, disabilities, poverty-aid require adequate funding as well. Poor socio-economic conditions are detrimental to mental health and inadequate facilities will only worsen the mental health condition.
One of the biggest barriers to available resources is due to centralized investment. The National Mental Health Survey conducted in 2015–2016 found that state budgets allocated less than one percent towards mental health.
In the future, to strengthen the health infrastructure, support must be provided at all levels, especially to those in poorer socio-economic backgrounds. It is essential to make mental health services universally available and patient-centred at a timely manner.
While union and state governments have major roles to play in de-stigmatizing mental health, they cannot break the stigma alone. Other stakeholders such as, academic and research institutions, primary care providers, civil society organizations and even families have a significant role to play and should work together. Schools and homes are the primary comfort environments for children. It is important to create a safe space for them to express themselves without the fear of stigma or judgement.
Over the years, India has evolved into taking steps in the right direction to normalizing mental health, but it is not enough. Through the development of relevant policies, laws and programmes across pertinent sectors, a comprehensive and supportive mental healthcare system be set up.
An intergenerational right
Sufficient budgetary provisions must be implemented not just at a national level, but also at regional levels. An effective monitoring and evaluating system must also be created to ensure suitable mechanisms. By working with schools, parents and relevant mental health professionals, appropriate intervention and prevention solutions can be developed for children.
A healthy mental state allows a child to cope with day-to-day challenges and realize his or her own abilities. This is a universal right, an intergenerationally fair right, and no child should be denied the same due to fear or shame.
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