India’s mental health system grossly inadequate: experts

By Kavita Bajeli-Datt, IANS,

New Delhi : As many as 20 million Indians are believed to be suffering from mental illnesses, but there are only 3,500 psychiatrists and 1,500 psychiatric nurses to treat them, say experts.

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Not only does India lag far behind western countries when it comes to mental health manpower but it also falls short of some Asian countries, they say.

“India’s mental health manpower is grossly inadequate. The number of psychiatrists for one million population ranges from 0.4 in India to 3 in the Maldives, and the number of psychiatric nurses from 0.4 in India to 18 in Sri Lanka,” R.C. Jiloha, head of the department of psychiatry in G.B. Pant Hospital, told IANS.

He said it is estimated that about one to two percent of India’s billion-plus population suffers from major mental disorders and about five percent of the population from minor depressive disorders.

“The number of patients in this country is totally disproportionate to the number of doctors. We urgently need more psychiatrists,” he added.

“There are not many training centres,and less of teachers. Most of these students and teachers are going abroad for greener pastures. The number of such doctors is going up very fast,” he added.

He said the government expenditure on mental health in the majority of SAARC countries was less than one percent of the total national health budget.

“Most of the people needing treatment have to spend from their own pocket, and most are not covered by insurance schemes. The majority of poor people do not get adequate treatment, or they prefer alternatives which are not effective,” he added.

Jiloha said one way to handle the paucity is by training general practitioners and by exposing the undergraduate students to tackle mental health problems.

In fact, their hospital has trained 800 doctors in Delhi.

“Patients first go to general practitioners. If they get the right treatment there, half the problem is solved and there is not much burden on psychiatrists,” he said.

“The magnitude of mental health problems is huge, with limited financial and other resources, the paucity of skilled mental health professionals and more emphasis on treating communicable diseases. Thus a cost-effective strategy is necessary for better healthcare delivery,” Jiloha added.

M.S. Bhatia, head of the psychiatric department at G.T.B. Hospital, said: “A shocking 70 million people suffer from mental ailments and yet, 50-90 percent of them are not able to access corrective services. Awareness of mental health is just not enough.”

“Most of the psychiatrists are based in cities or private hospitals. But it’s the government hospitals that face an acute shortage, although they are the ones which treat the poor,” said Bhatia in whose hospital there are posts for five psychiatrists, but only two are occupied.

“I know some government hospitals where posts are lying vacant because of the slow recruitment process or doctors have gone abroad. These doctors have not returned after their two-year stint; nor have they resigned from the post,” Bhatia told IANS.

In some states like Uttar Pradesh, Punjab and Rajasthan, the situation is pretty bad, he added.

The government says it is planning to upgrade services under the National Mental Health programme that was launched in 1982 with the objective to provide at least minimum mental health services to all.

According to a health ministry official, the ministry has allocated Rs.1,000 crore for the programme in the 11th Five Year plan.

“There is a proposal to support the setting up of or strengthening more psychiatry departments in the country. This move will generate 60 psychiatrists, 240 clinical psychologists and 600 psychiatric nurses per year,” said the official who did not want to be quoted.

But experts said much more is needed to be done.

Praveen Thapar, chairperson for the Sanjivni Centre for Mental Health, said: “The national programme has been in place for a long time now. However, its implementation is hindered because of the shortage of manpower and because the focus has been more on illnesses than on overall mental well being.”

(Kavita Bajeli-Datt can be contacted at [email protected])