Cost, Access, Stigma: Getting Mental Healthcare is Not Easy

Cost, Access, Stigma: Getting Mental Healthcare is Not Easy

Why accessing mental healthcare in India is not easy. 

In the last few days, there has been a lot of talk around mental health, which is fast becoming a silent epidemic in India. A young actor’s tragic death has opened up conversations again on a topic that is still considered a taboo or given the ostrich treatment. And even as one hopes that mental healthcare will become a serious priority for all stakeholders involved, the grim reality is that accessing mental healthcare, whether it is information on it or diagnosis and treatment for it, is not easy in India. There are several factors, most important of them being - Cost, Access and Stigma.

Every 6th Indian Needs Mental Healthcare 

‘Every 6th Indian Needs Mental Healthcare’

The National Mental Health Survey done in 2015-2016, revealed that at least 150 million people needed active mental healthcare and support in India. But only 30 Million are getting the support and access needed, which means eight out of ten patients don’t have mental healthcare access. And this are just the reported cases. India has one of the highest number of suicide rates in the world, the highest in South East Asia. According to National Crime Record Bureau, there are at least 1,00,000 deaths due to suicide in India every year. Again these are only reported cases.

Still not enough awareness around mental health

Despite all the talk on social media, there still isn’t enough awareness or information around mental health, including seeking treatment for it. Just one small example of how stigma still prevails, in 2017, suicide was finally decriminalised in India, making article 309 of IPC redundant. But the section still remains in law books, adding to the confusion.

A Lack of Awareness Around Mental Health

Not Enough Doctors

The other reason accessing mental health is difficult, is that there simply aren’t enough psychiatrists in India. According to the data released by National Centre For Biotechnology Information, India is around 27,000 psychiatrists short. Right now, there are only around 4,000 psychiatrists in India, that is .075 psychiatrists/1,00,000 population. There are many reasons, why there aren’t enough doctors. To bridge the shortage in doctors over the next ten years, we need to train 2700 doctors per year. But only 700 psychiatrists are being trained every year. The shortage of doctors across the country is telling, with some states having less than 10 psychiatrist.

There aren’t enough doctors 

How do we fill the gap

Therapy is an Expensive and Long-term Project

A person diagnosed with any form of mental illness, is likely to need treatment and therapy for a long time. Adding to the fact that there aren’t enough doctors, treatment for mental illness is often expensive. In metros like Mumbai and Delhi, private practitioners charge anywhere from Rs 1,500 to Rs 3,000 per session. Often patients need to see psychiatrists every week, and over a period of time, seeking treatment becomes an expensive affair, reason why many people discontinue treatment, mid-way.

Therapy is expensive and a long term project 

The Mental Healthcare Act passed in 2017 tried to address the high cost of treatment by mandating health insurance companies to provide cover for mental healthcare. But this has not been widely applied and there is still not complete clarity on how the insurance cover will work. For example, while you are guaranteed cover if you are admitted in a hospital for treatment, but there is no clarity on whether OPD charges are covered, which is how most patients are likely seek treatment.

On June 16, the Supreme Court pulled up the Insurance Development and Regulatory Authority (IRDA) to explain why mental illness was still not covered properly and completely by insurance companies.

Insurance for Mental Healthcare 

SC Pulls Up Insurance Regulatory Body

So, Where Do We Go from Here?

There is a need for a multi-pronged approach that bridges the deficit in psychiatrists in urban, semi-urban and rural areas. To increase the number of psychiatrists, the capacity to train them also needs to be increased. Comprehensive public messaging at all levels need to be worked on and information disseminated to remove the stigma around mental health and seeking help for the same, needs to be ramped up. And finally, access also has to ease up on the basis of cost and health insurance.

Mental health illness is serious and all pervasive, affecting people of all ages and from all socio-economic strata. With the pandemic and lockdown, more people are likely to feel the for counselling, emotional care and support. Ease of access, good support and removal of stigma is imperative.

The way forward