“Changing cities, beginning a new life triggered anxiety and panic attacks in me, the reasons were unknown until I took professional help and came to know how deep-rooted my thoughts and actions were,” said 25-year-old Ankita, a working woman, who went to New Delhi- based Sanjeevani Society for Mental Health — an NGO functioning since 1976, providing free counselling sessions.
Like Sanjeevani, non-governmental organisations are playing a significant role in strengthening the country’s crumbling mental health infrastructure. In the last few decades, NGOs have been bridging the gap between unaffordable private healthcare systems and inaccessible and overburdened government facilities. These NGOs have been creating low-cost replicable models of care and have been active in a wide array of areas such as child mental health, schizophrenia and psychotic conditions, drug and alcohol abuse, dementia, alzheimers, anxiety and depression etc. Several NGOs have even supported people in war-torn areas by providing treatment, rehabilitation, community care, research, training, capacity building, awareness and lobbying.
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On World Mental Health Day, we take a look at the role NGO’s have been playing in the mental health sector in the absence of much government intervention.
Bridging Treatment Gap
The World Bank defines Non-governmental Organisations as ‘private organisations’ that pursue activities to relieve suffering, promote the interests of the poor, provide basic social service or undertake social development.
The rise of NGOs in India can be attributed to the non-availability of government services and the unaffordability of private systems. In a paper titled ‘Role of non-governmental organizations in mental health in India’, psychiatrists Vikram Patel and R Thara write that there have been three changes during the evolution of NGOs. First, the greater degree of professionalisation of NGO activities; second, the widening of sources of funds for NGO activities to include major national and international donor agencies and last but not least the secular origins of NGOs.
Meanwhile, India Psychiatry Journal highlighted how some of these NGOs have become large institutions in their own right, providing primary care services and strengthening community action.
One of the prime reasons for the widening treatment gap is the lack of public spending on healthcare. The Union Budget 2021-22, proposed a corpus of Rs 71,269 crore for the Ministry of Health and Family Welfare, which included a budget for mental healthcare – a total of Rs 597 crore. Shockingly, only 7 per cent of the entire budget went to the National Mental Health Programme (NMHP), Rs 57 crore for Lokpriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur and the rest went to the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bengaluru (Rs 500.44 crores).
Globally countries are spending less than 2 per cent of their national health budgets on mental health and are still struggling to meet their populations’ needs. Data shows that around 80 per cent of people with mental illnesses live in low-income countries, out of which nearly 75 per cent never receive treatment.
Dr Soumitra Pathare, director of the Centre of Mental Health Law and Policy said that the government must begin to look at itself as an enabler to do what exactly should have been done in terms of mental health care. He said, “As a poor country, we cannot afford to not focus on promotion and prevention. The government needs to build a policy framework, where self-care, prevention, and informal care are a major part so that we do not have the need to access the most expensive treatments.”
Dr Pathare pointed out that mental healthcare needed its own range of service providers. He said, “We need a range of mental health service providers, not just psychiatrists and psychologists- which we haven’t managed to achieve so far. We need structures or frameworks where different mental health professionals can be trained and regulated.”
While the public healthcare system is overburdened and the overall spending has not been enough, the private health sector has successfully created a monopoly in the healthcare sector. Emphasising how the unaffordability gap can be filled, Dr Samir Parik, director of the Department of mental Health and Behavioural Sciences at Fortis Healthcare, said, “In order to bridge the unaffordability gap, all providers of healthcare whether government or private, should figure a way out, for example, utilising available resources like telemedicine- it is a great equaliser which reduces cost, and improves outreach at a significant level.” We also need primary intervention helplines, and school-level mental health education to bridge this gap, he added.
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NGOs strengthening the dilapidated mental health structure
Mostly in urban spaces, but several NGOs have curated modules of psycho-social rehabilitation (PSR), where a spectrum of activities are included such as individual and group counselling, vocational rehabilitation and livelihood skills training, cognitive retraining, family support and counselling, self-help groups, recreation and leisure activities.
“Historically and largely NGOs have played a significant role as implementers. They have addressed issues of access, wherever the government did not have physical presence to provide a facility. From addressing access to now acknowledging the need of policy making, awareness and advocacy, NGOs have reached and are catering to every need remarkably. As NGOs work with fixed agendas, now the government is also reaching out to NGOs for a third point of view in policy-making and for better implementation,” said Dr Preeti Kumar, vice president of the Public Health Foundation of India.
Reena Nath, a New Delhi-based systemic therapist, who was associated with Sanjeevani Society for Mental Health for 17 years said that Sanjeevani was one of the first walk-in crisis intervention centres and “that could have happened only in New Delhi in those years.”
Sanjeevani still exists as a place for those who cannot afford private mental health care which is very expensive.
“It created a safe environment where people were ‘self-referred’, they heard about the centre and they decided to walk in fighting the ‘South Delhi stigma’ around mental health. India needs more crisis centres like Sanjeevani to strengthen the overall infrastructure,” Nath said.
Reportedly, NGOs working with severe mental health disorders like schizophrenia often focus both on symptom controlling during the acute phase of illness and also on rehabilitation of the patient. One such example of such Chennai-based NGO is Schizophrenia Research Foundation (SCARF). It was set up to focus on a holistic approach. In case of severe mental disorders, NGOs ensure that patients are being provided vocational training in skilled professions such as carpentry and printing, social skills training and family therapy, so that patients lead a normal life.
Talking about the equal quality of care available in both private and social sector, 27-year-old software engineer Ankita, who has opted for both private therapy sessions and is also a part of a social mental health support group, said, “we all are dealing with something and accessing treatment should be a priority so that it doesn’t worsen.”