Examining the Examiners: A Review of Parliamentary Committee Report on Mental Health
Part I of my critical analysis of Parliamentary Standing Committee on Health and Family Welfare report on ‘Mental Health Care and Its Management in Contemporary Times’
psytizenship is back. Thank you for your subscription. Special thanks to all the subscribers and strangers who asked why I had stopped writing here. It gave me motivation to start again. From now on, the articles will be published every Tuesday.As we begin again, I want to state this, in case you did not know: psytizenship is pronounced same as citizenship, not ‘saitizenship’. The idea is simply that the psychologists should be citizens aware of policy and legal developments, particularly those relevant to their profession. psytizenship is a small effort in that direction.Let us dive into the article now.Last year, on August 4, the Department-Related Parliamentary Standing Committee on Health and Family Welfare presented a report on the subject ‘Mental Health Care and Its Management in Contemporary Times’.
[For the uninitiated, the Parliamentary Standing Committees comprise Members of Parliament belonging to Lok Sabha and Rajya Sabha. These Committees examine various matters, including budget and bills, related to the departments and ministries of the Union Government and are supposed to play a vital role in holding the government accountable.]
This article is the first in a mini-series of my articles highlighting and evaluating the analysis and recommendations of the ‘Mental Health Care and Its Management in Contemporary Times’ report. The Parts II and III will be published over the next weeks. [As much as possible, I want to limit every article to 1000-1500 words so that it is easy to read for the subscribers.]
The aim of the Committee for taking up this subject, in its own words, was to “examine the landscape of mental healthcare in India, regulatory structure, the status of mental health infrastructure, causes behind the high prevalence of mental health issues and the rising cases of suicides in the country.”
To examine the subject, the Committee held multiple meetings between October 2022 and March 2023. It heard the officials of Ministry of Health and Family Welfare, Ministry of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy), Department of School Education and Literacy, Department of Biotechnology, Department of Empowerment of Persons with Disabilities, NITI Aayog, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, and Central Institute of Psychiatry (CIP), Ranchi. It also held meetings with the two NGOs - Manas Foundation, New Delhi and Ashadeep, Guwahati.
The Committee, "to understand the ground realities", visited the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru and Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, Assam.
In November, 2022, the Committee also requested views from stakeholders and the public. I am not aware if any psychology association sent a memorandum to the Committee. If you know of any association that did so, please let me know so I can add their name here.
Further, as far as I know, it was for the first time that a Parliamentary Committee, outside of demand for grants and bills, took up the topic of mental health for examination. Especially after the COVID-19 pandemic, the Committee was presented with a historic opportunity to study the mental health landscape in India and hold the government accountable for its omissions and commissions.
Although the Report is of 65 pages, its substance comprises only of 40 pages, excluding the pages before the Introduction and the last 19 pages, which just repeat the observations and recommendations of the Committee. That the Members of the Committee required only 40 pages to examine the entire gamut of mental health care in India and give their recommendations was the first thing I could not digest about the Report. However, hoping it had the saying ‘brevity is the soul of the wit’ on its side, I dived into it.
The Report is divided into three chapters entitled (A) Introduction, (B) Mental Health Policy and Legislation, and (C) National Mental Health Programme and Mental Healthcare Infrastructure. I review the most of the first chapter in this article.
The Chapter I focuses on the present status of the mental health issues in India, the results of the National Mental Health Survey 2015-16 (NMHS), effect of the COVID-19 pandemic on mental health, the mental health issues in children and youth, and suicides. Let us analyse them one by one.
1. Present status of mental health issues in India: In this section, the Committee has highlighted some common challenges to mental health. Two of them stood out to me: environmental and geopolitical issues, and migration. On migration, the report says: “Migrants often face stressors such as adapting to a new culture, language barriers, discrimination, financial difficulties, and social isolation. These factors can significantly impact an individual's mental well-being and increase the risk of developing mental health problems such as anxiety, depression, and post-traumatic stress disorder.”
I appreciate the fact that the Committee recognised these challenges.
2. National Mental Health Survey 2015-16 (NMHS 2015-16): As per the Committee, the NMHS 2015-16 "provided valuable insights into the state of mental health in India and offered a comprehensive overview of the challenges and gaps in addressing mental health issues." It noted that “about 150 million Indians are affected by some type of mental illness” and the lifetime prevalence was 13.7%.
The Committee highlighted the huge treatment gap — the difference between the number of people who need care and those who receive care — and observed that it ranged between 70 to 92% for different disorders.
The Committee pointed out that most of the issues highlighted by the NMHS 2015-16 remained almost the same even in 2023. It flagged the “lack of mental health professionals, weak mental healthcare infrastructure, inadequate and inequitable access to mental health services, stigma and discrimination” as the reasons for huge treatment gap.
The Committee also called attention to several “limitations” of the NMHS 2015-16 which it recommended the government to address in the next Survey. These issues include relying on self-reports instead of clinical analysis, collection of data on specific disorders only, exclusion of “specific vulnerable populations, such as homeless individuals, prisoners, and those living in institutions”, limiting the Survey to only 12 states out of 36, and covering “only about 40,000 people which is a tiny sample considering the population of the country.”
Last, citing the NMHS 2015-16, the Committee wrote that “despite years of research and a continued focus on improving health systems, changes seen in the mental health field are few and limited.” My question: where are the “years of research and a continued focus on improving health systems”? Forget continued focus, other than spilling ink on paper in the form of a few laws and policies, I have not seen a single attempt on ground by the Union Government to improve mental health systems. This right here is the first step in our journey of seeing the Parliamentary Standing Committee on Health and Family Welfare abdicating its duty to hold the government accountable and giving it a free pass.
3. Global Comparison: In this section, the Committee has cited World Health Organization’s World Mental Health Report: Transforming Mental Health for All 2022, and Sapien Labs’ Mental State of the World Report 2022 to highlight “India's unsatisfactory status in terms of mental well-being, life satisfaction and happiness across the globe.” The Committee stated that “for India's sustainable socio-economic growth, it is necessary to give the citizens [a] sense of equality, inclusiveness, justice, social security and participation.”
4. Effect of COVID-19 on Mental Health: The Committee has underlined the impact of the COVID-19 pandemic on the people’s psychosocial well-being due to “fear and uncertainty surrounding the virus”, isolation and limited social interactions because of the lockdowns, economics hardships such as loss of employment and financial instability, and lifestyle changes such as blurring of boundaries between personal and professional life resulting from work from home policy.
The Ministry of Health and Family Welfare told the Committee that to provide psychosocial support, the government took initiatives such as “setting up of a 24/7 helpline” and issuance of several kinds of guidelines.
Here also, the Committee simply accepted the submissions of the government without asking if the reported initiatives were sufficient. It did not demand data about, for instance, the number of people who called the helpline. It did not ask if the guidelines were effective. Most importantly, it did not ask that during a once-in-a-century pandemic, was issuing guidelines and launching a telephone helpline the most a government could do for the mental health of 140 crore Indians?
The Committee expressed the need of a post-COVID-19 survey to “assess the prevalence and severity of mental health disorders” and recommended that “National Mental Health Survey - 2, which is scheduled to be completed in 2025, should be expedited so that the impact of Covid-19 may be accurately ascertained.” [NHMS-2 is being conducted in two phases: Phase 1 during October 2022 - Mar 2024 in 18 States/UTs and Phase 2 during April 2024 - March 2025 covering the remaining 18 states.]
The Committee said: “[it] is of the firm opinion that the findings from the Survey will serve as crucial evidence for policymakers to take informed decisions related to mental health funding, infrastructure development, and evidence-based interventions.”
My question: did the first Survey compelled the policymakers to take informed decisions related to mental health funding, infrastructure development, and evidence-based interventions? If the past is the best predictor of the government’s performance, then who can deny that the second Survey will also not be worth the paper it will be printed on?
Next week, I will review the remaining sections of Chapter I, and the Chapter II entitled Mental Health Policy and Legislation.
I cannot help but feel helpless and incompetent as a master's student in psychology, despite having a knack for technology. Struggling to generate new ideas and solutions, I shamelessly ask, where do we start?