Two Years Since Mental Health Act Was Passed, States Still Struggle for Trained Personnel, Better Facilities

Representational image. (Getty Images)

Representational image. (Getty Images)

The Mental Health Act mandates the states to have the authority functional within nine months of the law coming into force but most of the states have missed the deadline. States are also yet to draft the rules of the Act.

More than two years after the Mental Health Act, 2017 was passed, only 19 states have managed to get the State Mental Health Authority in place, as required under the new Act.

The state authorities are supposed to register and regulate all mental healthcare facilities and publish their details online. It is also required to register all clinical psychologists, mental health nurses and psychiatric social workers.

The Act mandates the states to have a functional authority within nine months of the law coming into force but most of the states have missed the deadline. The states are also yet to draft the rules of the Act.

“There is a lack of understanding among states about how to make rules. They need a bit of legal guidance and handholding,” said Preeti Sudan, secretary, Ministry of Health and Family Welfare.

With the lack of new rules, the rules of the old Mental Health Act (1987) are still being followed. The health ministry, along with the National Human Rights Commission (NHRC) on Thursday held a review meeting with the states to assess the progress in implementing the Act.

The Centre highlighted that the states are not using funds dispersed for the implementation of the Act, which has forced the health ministry to switch up systems for the transfer of the remaining amount. The ministry has now decided to reimburse the states instead of paying instalments.

“Despite the system of money dispersal having changed, no states have applied for reimbursements,” said Lav Agarwal, joint secretary, Ministry of Health and Family Welfare. He added that if the Centre releases money and the states don’t utilise it, then the manpower cannot be increased.

More than seven per cent of India’s population suffers from mental illnesses and 90 per cent of them remain untreated.

India has 9,000 psychiatrists and produces 845 graduates each year, which amounts to 0.85 psychiatrists per hundred thousand population. The globally accepted standard is six psychiatrists per hundred thousand population. While the shortage of psychiatrists is prevalent across the country, it is most acute in nine states, which has a 90 per cent deficit. Similarly, it will take India 74 years to augment the number of nurses specialising in mental health care.

As the scope of the Act expands from providing institutional care to reaching out to communities for spreading awareness on mental health, a push is being made for innovative methods to expand the pool of trained health staff in treating mental illnesses.

For instance, Chhattisgarh has started training 60,000 ASHA workers in identifying and referring patients to district mental health facilities for treatment. The state has also hiked the salaries of psychiatrists, who are willing to work at the district level health facilities, to Rs 1.7 lakh a month.

Sikkim, which has one of the highest suicide rates in the country, launched a suicide prevention helpline in April. The focus is now shifting towards strengthening mental health facilities at the sub-district level.

Preeti Sudan added that in the plan to expand mental health care to grassroots, out of the 1.5 lakh health and wellness centres the ministry is planning, 19,000 are already in place. These centres will be hubs of comprehensive healthcare services, including mental healthcare.

But representatives from states highlighted how even at the district level, mental healthcare is not given priority.

Agarwal added that the ministry has written multiple letters to states to speed up the process of implementing Act but the response has been sluggish.

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