'India Most Depressed Country In The World': Madras High Court Seeks Response From Central Authorities Over Mental Health Facilities

A Division Bench of Justices N. Kirubakaran and B. Pugalendhi was "shocked" that India is the most depressed country in the world and yet, it spent only 20 paisa per month per patient in the year 2018-2019.

Thus, while suggesting medical health reforms, including establishment of National Institute of Mental Health and Neuro Sciences (NIMHANS)in all zones of the Country, the Bench urged the authorities to address the following loopholes in the system:

• Lack of awareness & knowledge about the illness
• Inadequate human resources (less number of psychiatrists, psychologists, social workers and nurses)
• Inadequate treatment facilities
• Long distance to travel to get the treatment
• High cost of treatment
• Stigma attached to mental health patients

The Bench noted that even though understanding the mental health problems, the Central Government enacted the Mental Healthcare Act, 2017, no sufficient awareness programmes had been conducted to implement the same in spirit.

It remarked that mental illness is both preventable and curable and the following measures may be adopted to fortify the system in India:

• Premier institution like NIMHANS, Bengaluru for mental health should be established in Every zone;
• Psychiatry is not a subject in all the medical colleges and hence, psychiatry should be introduced in every medical college as the requirement of psychiatrists is more;
• Only a negligible number of mental hospitals are stated to be functioning in the country and for 130 Crore of population, more number of mental health care centres have to be established by the Central Government as well as by all the State Governments;
• Establish a Psychiatry Department in every District Headquarters Hospital and a Psychiatrist in every Taluk Level Hospital;
• Government does not have the centralised portal on treatment for the mental disorders and only they have patient-based data from three Central Institutes of Mental Health. In regular intervals, surveys of the prevalence of mental disorders across India have to be conducted and appropriate remedial measures have to be taken.

The observations were made in a writ petition seeking establishment of a Medical wing in either Trichy Central Prison or Madurai Central Prison exclusively to provide mental health care facilities to the prisoners with mental illness and with round the clock availability of treatment by the psychiatrist clinical psychologist psychiatric social workers mental health nurses and other paramedical staffs like institute of mental health setup in a central prison as per section 103 and other relevant provisions of the Mental Health Care Act 2017.

While allowing the petition, the Bench proceeded to expand the scope of the writ petition to give comprehensive directions to the Central Government, Medical Council of India and the State Government to identify the patients at the earliest by diagnosing the disease to give proper treatment by improving the infrastructures, like, establishment of hospitals, increasing the number of psychiatrists, psychologists, psychiatrist social workers and allocation of more funds towards mental health, including the conduct of regular surveys.

The Bench impleaded the following as Respondent-parties:

• Ministry of Family and Health Welfare
• Ministry of Finance
• Medical Council of India
• University Grants Commission
• National Institute of Mental Health and Neuro Sciences (NIMHANS)
• Indian Psychiatric Society (IPS)

While posting the matter for hearing on December 9, the bench asked the above authorities to answer the following questions:

• Is it a fact that one in seven persons of India's population is suffering from mental illness as stated by WHO?
• Whether any survey is being conducted by the Government or Government Hospitals / Health Organisations regarding the mental health of the India's population regularly?
• When such survey was conducted lastly?
• What are all the leading mental disorders among the people?
• Whether sufficient number of mental hospitals are available in India?
• If not, why not the Central Government/State Governments establish one mental hospital in each District or in each Zone of every State?
• Why not the respondents increase the number of Institutes offering psychiatry/psychology in higher studies?
• Why not the Central Government establish premier Institutes, like, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, in each Zone of the country, namely, North, East, West and Central?
• Is it a fact that only 50 Million Rupees have been spent for the mental healthcare in 2019?
• Why not the Central Government increase the allocation of funds towards mental health, especially, when one in seven persons of the population of the country is stated to be suffering from mental illness?
• What is the required strength of psychiatrists, psychologists and/or psycho health workers in India?
• Why not the Governments sensitise the people about the mental illness and remove the taboo/social stigma in the minds of the general public about the persons with mental illness and also the treatment for mental illness through Audio-Video programmes by conducting awareness camps?
• Why not the data for co-ordinated action be collected by the Central Government and the State Government in the interest of the people suffering from mental illness?
• Why not the Governments have one Department for Psychiatry in each District Headquarters Hospital and have at least one Psychiatrist in each Taluk Level Hospital?
• Why not Central Government engage the services of Foreign Psychiatrists, Psychologists to teach and train medical students?
• What steps Government has taken to establish the rehabilitation services?
• What are the incentives given for starting the rehabilitation services?
• What steps Government has taken to promote community based rehabilitation?
• Do we have sufficient rehabilitation professionals to manage rehabilitation homes?
• What is the Government budget for rehabilitation?
• What is the status of insurance coverage of mental illness?
• What are the steps taken to promote school mental health and community based mental health services?

Case Title: KR Raja v. State of TN

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