Policy issues in mental health: Maharashtra’s challenges

Abstract

The rising trend of mental disorders in the nation and its global burden makes it urgent for the State to look into the problems arising out of the fast changing society. This policy paper aims at addressing the policy level issues involved in this sector. It starts from assessing the literature on the extent of the problem in India. The legal and policy framework within which the sector is operating will be discussed. The Governments schemes to deal with the problem and its success and failure will give the base for thinking of what the major problems facing the sector are and what can be the policy alternatives. In order to go ahead with the paper , I have relied on secondary literature and extensive discussion with many of the stake holders in the sector. Field visits to many of the institutions who have delivered results has also been done. Based on this the various alternatives which need to be addressed are formulated as under. Four major policy alternatives are lined out . The first being the deepening approach where in the focus is on strengthening the existing system of mental health delivery so that a more effective , rights based and hygienic approach can be had for the institutions that are basically giving services for the care takers. The acute shortage of mental health professionals and the various alternatives that can be available by addressing this problem are discussed. The second approach is of widening the base. Here, what is being addressed is that the problems in the field are much more severe and our health system is failing to go and address it in its natural set up. Various successful models of Community psychiatry and rehabilitation along with preventive approach to the problems are discussed. The next approach being discussed is to have a phased manner of prioritizing which issues need to be addressed first. The benefits of such an approach and what can be the priority issues that can be thought of are given as an alternative. It is recommended to focus on adolescent and women issues , specially inn case of suicide prevention. The fourth approach is the wellness approach to mental issues. It focuses on wellness for the general society and thereby makes those potential persons access its services who do not consider themselves ill yet need some or the other help. Techniques like Vipassana, Yoga, Compassion therapy and cognitive based therapy are discussed . This approach can reduce the burden on the formal system and India has comparative advantage as many NGO’s already exist in this field. In conclusion, the paper tries to put forth that each of these alternatives have some positive and negative features. It is not that these approaches are total substitutes. They can complement each other. Given the acute shortage of physical and human infrastructure, the judicious mix of all these approaches may lead to a better way of addressing the problems. A comparative matrix is provided to elaborate the relative merits of each approach. The limitations of the above approaches and the issues not touched in the paper, though of importance are also highlighted for the help of policy formulators. While each state can have its own approach, while allocating financial budget, greater funding will be needed for first 2 approaches while greater coordination with private sector will be needed in latter 2 approaches.