Ankita, a working 25-year-old, said, “Switching cities, starting a new life gave rise to anxiety and panic attacks in me, until I sought professional help and realized how deep my thoughts and actions were, then The reason for this was unknown till now.” The woman, who provides free counseling sessions at New Delhi-based Sanjeevani Society for Mental Health – an NGO operating since 1976.
Like Sanjeevani, NGOs are playing a vital role in strengthening the crumbling mental health infrastructure of the country. Over the past few decades, NGOs have been bridging the gap between affordable private health care systems and inaccessible and overburdened government facilities. These NGOs are creating low cost replicable models of care and have been active in a wide range of areas such as child mental health, schizophrenia and psychiatric conditions, drug and alcohol abuse, dementia, Alzheimer’s, anxiety and depression etc. Many NGOs even supported people in war-torn areas by providing treatment, rehabilitation, community care, research, training, capacity building, awareness and advocacy.
On World Mental Health Day, we take a look at the role of NGOs in the mental health sector in the absence of government intervention.
Bridging Treatment Gap
The World Bank defines non-governmental organizations as ‘private organizations’ that pursue activities to alleviate suffering, promote the interests of the poor, provide basic social services or promote social development.
The rise of NGOs in India can be attributed to non-availability of government services and non-availability of private systems. Psychiatrists Vikram Patel and R Thara wrote in a paper titled ‘Role of NGOs in Mental Health in India’ that there have been three changes during the development of NGOs. First, the greater degree of commercialization of NGO activities; Second, to expand the sources of funding for NGO activities to include major national and international donor agencies and last but not least to include the secular origins of NGOs.
During this, 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 major reasons for the growing treatment gap is the lack of public spending on health care. A corpus of Rs 71,269 crore was proposed for the Ministry of Health and Family Welfare in the Union Budget 2021-22, which included the budget for mental health care – a total of Rs 597 crore. Shockingly, only 7 per cent of the entire budget went to the National Mental Health Program (NMHP), Rs 57 crore for the popular Gopinath Bordoloi Regional Mental Health Institute in Tezpur and the rest. National Institute of Mental Health and Neuroscience (Nimhans) in Bengaluru (Rs 500.44 crore).
Globally, countries spend less than 2 percent of their national health budgets on mental health and are still struggling to meet the needs of their populations. Data shows that about 80 percent of people with mental illnesses live in low-income countries, of which about 75 percent never receive treatment.
Dr Soumitra Pathare, Director, Center of Mental Health Law and Policy said that the government should start seeing itself as competent to do what it should have done in terms of mental health care. He said, “As a poor country, we cannot focus on promotion and prevention. The government needs to create a policy framework where self-care, prevention and informal care is a major part so that we can get the most. No need to reach for expensive treatments.”
Pathare pointed out that mental health care requires its own service providers. He said, “We need a range of mental health service providers, not just psychiatrists and psychologists – which we have not been able to achieve so far. We need a framework or a framework where different mental health professionals can get involved. to be trained and regulated.”
While the public health system is overburdened and the total expenditure is not substantial, the private health sector has successfully monopolized the healthcare sector. Dr Sameer Parik, Director, Department of Mental Health and Behavioral Sciences, Fortis Healthcare, emphasized that, “To bridge the intolerance gap, all healthcare providers, whether public or private, need to pay attention to For example, using available resources like telemedicine – it’s a great equalizer that reduces costs, and improves outreach to a significant level.” To bridge this gap, we also need a primary intervention helpline and school level mental health education, he added.
NGOs strengthening dilapidated mental health infrastructure
Mostly in urban areas, but many NGOs have designed modules of psycho-social rehabilitation (PSR) where a spectrum of activities is included such as individual and group counseling, vocational rehabilitation and livelihood skills training, cognitive retraining, family support and counseling, self-help groups, recreational and leisure activities.
“Historically and largely, NGOs have played an important role as implementers. They have addressed issues of access, wherever the government did not have a physical presence to provide the facility. From addressing outreach to now acknowledging the need for policy making, awareness and support, NGOs have reached out and are remarkably meeting every need. Since NGOs work with a definite agenda, now the government is also reaching out to NGOs for a third approach for policy-making and better implementation,” said Dr Preeti Kumar, Vice President, Public Health Foundation of India.
Reena Nath, a New Delhi-based systemic physician who had been associated with the Sanjeevani Society for Mental Health for 17 years, said that Sanjeevani was one of the first walk-in crisis intervention centers and “it was only in New Delhi in those years.” could. “
Sanjivani still exists as a place for those who cannot afford private mental health care which is too expensive.
“It created a safe environment where people were ‘self-referential’, they heard about the center and they decided to fight the ‘South Delhi stigma’ around mental health. India needs to strengthen the overall infrastructure There is a need for more crisis centers like Sanjivani,” Nath said.
Reportedly, NGOs working with severe mental health disorders such as schizophrenia often also focus on controlling symptoms and rehabilitating the patient during the acute phase of the illness. One such example of a Chennai-based NGO is the Schizophrenia Research Foundation (SCARF). It was established to focus on a holistic approach. In case of severe mental disorders, NGOs ensure that patients are provided with vocational training in skilled occupations such as carpentry and printing, social skills training and family therapy, so that patients can lead a normal life.
Talking about the equal quality of care available in both the private and social sectors, 27-year-old software engineer Ankita, who has opted for both private therapy sessions and is also part of a social mental health support group, said, “We Everyone is dealing with something and access to treatment should be a priority so that it doesn’t get worse. “
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