India’s current mental health crisis is precipitated by three key challenges. Firstly, poverty-related structural stressors exacerbate mental health issues for low resource populations who have limited pathways to access care. Secondly, there is a lack of demand due to low awareness and stigma (though beginning to change among some populations, as found by a recent study by Sattva for Live Love Laugh Foundation). And thirdly, there is a dearth of a strong supply-side infrastructure to address and solve for this at scale—India has only 1.93 mental health workers per 100,000 people. Pandemic has worsened this crisis — India lost more people to suicide than to Covid-19 in 2020.
While there have been efforts across multiple stakeholders to advance mental healthcare priorities, and policy level emphasis through the Mental Health Care Act 2017 (including the recent provision in the budget for 24x7 free tele counseling for mental health), this is an area that has been chronically underfunded by the philanthropic sector.
Philanthropy actors across foundations, multilaterals as well as CSRs have invested in the health sector as a broad area of focus. However, mental health has got very little investment and attention. The current network of PHCs — while by no means adequate — has been leveraged to implement large scale public health initiatives in areas such as maternal and child health as well as immunization, which have gone a long way in improving critical health indicators.
The need for stronger capacity building as well as more local accountability and contextualisation for mental health interventions to be seeded and scaled effectively. Technology is an important catalyst; where it is also critical to have a human element embedded to ensure community-based contextualized care.
The philanthropic sector can be a catalyst in helping to leapfrog access to this care. Philanthropic entities (Foundations and multilaterals, HNIs and CSR initiatives) can take a two-pronged approach, a) supporting necessary programmatic interventions to address immediate needs and b) focusing on system-level strengthening, to enable appropriate, evidence-based care for the long-term, in a sustainable manner.
Clear pathways for philanthropic intervention and support in the following systemic areas emerge out of the analysis of the current mental healthcare ecosystem. The leadership in stakeholder organisations — government bodies, corporate firms, not-for-profits, other implementing agencies — must be sensitised to mental health issues. Interventions are needed to initiate conversations and steer a paradigm shift in the approach, to ensure mental health is a core part of diverse initiatives that are being designed with and for the community. Using an evidence-based approach, a common nomenclature must be established and universal concepts must be defined, to ensure consistency in service delivery at scale.
Stakeholders could benefit from developing a collaborative approach that enables creation of commons, and a platform for continuous sharing of data and best practices. Philanthropic spending could be directed towards building ecosystem-level assets that enable information flow, data culture, evidence-building, and dissemination of best practices, which will increase efficiency, reduce duplication of effort and encourage innovation amongst service providers.
Digital platforms have emerged as a viable avenue for healthcare delivery, particularly in the post-pandemic scenario. There is value in creating responsive platforms for mental healthcare delivery, as well as channels for product innovation that facilitate peer-to-peer learning. Intervention in existing areas, including mental health awareness, skilling of healthcare personnel and quality management in service delivery, is a priority.
Mental healthcare delivery involves a multitude of aspects that require resources and problem-solving. However, philanthropic organisations can make an impact by identifying the right focus areas, selecting a viable approach and enabling experiments across different care delivery models. It is through a combination of such models, propelled by philanthropic funding, that an effective, replicable approach to mental healthcare could emerge.
(The writer is the Principal,
Sattva Consulting)