Can India embrace WHO’s push for community-based mental health care? What are some challenges?

Saima Wazed, WHO Regional Director for Southeast Asia, addressed the pressing issue in a virtual meeting focused on “Transitioning from long-stay services to community mental health networks: towards deinstitutionalisation in the Southeast Asia Region”. She highlighted the transformative potential of community-based care, emphasising its role in enhancing personal autonomy, reducing stigma, and ensuring more personalised and effective care.

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A shift to community-based care 

WHO urged the Southeast Asia region to prioritise the shift from long-stay institutional to community-based mental health services to make them accessible, equitable, stigma-free, and enabling productive lives.

“Transition to community care benefits individuals and society by reducing judgement, increasing autonomy, enhancing the quality of life, and offering persolnalised care,” said Wazed.

She underscored the grim reality of the treatment gap, which stands at a staggering 95 percent, coupled with over two lakh suicides annually in the region. Wazed lamented the plight of individuals confined within long-stay mental institutions, citing inadequate treatment, segregation, abysmal conditions, resource scarcity, and overcrowding as recurrent issues.

“The shift to community-based care is motivated by the negative effects of long-term institutionalisation, treatment advancements, and recognition of patients’ rights and dignity,” she emphasised.

The reliance on institutionalisation is being reevaluated as understanding of mental health care evolves, she said.

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The ‘community services for mental health’ model

Meanwhile, shedding light on the virtues of community services, Wazed elucidated how they facilitate early identification of mental health issues, alleviate burdens on emergency services, and reduce overall care costs, thereby yielding superior outcomes and broader coverage.

The report further expounded on how community care cultivates supportive environments, fostering public empathy and understanding, consequently mitigating stigma.

However, for deinstitutionalisation to be a resounding success, meticulous planning, collaborative efforts, adequate funding, and continuous monitoring, alongside the expansion of community services and networks, are imperative, as articulated in the report.

Moreover, WHO advocates for the establishment of community resources such as housing, job opportunities, vocational training, and support networks, viewing them as indispensable for facilitating a smooth transition and reintegration. The report underscores the pressing need for training law enforcement officials, educators, and mental health professionals to ensure the full community inclusion of individuals grappling with mental disorders.

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Is deisntitutionalsiation, community service feasible?

Despite the undeniable merits and WHO’s fervent endorsement of community-based mental health care, implementing such a system in India presents significant challenges, asserts Dr Alok Kulkarni, a senior interventional neuropsychiatrist from the Manas Institute of Mental Health and Neurosciences in Hubballi.

Dr Kulkarni attributes this challenge to a dire shortage of mental health professionals compounded by deep-seated stigma and cultural barriers hindering individuals from seeking help.

“Moreover, the integration of mental health services into primary healthcare remains a logistical and policy-driven hurdle, with insufficient funding further exacerbating the situation,” he told South First.

Dr Kulkarni said that the transition from institutional to community care is not just a matter of shifting locations but involves a fundamental change in the approach to mental health treatment.

“It requires building a supportive infrastructure, training healthcare providers, and most importantly, changing public perception towards mental health,” Dr Kulkarni explained.

Challenges galore

Echoing similar sentiments, Dr Preethi Galgali, an adolescent health counsellor, acknowledges the feasibility of deinstitutionalisation in India but underscores its inherent challenges. “We are a collectivist society; this is our strength. Unfortunately, this is getting replaced by individualism due to Westernisation,” she told South First.

Dr Galgali attributes these challenges to societal characteristics like poverty and illieracy, emphasising the need for intense policy commitments to enhance health literacy and promote community and family-based care for severe mental disorders.

“It would require an intense commitment at the policy and governmental level, in terms of training and improving health literacy, and follow up initivatives to provide community and family care for severe mental disorders including rehabiliation and vocation,” she said.

Dr Galgali emphasised the importance of partnerships and teleconsultations between tertiary mental healthcare institutions like NIMHANS and grassroots healthcare professionals to extend community care to resource-depleted and vulnerable populations.

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Already in existence?

On a more optimistic note, Dr NR Mutalik, Professor and Head of Psychiatry at S Nijalingappa Medical College in Bagalkot, asserted that India has already laid the groundwork for implementing WHO’s recommendations. “India, as part of the District Mental Health Programme (DMHP), under the National Mental Health Programme (NMHP), has already recommended to decentralise mental health services and provide mental health service at the community level, by integrating mental health with the general healthcare delivery system,” he told South First.

He elaborated on the National Mental Health Programme (NMHP), which India adopted back in 1982, positioning the country as one of the first developing nations to embrace such an initiative.

This programme is designed to ensure the availability and accessibility of basic mental healthcare for all, particularly targeting the most vulnerable and underprivileged segments of society, Dr Mutalik said. It aims to integrate mental health knowledge into general healthcare and social development, fostering community participation in mental health services.

A burgeoning trend in mental health services is the adoption of digital platforms, including telemedicine and mobile apps, to deliver care. These technologies hold the promise of enhancing access to mental healthcare, especially in remote or underserved areas.

However, Dr Jamuna Rajeswaran, Head of the Department of Clinical Psychology at NIMHANS in Bengaluru, injected a note of caution. She asserted that while the aspirations outlined in the report are commendable, their realisation hinges on societal acceptance.

“Are we ready to accept these people into our fold? The answer is a big NO. Though there has been increase in awareness about mental health among people post-pandemic, acceptance is still at its infancy,” she argued.

(Edited by Kamna Revanoor)