A policy for mental healthcare

The Meghalaya government putting its draft mental health policy in the public domain on World Mental Health Day is a laudable initiative. It has become the third state in the country after Kerala and Tamil Nadu and the first state in the northeastern region to come up with a mental health policy. The Meghalaya Health and Family Welfare Department have published the draft on its website for public consultation and the opportunity must not be missed by stakeholders to enrich it with pragmatic suggestions. The policy aims to "promote overall mental health and wellbeing and facilitate appropriate access and care pathways for common and severe mental health concerns" and "to reduce the extent of disability, morbidity, mortality, and social suffering." Five key strategic priorities of the draft policy are: strengthening health and social care systems, focusing on person-centred care, building an accessible dissemination platform for health information, focusing on life satisfaction, hope and cultivating constructive emotions, early identification and appropriate care and referral for Common Mental Disorder (CMD) and early identification and appropriate care and referral for Severe Mental Disorder (SMD). Citing from the records of the District Mental Health Programme (DMHP), the policy sheds light on the prevalence of commonly observed mental illness in the state. The figures of a number of reported cases in 2021-2022 which include 1684 cases of depression, anxiety disorders-1315, bipolar affective disorder-1151, schizophrenia-2822, Psychosis-1769, intellectual disability-911 and 1315 cases of mood and anxiety disorder among others are a tip of the iceberg. The DMHP is operational in all 11 districts of the state with Public Health Centres as the basic unit but only two of 11 district teams have a psychiatrist who treats common and severe mental disorders and in the rest nine districts medical officers trained by a psychiatrist may treat cases which do not require hospitalization. The recommendation in the policy for conducting a comprehensive screening and identification exercise across the state, in combination with a strong data-management system, in order to determine the true prevalence and incidence rates and address any data gaps or discrepancies in different sources is timely advice to ensure early intervention. The policy paper identifies interpersonal conflict (with family, friends, at the workplace), loss of employment, financial pressure, land disputes, peer pressure and exam-related stress as "important psychosocial stressors, triggering mental distress," and finding sustainable solutions to address these problems is crucial for the management of the overall mental health situation. Delayed identification of mental health concerns coupled with stigma and poor mental health literacy, poor coordination within and across departmental care teams affecting the continuity and consistency of care and the outcomes of interventions that are intended to reduce disability and improve community inclusion are some of the key challenges and gaps which the policy seeks to address. Specific vulnerable groups sought to be reached out to through the policy include children and adolescents, women, the elderly, migrant groups, persons living in poverty, persons requiring long-term care support, and homeless persons with severe mental issues. This will require building a comprehensive healthcare system for reaching out to every single household. It has flagged the issue of inadequate human resources to address the issues of mental health in the state and mentions that mental health professionals take on a large workload because there are so few trained professionals in the state and the state creating the required pool of trained mental health professionals will be vital for successful implementation of the policy. The Meghalaya policy is articulated on the basic premise of the National Mental Health Policy of recognising mental health as a basic right and focusing on community living, special attention to vulnerable groups, coordination and convergence between health and social sectors and lessons learnt in the implementation of the national policy will be useful in preparing the roadmap of implementation in the state. National Mental Health Survey findings presented a harsh reality that of about 150 million Indians, who are in need of mental health care service, less than 30 million seek care. According to estimates from the World Health Organization, the cases of anxiety and depressive disorders rose by 25% during the first year of the COVID-19 pandemic. The cascading economic crisis precipitating anxieties is a serious challenge that needs to be addressed by national and state governments with poverty alleviation and social welfare programmes and other measures on a priority basis. Building awareness in the community on mental health is crucial for timely institutional care and treatment. A state policy aligned with the national policy and addressing specific issues of the state with clear objectives and vision can bring about a radical change in the overall situation if the necessary budgetary support is provided. Active participation of every non-government stakeholder will be critical for the successful implementation of the policy to be adopted after public consultation. Other Northeastern states can take a cue from Meghalaya.