A new report on mental health has recommended that India should establish a National Steering Committee to ensure implementation of the process of long-term institutionalization to the community-based living of mental health issues.

A report `National Strategy for Inclusive and Community based Living for Persons with Mental Health Issues prepared by the Hans Foundation on the recommendations of the Ministries of Health and Family Welfare and Social Justice and Empowerment has suggested that the National Steering Committee –under the aegis of the Ministry of Health and Family Welfare  should function as leadership and stakeholder collective to pursue shared visions of moving from long-term institutionalization to community-based alternatives. 

It has suggested that the Committee should create and implement an expansive Community Care System that allies with the Social Care Sector to keep pace with supports needed when people move out of hospitals and decisively alter progressions and re-entry into homelessness and long-term institutionalisation.

Designate investments for defined pathways out of hospitals with accompanying legislative and policy support, particularly to support discharges into community living alternatives. It has also recommended financial support also for such people.  

Some other recommendations made in the report are to align efforts of community placements with key social entitlements linked to the Community Care System – disability allowance, voting rights, banking access, ration card – that can positively impact social inclusion and long-term sustainability of placements. 

Overhaul the Institutional Care System to embrace effective, appropriate, high quality, rights-based emergency and acute care, the report has said while asking for re-imagining care by separating it from Âcontrol and Âmanagement and enhance quality across domains from personal grooming and menstrual hygiene choices to access to diverse choice-based work engagement options. 

In addition to enhancing staff capacities so that they can embrace contemporary modes of care, the report has also suggested decentralising bed capacities from hyper-segregated, large facilities to localised services in District – and Taluk-level hospitals. 

ÂIntroduce a Family Assistance Scheme or Cash Transfers to support Family Placements when households face socio-economic distress. Set up a national network online with a database management system to record, monitor, track, update status with a view to enabling a robust aftercare system in place,ÂÂ the report has said.

It is imperative to recognize and urgently restore the right of people with psychosocial disabilities to live in the community, with flexible support that enables them to make choices about and exercise agency over their care and daily living, and engage in lived experiences with personal meaning, the report has said. For this right to become a reality, governments need to increase financial investment defined by policy and accompanying National Scheme for Personal Assistance and Housing Options to promote community living for people with long-term care needs, the report has said. 

A national-level movement for inclusive living options for people living for extended periods in state mental hospitals has the potential to contribute to social justice and human rights, alter stigmatizing notions of mental ill-health and change the landscape of mental health care in the country, the report says. 

The aim of this study was to evolve a comprehensive national strategy for inclusive and community based living for persons with mental health issues.

In the Indian context, where 10.6% of the population is estimated to be living with mental health issues, 13.7% have experienced a mental illness at some point during their life. Consistent with global trends, those with low educational attainment (less than primary level schooling) and low-income households have higher rates of prevalence. Income disparities lead to stark biases in health including mental health – low-income households are estimated to have a 40% higher prevalence rate of mental disorders than households in the highest income quintile.14 Among the 150 million Indians in need of mental health services, fewer than one in ten with common disorders and only 40- 50% of those with serious mental disorders are receiving any form of care.15 There are only 0.8 mental health nurses, 0.06 social workers, 0.07 psychologists, and 0.29 psychiatrists, per 100,000 people.16 The number of mental health hospital beds is around 2 per 100,000, well below the world average of 6.5 per 100,000.17 Only 1.3% of health expenditure in India is set aside for mental health, mainly concentrated in upgrading tertiary care, state mental hospitals into Centres of Excellence.