Budgeting a Beg for Well-Being
PAYING THE COST OF THE PANDEMIC IS NOT GOING TO BE EASY WITH SLASHED ALLOCATION TOWARDS THE PILLARS OF CARE
26th February, 2021
Written by Muskaan Palod
Artwork by Ojaswi Kejriwal
The budget should ideally have been designed not just to cover COVID, but the price of this virus that shall have to be paid for the many years to come.
While the pandemic continues its threat, perhaps in belittling effect and some relief with the vaccine drive, there is still an unaddressed epidemic set loose in the country. This epidemic is of emotional, mental and largely a lot about one’s nervous system health. This epidemic has probably stayed with us for the longest time and continues to pose its threat for longer than one can fathom. Resilience to this epidemic is not provided for with a vaccine or with herd immunity. There are layers of privilege and oppression to be overcome, to fully realise the reality of life beyond disease for those with one; and mind you, most of us have it at some point in our lives. This epidemic concerns the mental health of the citizens, left ignored, reduced to being a matter of ridicule, or a joke at best. An average citizen, in their inability to access required care, is left with no choice but to write blog pieces like these, sometimes in angst, but mostly in grief.
There have been no statistics that have proven to be glaring enough, to date, to substantiate the need for proper institutionalised mental healthcare in the country. To have that expectation from the Union Budgetary would have been a dubious one. However, having the whole whirlwind around famous celebrities dying of suicide, the agrarian crisis coming to centre focus, and the digital divide in the educational spectrum, we saw some cases highlighting collective grief in the past year. These reflected the need to have better discourse around mental health, one surrounding community care and of course, the need to bridge the gap between those who can afford therapy and those who cannot.
The budget should ideally have been designed not just to cover COVID, but the price of this virus that shall have to be paid for the many years to come. Finance Minister Nirmala Sitharaman, in the Union Budget 2021-22, proposed an outlay of Rs 2.23 lakh crore towards health and well-being. That's a 137% increase over the Rs 94,452-crore budgeted expenditure on healthcare in the ongoing fiscal. It is interesting to note, even in the near-death of well-being, the allocation to mental-health was slashed to being less than 1%, a total of Rs 597 crore.
How is the budget allocated?
You would expect that a significant percentage of this meagre amount would go to the National Mental Health Programme (a national government scheme, meant to be applicable and accessible across the country). However, the majority of this money has been set up for two centres of education and research, Rs 500 crore for Bengaluru based National Institute of Mental Health and Sciences (NIMHANS) and Rs 57 crore for Lokpriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur. only seven per cent of the mental health budget has been allocated for the NMHP, ie, 40 crores of money actually (ideally meant to be) invested to advocate, prevent, and for intervention purposes in a country of 1.38 billion people. Let me reiterate other already known facts about mental illnesses in this space.
According to a 2017 Lancet study, 1 in every 7 people in India had a mental disorder ranging from mild to severe. Additionally, with only 0.29 psychiatrists per 100,000 people, India faces a severe treatment gap in meeting mental health care needs; the situation during COVID-19 times is likely to have only gotten bleak. Mental health practitioners are overworking, reaching their care-fatigue in psychoeducation online and counselling services. In the very limited research in the country, it has been estimated that according to the numbers, 56 million Indians suffer from depression and another 38 million Indians suffer from anxiety disorders. This is alarming. One cannot understand mental illness without understanding mental health. It is not “just” your mind, it is your nervous system, it is your entirety. Learning to regulate and co-regulate the nervous system is a lot of political work; lack of which is the cause of a lot of developmental trauma across sections of society in the country. Where the GoI draws the line of parity between the physical and the mental in the healthcare industry is alarming, infuriating and speaks a lot about their dysfunctional understanding of human health.
While there is a general lack of awareness, a lot has to be accredited to the loss of resources, loss of safety, lack of institutional support for housing, employment and rehabilitation.
There are policies in place to facilitate better care for individuals and communities, however, because of the lack of budgetary allocation, we have never seen it translate into practice. The taboo and stigma simply get thrown around on a loop. Funding for medical research should ideally not be determined by the profitability in money, but by the potential it proposes to save and improve the life-course of individuals.
We have to understand how systemic India’s mental healthcare crisis is. While there is a general lack of awareness, a lot has to be accredited to the loss of resources, loss of safety, lack of institutional support for housing, employment and rehabilitation. Abuse lingers in every corner, justice remains a far-fetched service, and not an entitlement by the virtue of being human.
While psychotherapy remains to be a privilege afforded by very few, there are different other community programs that could have substantially improved lives. The one space that has not gotten its due credit in being the face of care providers, especially during the pandemic is the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGA). In addition to providing employment to the daily wage labourers in the villages, MGNREGA has proved to be crucial in the development of basic infrastructure in the villages, which was called an opportunity in disaster and under the self-sufficient India package. However, the Union Budget 2021 has made a 35 per cent lesser allocation (than 2020-21 Revised Estimate) of 1,10,568 crore allocation towards the MGNREGA in its Budget estimate (BE) 2021-22.
In May, Sitharaman had raised the allocation by another Rs 40,000 crore to help generate a total of 300 crore person days’ work to mitigate the impact of the coronavirus-induced lockdown on the rural economy. The allocation was made in the fifth and final tranche of the government’s Rs 20-lakh-crore economic package. How will this prove to be near enough to provide for the grief-stricken labour groups? The economy is not subject to autonomy over its own resilience.
Does the government imagine the rural distress has come to an end? Well, with absolutely no data recording, we can assume the GoI can afford to live in the shock-saving bliss of denial.
The MGNREGA was the sole lifeline for the acute migrant crisis the country saw. There has also not been any urban employment scheme offered as an alternative. Only a sharp rise has been observed in the number of people dependent on the rural employment scheme for their sustenance. Does the government imagine the rural distress has come to an end? Well, with absolutely no data recording, we can assume the GoI can afford to live in the shock-saving bliss of denial.
“Given the acute and widening economic inequalities in India, the Budget could have been an opportunity to strengthen MGNREGA and stem distress migration to cities”, said Rajendran Narayanan, assistant professor at Azim Premji University.
Throughout the speech, the Finance Minister focused on allocation towards large infrastructure schemes and initiatives that will create employment opportunities. However, they are unlikely to be realised anytime soon for they are largely capital-intensive, with way longer gestation periods than the country can possibly afford. There is a lot amiss and I wonder if the one who profits off this budgetary planning is anyone other than the crony big-pocketed capitalists. The large scale privatisation, big cuts in rural schemes only hints at self-reliance translating to be servility at the hands of big corporates.
How does the MGNREGA relate to the health landscape?
We experience ecological distress in our bodies. The panic, grief, helplessness and despair at the hands of loss of employment or home can be intensely disabling. The number of deaths by suicide is at an all-time high, again a database completely missing by the GoI. Healthcare is a lot about one’s social location and ability to move. Sharing distress with trusted community spaces can help bring one back to regulated nervous system states, therefore programs and initiatives like MGNREGA are extremely crucial for the “well-being” the budget aimed for.
With the tightest fiscal space of all times, the Government choosing to maintain its Defense allocation static and cutting through necessary rural access programs and mental health allocation was disastrous.
Every single person deserves nutritious food, comfortable housing, comprehensive healthcare, transportation to get around, access to education, well paid, meaningful work and protective ecologies. These are basic human needs. While water was acknowledged as one, we are far from acknowledging the rest of our human needs as part of the budgetary focus.
Infantilising, romanticising, exoticising and monolithicising people in the struggling rugs, living with poverty, living with mental illnesses is easy. There needs to be a constant investment into the creation and development of trauma-informed communities and work spaces where the disablers of the society will be acknowledged, understood and the disabled would be accommodated and accepted.