Economic and Financial Implications of Mental Illness - An Open Letter to the Prime Minister

Economic and Financial Implications of Mental Illness

An Open Letter to the Prime Minister

Some Time in May, 2010-Abridged part of this Article was Published in the Economic Times on the OP-ED Page (Editorial) Page on 1st June,2010

Respected Dr. Singh,

In the Life of a Nation some dates are defining. For India, August 6, 2001 was one, when dozens of hapless chained mentally ill were roasted alive at Erwadi, Tamilnadu, when fire engulfed the Moideen Badusha Mental Home. Sadly, as we enter the decadal year of the monumental tragedy, Lessons of Erwadi largely remain unlearnt.

This letter solicits your attention to the existential, institutional and policy implications of the grave malady of Mental Illness inflicting the nation. It also appeals, on behalf of muted millions, to intellect, erudition and conscience of the Prime Minister. And, there is urgency -seldom do nations get second shot at deliverance after squandering the first - 7th May, 2010 was one such date, on which following two coincidently happened simultaneously:

First, an open letter reached Union Minister of Health, architect of the letter being Hon’ble Justice Ajit Prakash Shah, retired Chief Justice of Delhi High Court. Six page letter is a factual account of state of rightlessness and non-person status of mentally ill in India. One paragraph of the letter is reproduced verbatim here “discrimination against people on the basis of diagnosis of mental illness is common place in India and even in the laws in India. If the multiple laws which sanction the discrimination are not addressed simultaneously then the persons living with mental illness will continue to be incarcerated in institutions”.

Second, latest issue of Tehelka has come out with the headline: “Someone close to you is screaming for help-LISTEN” and the byline “unattended, ignored, millions of families are struggling with someone who is mentally ill. But India has virtually no mechanisms to deal with this”. Its cover story “Mind Snare” traces the tragic debris of destroyed lives in a well-researched and objective manner. You will find the story heart wrenching and as one which brings the Naked-Naked-Truth of the suffering of mentally ill and their equally hapless care-givers. But, I doubt the article will have any lasting impact on our conscience, so deep rooted and exasperatingly imbedded is the stigma against psychiatric illness in our national psyche.

Sir, through most of human existence, 99.99% people, leave the world, having embattled their life as a symbol of inertia and cultural statis, some how managing to keep their life and family together. Dr. Manmohan Singh, over two decades has proved to be one from among that 0.01% people, who disrupt equilibrium and to whom posterity accords the status of world changers. Today the subject of Psychiatric Illness begs your personal attention, if not for the reasons of rights and inclusion as brought out by Justice Shah or for the sheer state of desperation as brought out by Tehelka, then for the sound economic and financial reasons brought out here. I dare say Sir, psychiatric illnesses as a group have turned serious deflators of Indian Economy, and the impact is 2-3% of GDP per annum.

The task of making difference to life and times of sufferers of psychiatric illness is humongous and shall remain non-starter unless championed by you. I do understand your compulsions- governmental resources are finite, and the buck stops at your level to exercise the hard choice between alternative uses of same resource. But Sir, how can the dream of Indian century be actualized if we persistently refuse to or are unable to use Whole Mind of the Nation.

I trust this letter ignites the mind of humane development economist in you and my aim is definitely not to elicit sympathy or empathy quotient for the mentally ill. Assuming we ascribe zero value to human costs of psychiatric illness, the economic costs themselves-both direct and indirect are staggering. Given the famine of even homegrown etiological and epidemiological studies of mental illness in India, for analyzing complex issue of economic and financial implications, I have relied on the external wisdom. Nevertheless, they do provide insight and replicable lessons for informed public policy:

One, during your tenure as Finance Minister, the World Bank in its 1993 World Development Report, highlighted Mental Illness as major contributor to the Global Burden of Disease. Also in 1995, a study by the Massachusetts Institute of Technology found depression costing American industry $43.7 billion annually, including $23.8 billion in lost time due to absenteeism and reduced productivity, $7.5 billion in lost earnings due to depression related suicide and $12.4 billion in direct care costs

Two, Dr. Kathleen Merikangas of NAMI and Ronald Kessler of Harvard Medical School in a study published in Archives of General Psychiatry in 2007, concluded, annual loss of 1.3 billion working days in U.S. due to mental disorders, 50% to all chronic physical conditions combined. Subsequently, in, 2008 the American Journal of Psychiatry, extrapolating from another study by Kessler et. estimated total annual economic cost of serious mental illness in US having doubled from US $ 156 to 317 billion between 1992-2002 excluding costs of comorbidity, incarceration, homelessness, and mortality. By, 2010, this annual loss is, expected to be nearly half of annual GDP of India

Three, WHO in its 2005 Report “Economies of Mental Health’’ concluded that economic costs related to mental illness accounted for 3-4% of GNP in EU nations. Also, Sainsbury Centre for Mental Health in UK estimated this cost to English Economy as Pound Sterling seventy seven billion per annum. Both these numbers are dated today.

BY 2020, the pandemonium of Mental Illness will engulf one member of every family in the country and we need Indian Next Practices and the golden touch of Manmohanomics to combat the scourge. Present dysfunctional paradigm which perpetuates incarceration of sufferers needs speedy burial. The CHOICE program of WHO provides some hope- 300 to 500 million years of healthy life could be gained for every US$ 1 million invested on mental care. The pay back period is nano-low and rate of return exponentially high. You can make tomorrow come today.

Yours Truly,
Akhileshwar Sahay
Principal Instigator
Whole Mind India Foundation