How a guerrilla campaign made history by pushing mental health into Cong, CPM’s election manifestos

On April 2, Rahul Gandhi, Sonia Gandhi, and other senior Congress leaders unveiled the party's manifesto for the Lok Sabha elections. The Congress website crashed with a huge spike in traffic. Most analyses of the manifesto focused on the usual themes - the party's universal basic income scheme NYAY, and its vision for jobs and farmers.

Not many noticed a clause in a section called "Samman" ("Dignity") in the manifesto document:

"Congress promises to implement the National Mental Health Policy, 2014 and the Mental Health Care Act, 2017 in letter and spirit. We will ensure that mental healthcare professionals are appointed in all public district hospitals and that mental healthcare services are provided in such hospitals."


On March 28, the CPI (M) manifesto had also pledged to implement the Rights of Persons with Disabilities Act and the National Mental Health Care Act, "supported by adequate budgetary allocations".

The twin developments were hailed as historic by the mental-health community on Twitter.



Why is this a big moment? For starters, India is among the world's most depressed countries. According to the National Mental Health Survey 2016, 13.7% of Indians suffer from some form of mental illness over their lifetime. And to cater to this massive population, there are fewer than 4,000 psychiatrists.

Rampant mental illness isn't just a social problem. It comes with crippling economic costs. In 2012, INR 10,000 crore was the estimated cost of outpatient treatment for mental illness. India leads the world in suicides among 15-29-year-olds, a scourge in which mental illness plays a big hand (see graphic below). In 2014, the short-term burden of suicides was estimated at INR 3,488 crore. Mental illness is also the largest contributor to the burden of non-communicable diseases in India - at more than a trillion dollars.

In 2017, India got the landmark National Mental Healthcare Act that takes a rights-based approach to mental healthcare. But while the mental-health movement acquired momentum in almost all circles of society, the political class has continued to show a jarring lack of sensitivity. Politicians still routinely invoke mental illnesses and intellectual disabilities to insult their opponents. Healthcare at large became a hot election issue thanks to big-bang schemes like Ayushman Bharat. But in this year's interim Union budget, the allocation for the National Mental Health Programme was cut from an already paltry INR 50 crore to a pitiable INR 40 crore.

It would seem that even as India got busy fashioning itself as a strong, aggressive state, its most vulnerable struggled for dignity.

Two national political parties committing to support mental health in their poll manifesto promises a significant shift in the narrative.

It also reflects the growing clout of the youth as a vote bank. Non-mainstream issues like environment and mental health resonate better with the youth, making them attractive as poll promises for political parties.

"Mental health has been ignored for a long time, to the extent that until recently it was considered a taboo," Angellica Aribam, former national general secretary of the National Students Union of India, the Congress's student wing, tells ET Online. "I am happy the Congress party has recognised the need for the implementation of a comprehensive mental health policy. This is a much welcome step. Hopefully this would be the beginning of a change in the worldview towards the subject."

Bridge the Care Gap: the makings of a guerrilla campaign
Behind this achievement is the quiet, sustained work of a loose federation of activists, mental-health workers who are also mental-illness survivors, and, ultimately, political good Samaritans with personal connections to the cause.

The improbable plan was set in motion in July 2018 by Dr Soumitra Pathare and Rajvi Mariwala.

"We were convinced that mental health needed to become a political issue, otherwise it was not going anywhere," says Pathare, who is director at the Pune-based Centre for Mental Health Law and Policy and one of the architects of India's ground breaking Mental Health Care Act, 2017.

"We wanted to build a cross-sectoral alliance. We were not asking people to join any organisation. It is an informal federation of organisations and individuals. Ratnaboli Ray (founder of Anjali, an organisation that works for mentally ill women) got involved. Ketki Ranade (chair of health and mental health at the School of Sciences and Social Sciences, Tata Institute of Social Sciences) got involved. Next, we wanted a simple, minimum agenda that everyone could agree upon. So we decided to push for the implementation of the new Act and the mental health policy."

Over 40 organisations active in mental health, gender rights, disability rights, and other fields have supported the Bridge the Care Gap campaign, including Anubhuti Trust, Sangath, The Banyan, and The Live Love Laugh Foundation.

"Everything we have managed has been organic," says Pathare. "You spread the word around. You ask friends. Somebody knows somebody. You use that as a thread to climb up the ladder and reach the people who are actually making the manifestos. It is all of us pooling our individual contacts in various places. It has been a guerrilla operation."

Along with lobbying politicians, the Bridge the Care Gap team has been running a public-advocacy campaign, urging citizens to declare that their vote will be influenced by a party's commitment to mental health. The campaign has sought to create buzz through in-person interviews with parties prior to drafting their manifestos, radio interviews with stakeholders, video-documentaries on first-person accounts from user-survivors, etc.

"We don't care which political party signs up," says Mariwala, director of the Mariwala Health Initiative, a mental-health advocacy and funding body backed by Marico chairman Harsh Mariwala. "We want all of them. We will keep on pushing."

Pathare says most parties were open to listening about the campaign, though some didn't put it in their manifestos after promising they would. Efforts are still on to find a foot through the door in the BJP.

"The government is anyway supposed to implement the National Mental Healthcare Act and the mental health policy. So the additional effort required is zero," Pathare argues. "When the Act came in the Parliament, every single party voted for it. We are only asking them to implement it now."

A logical step
Activists believe until politicians are made to realise that the mentally ill population is an important constituency that can translate into votes - like cancer or tuberculosis patients - real change on the ground is impossible.

"The only language parties understand is that this constituency could deliver a lot of votes," Pathare says.

To be fair, key functionaries in both the Congress and the CPI (M) would have been empathic to the cause. Rajeev Gowda, convener of the Congress manifesto committee, is an academic and a member of the National Institute of Mental Health Sciences (NIMHANS) in Bengaluru. CPI (M) leader Brinda Karat is also a prominent face of the equal-rights movement.

Also, there is a statistical reason supporting a mental-health campaign makes sense for the Congress and CPI (M). Three of the 10 states that top the suicide charts in India are Congress-ruled. These include Chattisgarh, Madhya Pradesh, and Karnataka (where Congress is the largest party but the chief minister is from JD (S)) - all states that it wrested from the BJP in last year's assembly polls.

For the CPI (M), Kerala and West Bengal are the most important states, and once again these states show up on the dubious list of India's suicide hot spots.

Even as the campaign basks in the early wins, there is the risk that the mental-health movement will get politicised and the agenda might get hijacked by other interests. The campaign has also not found favour with a section of the mental-health community that opposed the Mental Healthcare Act. Finally, everything will come undone unless whichever government comes to power pledges substantially more funding to fight mental illness.

But Pathare is unfazed. "Getting space in the manifestos is in itself a big step towards reducing stigma," he says. "But it is just the first step. In the next five years we have to hold parties to their promises. This could mean building some sort of observatory to maintain pressure and accountability and see how much of the commitment is really being delivered. We are also working with individual states (since health is a state subject). All this will be vital to keep the momentum going."

It remains to be seen whether the ruling party at the Centre and regional parties in various states see the logic that the Congress and CPI (M) have seen.