In the Shadows: India’s Mental Health Crisis

Among the many challenges India faces, the most under noticed is the mental health crisis. In his recent address at the  22nd convocation of National Institute of Mental Health and Neurosciences (NIMHANS)  the President Ram Nath Kovind cautioned  that India is facing a possible ‘mental health epidemic’. “The number of affected in India is larger than the entire population of Japan. We need to address this gap and ensure that by 2022 at least those who are suffering from severe mental disorders have been diagnosed and have access to treatment facilities. Let us take it up as a national mission,” he said.

The importance of emotional and mental health in the overall wellbeing of an individual and its impact on national economy and growth is now being increasingly acknowledged. At present, the mentally ill account for nearly 6.5 percent of the country’s population and it is estimated that by 2020 this number will increase to a staggering 20 percent.

Further, the World Health Organisation (WHO) estimates that nearly 56 million Indians, that is 4.5% of India’s population, suffer from depression. Another thirty-eight million Indians, or 3% of India’s population, suffer from anxiety disorders including panic attacks, phobias, post-traumatic stress disorder, and Obsessive-Compulsive Disorder. Depression is the single largest contributor to   disability.

The pathetic state of mental health care in the country and the apathy of government is a cause for great concern. The plausible reason is the sheer scale of the problem .Hence nobody wants to discuss about the elephant in the room. But the nation cannot afford to ignore the stark realities .There are only about 43 mental hospitals in the country  and most  of them are in disarray  .they lack essential infrastructure and treatment facilities and have a sickening ambience. Visiting private clinics and sustaining the treatment — usually a long drawn out affair — is an expensive proposition for most families.

According to the Ministry of Health and Family Welfare report, India faces a treatment gap of 50-70 percent for mental healthcare. The government data highlights the dismal number of mental healthcare professionals in India — 3,800 psychiatrists, and 898 clinical psychologists. A large number of them are in urban areas .The WHO reports that there are only three psychiatrists per million people in India, while in other Commonwealth countries, the ratio is 5.6 psychiatrists for the same. By this estimate, India is short of 66,200 psychiatrists.  Mental health accounts for 0.16 percent of the total Union Health Budget, which is less than that of Bangladesh, which spends 0.44 percent. The developed nations’ expenditure amounts to an average of 4 percent.  ..  India must find better ways to parlay its impressive economic growth into faster progress in this critical area .it has till now looked at it only with a distant lens.

The National Mental Health Survey 2015-16 conducted by National Institute of Mental Health and Neuro-Sciences (NIMHANS) estimates that 13.7 percent of the Indian population above the age of 18 suffers from mental morbidity, requiring active intervention. It also suggests that one in every 20 Indians suffers from depression and nearly 1 percent of Indians suffer from high suicidal risks. A survey by conducted by  All India Institute of Medical Sciences (AIIMS) in collaboration with WHO  across 11 centres in the country, involving3,000 people from each city found that 95 percent of those with mental-health problems  remain deprived of treatment due to stigma, shame  and being shunned from  societies. Three age groups are particularly vulnerable to depression – pregnant or post-partum women youth, and the elderly.

The economic consequences of poor mental health are quite significant. The cognitive symptoms of depression like a difficulties in concentrating, making decisions and remembering cause significant impairment in work function and productivity A World Economic Forum/Harvard School of Public Health study estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to $16.3 trillion between 2011 and 2030. In India, mental illness is estimated to cost $1.03 trillion (22% of economic output) between 2012-2030.

The fact is that poor mental health is just as bad as or maybe even worse than any kind of physical injury. Left untreated it can lead to debili­tating, life-altering conditions.   Medical science has progressed enough to be able to cure, or at least control, nearly all of   the mental-health problems with a combination of drugs, therapy and community support. Individuals can lead fulfilling and productive lives including going to school, raising a family and pursuing a career.

Although mental illness is experienced by a significant proportion of the population, it is still seen as a taboo. Depression is so deeply stigmatized that people adopt enforced silence and social isolation.  In villages there   dreadful cases of patients being locked up in homes during the day, being tied to trees or even being flogs to exorcise evil spirits. In some cultures family honour is so paramount that the notion of seeking psychiatric help more regularly is uncomfortable and an anathema. We should recognize mental-health problems like we would asthma or diabetes or any other health condition.

Several times mental-health problems are looked down upon or trivialized. These barriers deprive people of their dignity. We need to shift the paradigm of how we view and address mental illness at a systemic level. Tragically support networks for the mentally ill are woefully inadequate. There is need of an ambience of empathy , awareness and acceptance of these people so that  prejudices dissipate and patients are able to overcome stigma and shame .

We must push the conversation about mental illness forward whether it be in the classrooms or workplaces or with our families, neighbours and friends. These issues are real and lethal, and the first means of prevention is acknowledging their existence. People are quite scary about talking of mental illness but it doesn’t need to be like that .to get real relief they  have to come out  of the shadows, patients should be coaxed  and counseled   to open   up    feelings about their pain. This has a powerful cathartic effect.

There have been some encouraging innovations in India led by voluntary organizations that are both impactful and replicable .Dr Vikram Patel, who is a professor at the London School of Hygiene and Tropical Medicine and co-founder of Goa-based mental health research nonprofit Sangath   has been in the forefront of community mental health programmes in Central India.

It deploys health workers, some with no background in mental health. These workers are trained to raise mental health awareness and provide “psychological first-aid”. Since they are drawn from the same community, they are able to empathies with the patients .The next consists of mental health professionals. The programme uses Primary Health Centres for screening   people with mental illnesses.

According to Patel, mental health support workers can be trained at a modest cost. Given the limited availability of mental-health professionals, such first-aid approaches can be suitably and successfully adapted to community needs with limited resources. The senior therapists  can be given basic training in general medicine, psychology, psychiatry ,psychopharmacology, social work and patient management

Community mental health services a can offer a mix of clinical, psychological and social services to people with severe, moderate and mild mental illnesses. These can be provided by teams including mental health professionals, occupational therapists, social workers, psychologists, and peer workers. Counseling can make a profound difference and build resilience to cope with despair. Providing psychoeducation to patients’ families can also help. Unfortunately, in recent decades academic psychologists have largely forsaken psychoanalysis and made themselves over as biologists.

We can turn the tide in the struggle of these people through the simple power of compassion. With this contribution, we can become a powerful force for lifting the dark shadows.

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Moin Qazi, PhD Economics, PhD English, is a member of the TRANSCEND Network for Peace Development Environment and author of the bestselling book, Village Diary of a Heretic Banker. He has worked in the development finance sector for almost four decades in India and can be reached at moinqazi123@gmail.com.

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