Mental health crisis in India

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Manifest Pedagogy:\

Mental illness is an amalgamation of biological, social, psychological, hereditary, and environmental stressors.Though Mental Health Act 2017 has granted patients the legal right to live with dignity without discrimination, coercion and harassment, the endeavour in this segment is too scattered and lacks focus and coordination.To address the mental health issue promotion of awareness through campaigns, utilising celebrities and social influencers, mobilising the support of NGOs, deeper engagement of local communities and local governments are some of the measures which could improve outcomes

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According to the World Health Organisation (WHO), mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

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• Although Covid contributed to bringing the topic of mental health out of the closet, the current crisis started developing well before the pandemic.
• Mental health problems have been growing rapidly over the last few decades, but our infrastructure has remained woefully inadequate.
• Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990. 
• In 2017, an estimation of the burden of mental health conditions for the states across India revealed that as many as 197.3 million people required care for mental health conditions. 
• This included around 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders.

Facts related to the matter

• The World Health Organisation reported in 2017 that there were about 9,000 psychiatrists practising in India, which equates to 0.75% per lakh of people.
• WHO estimates that the ideal ratio is three psychiatrists for every lakh of people. Similarly, India has 1.93 mental health care professionals per 10,000 residents, compared to the global average of 6.6.
• An estimated 15% of working-age adults have a mental disorder at any point in time.
• Depression and anxiety are estimated to cost the global economy $1 trillion each year driven predominantly by lost productivity, according to the WHO.

Covid-19 a great disruptor of people’s lives

• COVID-19 a great disruptor of people’s lives with its uncertainties and the economic recessions,women, young people and disadvantaged communities have been much worse hit due to the potential loss of income and work, school shutdowns and an increase in domestic violence and household work for women during lockdowns.
• Serious mental disease patients depend on routine care. For many who require such ongoing care, the shutdowns were disastrous. 
  • Although the full effects have not yet been documented, they seem to be pervasive and quite palpable for many of us,
• A 2022 WHO report mentioned that there was a 25 per cent increase in anxiety and depression among people.
• When Covid caught people off guard, they were all taken aback by the rising mortality rate; it was portrayed as a deadly disease with no effective treatment.
  • Anxiety about one’s own and other family members’ health became a prominent cause of anxiety increase. 
  • Also, this was the first time we had been hit by a virus with such high mortality, and people had never experienced lockdown before. 
• Covid increased people’s reliance on the digital world and social media and were exposed to a lot of unverified information which resulted in a significant increase in anxiety and depressive disorders.
• Increase in anger and irritability in some people. 
  • Some people were so afraid of being infected by the virus that they went overboard to maintain hygiene, started washing their hands and using hand sanitizers excessively, which led to compulsive disorder in some people.
• Children-The transition from having a routine, familiar school environment and playing, to having no friends to spend time with and being confined at home had a significant impact on children.
  • Children suffering from psychological disorders. 
  • Furthermore, because all of their education was confined to online classes, most of the children were given devices for classes, and many of them became addicted to digital devices. 
  • Screen addiction in children increased dramatically

Challenges Related to Mental Health in India

• Lack of Awareness: Most of the mental health patients are not aware that it is actually a disease of concern and remain untreated. 
• Social Stigma-Poor awareness about symptoms of mental illness, myths & stigma related to it, lack of knowledge on the treatment availability & potential benefits of seeking treatment, makes a large number of patients deprived of care.
• Mental Health Resources-There is a considerably low proportion of the mental health workforce in India (per 100,000 population) including psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07).
• Poverty-Individuals with lower levels of education, low household income, lack of access to basic amenities are at high risk of mental disorder.
• Mentally ill patients are vulnerable to discrimination, physical and sexual abuse, wrongful confinement, even at homes which is a cause of concern and a gross human right violation.
• Education-Due to lack of stress on personalised and holistic educational structure in India, a large % of students show signs of mental disorders. Shockingly, every 1 hour a student commits suicide in India.
• Post-Treatment gap: There is need for proper rehabilitation of the mentally ill persons post his/her treatment which is currently not present.

Steps Taken by the Government

• Constitutional Provision: SC has held healthcare to be a fundamental right under Article 21 of the Constitution.
• National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the National Mental Health Program (NMHP) since 1982.
  • The Program was re-strategize in 2003 to include two schemes, viz. Modernization of State Mental Hospitals and Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals.
• Mental HealthCare Act 2017: It guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
• It has significantly reduced the scope for the use of Section 309 IPC and made the attempt to commit suicide punishable only as an exception.
• Kiran Helpline: In 2020, the Ministry of Social Justice and Empowerment launched a 24/7 toll-free helpline ‘Kiran’ to provide support to people facing anxiety, stress, depression, suicidal thoughts and other mental health concerns.
  • Manodarpan Initiative-An initiative under Atmanirbhar Bharat Abhiyan aims to provide psycho-social support to students for their mental health and well-being.
•  Tele Mental Health Assistance and Networking Across States (Tele-MANAS)-A toll-free, 24/7 helpline number (14416) has been set up across the country allowing callers to select the language of choice for availing services.

Suggestions for good mental health

• Ensuring that one invests in relationships and support system, need to collectively prioritise mental health, creating awareness and access as well as early identification
• National mental health policies should be concerned both with mental disorders and with broader issues that promote mental health. 
• Mental health promotion should be mainstreamed into governmental and non-governmental policies and programmes. 
• More human resources– More Psychologists, psychiatrists, nurses and social workers.
• Support children through life skills programmes, child and youth development programmes, mental health promotional activities in schools.
• De-Stigmatizing Mental Health: This apathy can be mitigated if the focus shifts from viewing mental health as a negative concept to a social responsibility of improving health literacy, setting up self-help groups, and providing emotional support to the concerned.
• Concerted Suicide Prevention Strategy: India needs a ‘Concerted Suicide Prevention Strategy’ at the national, state and local level.
• Programmes targeted at vulnerable people, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters)
• Promoting an environment that respects and protects basic civil, political, socio-economic and cultural rights.
• Community development programmes (e.g. integrated rural development); poverty reduction and social protection for the poor; anti-discrimination laws and campaigns.

Wayforward

• There is a need for massive awareness and sensitivity to tackle the issue of mental health.
• It is crucial to deconstruct the stigma related to mental disorder, through targeted awareness-raising and outreach through campaigns, utilising celebrities and social influencers.
  •  For example, Deepika Padukone talking about her struggles with mental health.
• The increase in the expenditure in mental healthcare in the overall budget.
• Expansion of yoga and meditation would also provide enormous relief.
• Need to build more inclusive and resilient healthcare infrastructure incorporating mental health aspects with emphasis on collective social health, access to affordable and quality care

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