People & Their Problems

New Delhi, 21 January 2018

Mental Healthcare

NEED FOR URGENT REFORMS

By Moin Qazi

An India Spend report has stated that the number of Indians suffering from mental illness exceeds that of the population of South Africa. An average of 300 people committed suicide daily in the year 2016. At present, the mentally ill account for nearly 6.5 per cent of the country’s population and it is estimated that by 2020 this number will increase to a staggering 20 per cent.

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 disorder. Many people suffer from both illnesses. This is an appalling situation staring for a sensible response from the political class.

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.

Recently, while delivering the 22^nd convocation address at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru, even President Ram Nath Kovind noted  that India is facing a possible “mental health epidemic”. He said: “For those getting their degrees at the convocation, the real challenge has just begun. They are going into a world where their skills are acutely needed more than ever before. The country does not just have a mental health challenge but is also facing a possible mental health epidemic.”

The country has only about 43 mental hospitals. Most of them 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. India ranks 11th in a list of 15 countries of the Asia-Pacific region, in a study done to evaluate various indicators of mental health care. It 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 and will have to change course and shift away from business as usual approach.

According to the Ministry of Health and Family Welfare report, India faces a treatment gap of 50-70 per cent for mental healthcare.  This implies that more than half of the population does not get the required treatment and medical facilities. 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 per cent of the total Union Health Budget, which is less than that of Bangladesh, which spends 0.44 per cent. The developed nations’ expenditure amounts to an average of 4 per cent.

The National Mental Health Survey 2015-16 conducted by National Institute of Mental Health and Neuro-Sciences (NIMHANS) estimates that 13.7 per cent 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 per cent 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, involving 3,000 people from each city found that 95 per cent of those with mental-health problems  remain deprived of treatment due to stigma and shame.

The World Bank has recently identified mental health as a Global Development Priority. The economic consequences of poor mental health are quite significant. 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 and 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. There are many forms of mental-health problems and medical science has progressed enough to be able to cure, or at least control, nearly all of them with a combination of therapy, drugs, 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 stigmatised that people adopt enforced silence and social isolation. In some cultures, family honour is so paramount that the notion of seeking psychiatric help more regularly is uncomfortable and an anathema. People are quite scary about talking of mental illness but it doesn’t need to be like that.

Several times mental-health problems are looked down upon or trivialised. 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. We should recognise mental-health problems like we would asthma or diabetes or any other health condition.

There have been some encouraging innovations in India led by voluntary organisations 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 non-profit 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 empathise 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, whose research has been applauded by TIME magazine which featured him in its annual list of the 100 most influential people in the world, 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.

We increasingly have the tools; but we need to summon the will the way game changers like Patel are doing. People like him have shown there are solutions if we think out of the box. And don't accept limits to how the world works.---INFA

(Copyright, India News & Feature Alliance)