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India cannot afford to ignore mental health

By Moin Qazi

An India Spend report has stated that the number of Indians suffering from mental illness exceeds the population of South Africa. At present, the mentally ill account for nearly 6.5% of the country’s population. It is estimated that the same will increase to a staggering 20% by 2020. Further, the World Health Organisation (WHO) estimates that nearly 56 million Indians, that is 4.5% of India’s population suffer from depression. Thirty-eight million Indians or 3% of India’s population suffer from anxiety disorders. Many people suffer from both illnesses. Most of these illnesses can be treated, but access to treatment is often difficult. Moreover, the stigma continues to scare individuals away from seeking diagnosis and appropriate treatments even when available.

As the world observes World Mental Health Day on October 10, India must renew its efforts to improve its mental health services. The abysmal state of mental health care in the country is a cause for great concern. Hence, the nation cannot afford to ignore the stark realities. Most government-run hospitals do not have psychiatric drugs or a visiting a private psychiatrist. Furthermore, sustaining payment for long-term treatment is an expensive proposition for most families.

India’s mental health crisis

According to the Ministry of Health and Family Welfare report, India faces a treatment gap of 50-70% for mental health care. 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, 898 clinical psychologists, 850 psychiatric social workers, and 1,500 psychiatric nurses nationwide. 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. Similarly, based on the global average of 21.7 psychiatric nurses per 100,000 people, India needs 269,750 nurses

Mental health accounts for 0.16% of the total Union Health Budget, which is less than the 0.44% spent by Bangladesh. The developed nations’ expenditure amounts to an average of 4%.

A National Institute of Mental Health and Neurosciences (NIMHANS) survey estimates that 13.7% of the Indian population above the age of 18 suffers from mental morbidity. It also suggests that 1 in every 20 Indians suffer from depression. Nearly 1% of Indians suffer from a high risk of suicide. In addition, 9.8 million children in the age group of 13-17 years suffer from mental health concerns and require active intervention.

Economic and social costs

The World Bank has recently identified mental health as a Global Development Priority. This recognises the critical impact mental health has on economic development and well-being. The economic consequences of poor mental health are equally significant. A World Economic Forum/Harvard School of Public Health study has 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, that is, 22% of economic output between 2012-2030.

A majority of these illnesses can be cured; individuals can lead fulfilling lives including going to school, working, raising a family, and being productive citizens in their communities.  Although mental illness is experienced by a significant proportion of the population it is still seen as a taboo. These barriers deprive people of their dignity. To make dignity in mental health a reality, it requires every member of society to work and take action together.

A field-based research study in the prestigious medical journal The Lancet (by Pandit et al) concludes, “Most Indians do not have community or support services for the prevention of suicide and have restricted access to care for mental illnesses associated with suicide, especially access to treatment for depression, which has been shown to reduce suicidal behaviours.” Counselling plays a great role in alleviating stress, helping depressed people improve their self-esteem and their ability to cope with despair.

Voluntary organisations: Promoting innovative solutions

There have been some encouraging innovations in India led by voluntary organisations that are both impactful and replicable. Dr Patel, Professor, London School of Hygiene and Tropical Medicine and Co-Founder of Goa-based mental health research non-profit ‘Sangath’, is the architect. He has been in the forefront of community mental health programmes in Central India.

The programme is designed to establish a sustainable rural mental health support to address issues relating to stress and tension that abet suicide, alcohol abuse, and depression. It deploys health workers from within the community—some with no background in mental health. These workers are trained to raise mental health awareness and provide “psychological first-aid”. The programme also includes counsellors who are imparted mental health literacy. The third line of workers consists of expert psychiatrists. These individuals are qualified to provide medications for more serious mental health disorders. The programme uses Primary Health Centres for screening and feeding people with mental illnesses.

Dr Patel’s vision has been the provision of superior mental health care to low-resource communities. He argues that 90% of people affected by mental illnesses go untreated owing to the paucity of psychiatrists. Importantly, his research has effectively demonstrated that evidence-based treatments for mental illnesses can be delivered in low-income countries by non-specialist healthcare workers. His work has been applauded by TIME magazine, which featured him in its annual list of the 100 most influential people in the world.

Rich man’s disease?

Dr Patel feels that mental health problems are still perceived by many as rich man’s diseases. It is assumed that if you are poor, then the symptoms of depression are simply an expression of the misery of your life. Contrary to public belief, mental suffering is not a natural consequence of poverty. Those who are poor and depressed deserve, if anything, even more, attention than the rich.

A lot of good programmes emerged when one individual looked at a familiar landscape in a fresh way. These creative and passionate individuals saw possibilities where others saw only hopelessness. They have imagined a way forward when others saw none.

India has the tools, but the will is required to be summoned by game changers like Dr Patel. People like Dr Patel have shown that there are solutions. Individuals are just required to think out of the box and not accept limits to how the world works.

Featured Image Credits: Max Pixel

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