By Komal Sharma
The Mental Healthcare Act 2017 passed in April last year had many promising agendas to showcase importance of mental health in fresh light. To begin with, suicide was decriminalised, and an index was laid out for protecting rights of mentally ill to let patients have complete control over the process to minimise fear and stigma. We have progressed to accepting such sensitive issues constitutionally, but how far have we come in assimilating them socio-culturally? It is a far-fetched thought to imagine the Indian population addressing the magnitude of mental health issues with acceptance and understanding, let alone consulting psychologists or therapists. Even when they do, the patients usually have their own assumptions about people with mental health illnesses and resistance concerning the therapeutic process that interfere with the effectiveness of the help they get.
A psychiatrist for Bangalore District Mental Health Programme (DMHP) Dr Chetan Kumar stated, ďIndians arenít immune to mental health illnesses but they donít believe they suffer from it.Ē
To put some perspective as to why there cannot be anymore delay in acknowledging mental health related sicknesses, a WHO report states that in India, over five crore people suffered from depression, and over three crore from anxiety related problems (women were more likely to be affected than men) in 2015. Furthermore, India has the highest number of suicides in the world as of 2012. The suicide rate amongst men is 12.2 per 1,00,00 men, while amongst women, it is 9.1.
To cater this huge demand, the President of India Ram Nath Kovind had alerted that the country has only about 5,000 psychiatrists and less than 2,000 clinical psychologists. In my recent study that surveyed 70 individuals from different backgrounds (age, profession, class) and structurally interviewed 10 individuals from divergent demographics aimed to approximate towards a broader cognisance over state-of-the-art mental health scenario in India. Several facets were covered from participantsí approach towards mental health issues and their opinions pertaining to awareness and mental health aid. The exploratory studied revealed a few interesting themes that highlighted the gaps that exist in receiving mental health treatment. Let us review.
Stigmatisation of mental health problems
What does this really mean? To co-share a social space where existence of a person with mental illness is scorned for reasons of fear and judgment that might lead to excluding the person from social groups impacting or further deteriorating quality of life. My interviewee from a suburban part of north India, who is also an early-stage psychologist, shared with me that it is not only people who are affected by mental health issues that are despised in his community but also people who work in the field. In my study, 76% of the survey population agreed that relatively more awareness campaigns are needed in rural areas. My interviewees who have worked at community level informed me that a demand needs to be established by making people acknowledge the gaps, and also by helping them realise that working beyond certain levels of stress and anxiety is detrimental for normal functioning and requires professional attention.
Mental health workforce
A NIMHANS report suggests that 70-92% people in need of mental healthcare fail to receive any professional aid or treatment. This issue needs to be handled at grass roots level by engaging radically with communities. ASHA workers are helping strengthen communities with their work. One of the challenges they have taken up is to equip themselves to identify mild to severe mental illness, and use interventions to curb those difficulties that 64% people in the survey indicated more comfort in relying on online information for, in confiding in dear ones for issues related to anxiety and stress, instead of seeking professional help or advice. Also, an interviewee, who has been a mental health practitioner for 20+ years suggested that people often find it difficult to easily access manuals and online guides comprising an area-wise list of where and who to look to soliciting help in a manner well-suited for them and understanding the different communication options they have (such as telephone, video call, face-to-face). Itís important to note that it is okay to change your therapist if it is not working out with them. There are many techniques to resolve an issue, which one can find out by discussing with a psychologist.
Level of awareness
Delivering information is one of the aspects of the awareness seminars, but mode of delivery, language, and end result of understanding needs a check too. I came across many participants in my study who claimed to understand what mental health problems were, but they associated the people suffering from them with taboo words (such as mental, retards/idiots, unorganised, careless, etc.). A complete picture needs to be painted while sharing knowledge of stigma and knowledge of mental health issues which should be handled together; one without the other will lead to more misunderstanding or misguided approach towards mental illness in the communities at large.
If not now, when? If now, how?
Urban population in my study admitted a need for easier access and awareness to mental health treatment so as to perceive it as any other regular doctorís visit. They also stated that they felt more fulfilled and productive at work and life in general, if they were feeling mentally “healthy”.
A socially inclusive environment towards mental health issues will interest private stakeholders to invest in the perspective shift. With more funding, awareness campaign initiatives can expand at a massive scale encouraging people to contribute and also, to be a part of the workforce. Early introduction of awareness about mental health issues in schools will help acknowledge the problem in studentsí lives when they encounter it in themselves, or in someone they know. They will be able to seek reliable treatment before it turns extremely damaging to them and their loved ones.
Komal Sharma has a masterís degree in psychology from University of Delhi. She is an independent counsellor and a writer.
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