Skip to main content

13.7% adult India suffers from mental morbidity: Allocation 0.16% of Union health budget, B'desh's 0.44%

By Moin Qazi*
Among the many challenges India faces, the most under-appreciated is the ongoing mental health crisis. Mental illness is actually India’s ticking bomb. The National Mental Health Survey of India (2016), the largest exercise to count the numbers of those affected by mental disorders, reported that one of every ten adults experiences a clinically significant condition. Nearly 90% of these people have received no care at all in the past years.
The suvey further 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 one percent of Indians suffer from high suicidal risks.
The importance of emotional and mental health in the overall well-being of an individual and its impact on the national economy and growth is 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 percent of India’s population, suffer from depression. Another thirty-eight million Indians, or three percent of India’s population, suffer from anxiety disorders including panic attacks, phobias, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).
Particularly worrying is the intensity of mental disorders in the adolescents. Half of all mental illness starts by the age of 14, but most cases go undetected and untreated. Suicide is the second leading cause of death among 15-29-year-olds.depression is the third leading item in the burden of disease among adolescents Fortunately, there is a growing from the earliest ages, in order to cope with the challenges of today’s world.
The pathetic state of mental health care in the country coupled with government’s apathy is a cause of great concern. A plausible reason is the sheer scale of the problem. Hence, nobody wants to discuss the elephant in the room. However, the nation cannot afford to ignore the stark reality.
There are only about 43 mental hospitals in the country, and most of them are in disarray. Six states, mainly in the northern and eastern regions with a combined population of 56 million people, do not have a single mental hospital. Most government-run mental hospitals lack essential infrastructure, treatment facilities and have a sickening ambience. Visiting private clinics and sustaining the treatment, which is usually a long, drawn-out affair, is an expensive proposition for most families.

The Key facts

  • One in six people are aged 10–19 years.
  • Mental health conditions account for 16% of the global burden of disease and injury in people aged 10–19 years.
  • Half of all mental health conditions start by 14 years of age but most cases are undetected and untreated.
  • Globally, depression is one of the leading causes of illness and disability among adolescents.
  • Suicide is the third leading cause of death in 15–19 year olds.
  • The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.
  • Mental health promotion and prevention are key to helping adolescents thrive.
According to a Ministry of Health and Family Welfare report, India faces a treatment gap of 50-70 percent for mental health care. The government data highlights the dismal number of mental healthcare professionals in India; 3,800 psychiatrists and just 898 clinical psychologists. A large number of them are situated 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 care accounts for 0.16 percent of the total Union Health Budget, which is less than that of Bangladesh, which spends 0.44 percent. A developed nation’s expenditure on the same 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 as maintaining an ignorant stance on the issue will not help in its resolve.
A survey conducted by the 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 percent of those with mental-health problems remain deprived of treatment due to stigma, shame and getting shunned from societies. Three age groups are particularly vulnerable to depression: pregnant or post-partum women, the youth and the elderly.
With resources tight an effective method for successfully tackling mental illness is a major expansion of online psychiatric resources such as virtual clinics and web-based psychotherapies. The economic consequences of poor mental health are quite significant. The cognitive symptoms of depression like 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 percent of the economic output) during 2012-2030. Estimates suggest that by 2025, 38.1m years of healthy life will be lost to mental illness in India (23% increase).
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 while performing day-to-day activities such as going to school, raising a family and pursuing a career.
Although mental illness is experienced by a significant portion of the population, it is still seen as a taboo. Depression is so deeply stigmatised that people adopt enforced silence and social isolation. In villages, there are dreadful, recorded cases of patients being locked up in homes during the day, being tied to trees or even being flogged to exorcise evil spirits. Stories of extreme barbarity abound in tribal cultures.
In some societies, family honour is so paramount that the notion of seeking psychiatric help more regularly is considered to be anathema to them. Recognition and acknowledgement, rather than denial and ignorance are the need of the hour.
Many a time, mental-health problems are either looked down upon or trivialised. These man-made 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 an urgent need for an ambience of empathy, awareness and acceptance of these people so that prejudices dissipate and patients are able to overcome the stigma and shame.
India’s Mental Health Care Act is a very progressive legislation, and is the equivalent of a bill of rights for people with mental disorders. Fundamentally, the Act treats mental disorders on the same plane as physical health problems thus stripping it of all stigmatizations. Mental health issues get the same priority as physical disorders.
Conceptually, it transforms the focus of mental health legislations from supposedly protecting society and families by relegating people with mental disorders to second-class citizens, to emphasizing the provision of affordable and quality care, , financed by the government, through the primary care system.

Encouraging innovations

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 the Goa-based mental health research non-profit ‘Sangath’, has been at the forefront of community mental health programmes in central India.
It deploys health workers, some with no background in mental health. The mission tasks community-based workers to provide low intensity psychosocial interventions and 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 stage 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.
His model envisages the involvement of primary care based counsellors and community based workers to reduce the burden of depression in the population. There is no longer any doubt about whether community health workers can be trained and supervised to deliver clinically effective psychosocial interventions.
The challenge before us now is how to go beyond pilots and research studies and scale these innovations up in routine health care. Involvement of the social, health and education sectors in comprehensive, integrated, evidence-based programmes for the mental health of young people is vital for strneghtening the overall healthcare framework at the grassroots level.
Mental healthcare initiatives are presently focused on a narrow biomedical approach that tends to ignore socio-cultural contexts.Community mental-health services can offer a mix of clinical, psychological and social services to people with severe, moderate and mild mental illnesses. Also, counselling can make a profound difference and build resilience to cope with despair.
Providing psychoeducation to the patients’ families can also help. Unfortunately, in recent decades, academic psychologists have largely forsaken psychoanalysis and made themselves over as biologists. There is need for strengthening the cadre of behavioral health therapists.
Prevention must begin with people being made aware of the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school. Psychosocial support can be provided in schools and other community settings.
Training for health workers to enable them to detect and manage mental health disorders can be put in place, improved or expanded. Such programmes should also cover peers, parents and teachers so that they know how to support their friends, children and students overcome mental stress and neurotic problems.
There is a need for more open discussion and dialogue on this subject with the general public, and not just expert’s .this can help create a more inclusive environment for people with mental illness.
With simple yet effective steps, we can turn the situation around and build a more accommodating environment for those struggling with mental distress.
---
*moinqazi123@gmail.com

Comments

Chennai Minds said…
Mental Health is indeed a much neglected aspect of health care worldwide by both the system and population likewise.
80% of people do not even seek mental health treatment when needed. This leads to poor quality of life and loss of functioning. In turn this is an economic burden. Investing in good mental health care systems will reward economy likewise.
Chennai Minds
Mental Health Clinic

TRENDING

August 22 to be observed as Apostasy Day: International coalition of ex-Muslim groups

By Our Representative
In a unique move, an international coalition of ex-Muslim organisations has decided to observe August 22, 2020 as the Apostasy Day. To be observed for “the abandonment or renunciation of religion”, the coalition, calling upon people to join the call, said, the decision to observe the Apostasy Day has been taken because of apostasy is “punishable by death in Afghanistan, Iran, Malaysia, Maldives, Mauritania, Qatar, Saudi Arabia, Somalia, UAE, and Yemen.”

Buddhist shrines massively destroyed by Brahmanical rulers in "pre-Islamic" era: Historian DN Jha's survey

By Our Representative
Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book, "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

RSS' 25,000 Shishu Mandirs 'follow' factory school model of Christian missionaries

By Bhabani Shankar Nayak*
The executive committee of the International Union of Anthropological and Ethnological Sciences (IUAES) recently decided to drop the KISS University in Odisha as the co-host of the World Anthropology Congress-2023. The decision is driven by the argument that KISS University is a factory school.

India must recognise: 4,085 km Himalayan borders are with Tibet, not China

By Tenzin Tsundue, Sandeep Pandey*
There has as been a cancerous wound around India’s Himalayan neck ever since India's humiliating defeat during the Chinese invasion of India in 1962. The recent Galwan Valley massacre has only added salt to the wound. It has come to this because, when China invaded the neighbouring country Tibet in 1950, India was in high romance with the newly-established communist regime under Mao Zedong after a bloody revolution.

Time to give Covid burial, not suspend, World Bank's 'flawed' Doing Business ranking

By Maju Varghese*
On August 27, the World Bank came out with a statement suspending the Doing Business Report. The statement said that a number of irregularities have been reported regarding changes to the data in the Doing Business 2018 and Doing Business 2020 reports, published in October 2017 and 2019. The changes in the data were inconsistent with the Doing Business methodology.

Swami Vivekananda's views on caste and sexuality were 'painfully' regressive

By Bhaskar Sur*
Swami Vivekananda now belongs more to the modern Hindu mythology than reality. It makes a daunting job to discover the real human being who knew unemployment, humiliation of losing a teaching job for 'incompetence', longed in vain for the bliss of a happy conjugal life only to suffer the consequent frustration.

Delhi riots: Cops summoning, grilling, intimidating young to give 'false' evidence

Counterview Desk
More than 440 concerned citizens have supported the statement issued by well-known bureaucrat-turned-human rights activist Harsh Mander ‘We will not be silenced’ which said that the communal riots in Delhi in February 2020 have not been caused by any conspiracy, as alleged by the Delhi Police, but by “hate speech and provocative statements made by a number of political leaders of the ruling party.”

WHO chief ignores India, cites Pak as one of 7 top examples in fight against Covid-19

By Our Representative
In a move that would cause consternation in India’s top policy makers in the Modi government, Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) director-general, has singled out Pakistan among seven countries that have set “examples” in investing in a healthier and safer future in order to fight the Covid-19 pandemic.

Tata Mundra: NGOs worry as US court rules World Bank can't be sued for 'damages'

By Kate Fried, Mir Jalal*
On August 24 evening, a federal court ruled that the World Bank Group cannot be sued for any damage caused by its lending, despite last year’s Supreme Court ruling in the same case that these institutions can be sued for their “commercial activity” in the United States.