Skip to main content

Mental health: India's 95% patients "deprived" of medical care, treatment gap 70%

By Moin Qazi*
Among the many challenges India faces, the most underappreciated is the ongoing mental health crisis. Mental illness is actually India’s ticking bomb. An estimated 56 million Indians suffer from depression, and 38 million from anxiety disorders. For those who suffer from mental illness, life can seem like a terrible prison from which there is no hope of escape; they are left forlorn and abandoned, stigmatized, shunned and misunderstood.
The intensity of mental disorders is particularly worrying 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.
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 factsfacts:
  • 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. 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
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.
Lewis Carroll very succinctly summed up the plight of today’s human beings in the conversation between the Queen and Alice in her classic "Alice in Wonderland". Here’s the paraphrase: Alice tells the queen that one has to run at the top of one’s speed to excel in a competitive race. The queen disagrees and we see the essence of competitive existence when she tells Alice that in her country one has to do all the running at the top most speed to retain one’s position. But if you want to get somewhere you have to run twice as fast. This is the paradox. Everyone wants to go somewhere. But they don’t know where. This is the reason for the growing incidence of depression in society.
With simple yet effective steps, we can turn the situation around and build a more accommodating environment for those struggling with mental distress.
---
*Contact: moinqazi123@gmail.com

Comments

Anonymous said…
NIce
Anna Chandy said…
Psychoeducation Training is a thought to be told about the problems and crises that will change a person's full lifetime. It plays an influential role in determining a personal and a group of individuals' emotional and behavioral revolution. It's specially design to form awareness for the people themselves. 
Akhifa Pervin said…
most of the people of india are affected by Mental Health deases . For konwing more CLICK HERE
As a mental health therapist working for Life Coaching for over 10 years, it has been my honor to walk alongside individuals on their healing journey. It has been specifically gratifying walking alongside women, which is the focus of my podcast and private practice. I wholeheartedly believe that by helping one woman, we have helped a relationship, family, and community. As a mental health professional, podcast host, and private practice owner, it is my mission to serve women so they can Live. Conquer. Thrive.

TRENDING

Insider plot to kill Deendayal Upadhyay? What RSS pracharak Balraj Madhok said

By Shamsul Islam*  Balraj Madhok's died on May 2, 2016 ending an era of old guards of Hindutva politics. A senior RSS pracharak till his death was paid handsome tributes by the RSS leaders including PM Modi, himself a senior pracharak, for being a "stalwart leader of Jan Sangh. Balraj Madhok ji's ideological commitment was strong and clarity of thought immense. He was selflessly devoted to the nation and society. I had the good fortune of interacting with Balraj Madhok ji on many occasions". The RSS also issued a formal condolence message signed by the Supremo Mohan Bhagwat on behalf of all swayamsevaks, referring to his contribution of commitment to nation and society. He was a leading RSS pracharak on whom his organization relied for initiating prominent Hindutva projects. But today nobody in the RSS-BJP top hierarchy remembers/talks about Madhok as he was an insider chronicler of the immense degeneration which was spreading as an epidemic in the high echelons of th

Central pollution watchdog sees red in Union ministry labelling waste to energy green

By Chythenyen Devika Kulasekaran*  “Destructors”, “incinerators” and “waste-to-energy (WTE) incineration” all mean the same thing – indiscriminate burning of garbage! Having a history of about one and a half centuries, WTE incinerators have seen several reboots over the 19th, 20th and 21st centuries. 

First-of-its-kind? 'Eco-friendly, low cost' sewage treatment system installed in Gujarat

Counterview Desk Following the installation of the Unconventional Decentralized Multi-Stage Reactor (UDMSR) for sewage treatment, a note on what is claimed to be the  first-of-its-kind technology said, the treated sewage from this system “can be directly utilized for agricultural purposes”, even as proving to be a “saviour in the times of water crisis.”

A Hindu alternative to Valentine's Day? 'Shiv-Parvati was first love marriage in Universe'

By Rajiv Shah*   The other day, I was searching on Google a quote on Maha Shivratri which I wanted to send to someone, a confirmed Shiv Bhakt, quite close to me -- with an underlying message to act positively instead of being negative. On top of the search, I chanced upon an article in, imagine!, a Nashik Corporation site which offered me something very unusual. 

Indo-Bangla border: Farmers facing 'illegal obstacles' in harvesting, transporting yields

  Counterview Desk  In a representation to the chairperson, National Human Rights Commission, human rights defender Kirity Roy, who is secretary, Banglar Manabadhikar Suraksha Mancha (MASUM), has said that Border Security Force (BSF) personnel are creating "illegal obstacles" for farmers seeking to harvest their ripened yields and transport them to the market in village Jhaukuthi of Cooch Behar district.

'Flawed' argument: Gandhi had minimal role, naval mutinies alone led to Independence

Counterview Desk Reacting to a Counterview  story , "Rewiring history? Bose, not Gandhi, was real Father of Nation: British PM Attlee 'cited'" (January 26, 2016), an avid reader has forwarded  reaction  in the form of a  link , which carries the article "Did Atlee say Gandhi had minimal role in Independence? #FactCheck", published in the site satyagrahis.in. The satyagraha.in article seeks to debunk the view, reported in the Counterview story, taken by retired army officer GD Bakshi in his book, “Bose: An Indian Samurai”, which claims that Gandhiji had a minimal role to play in India's freedom struggle, and that it was Netaji who played the crucial role. We reproduce the satyagraha.in article here. Text: Nowadays it is said by many MK Gandhi critics that Clement Atlee made a statement in which he said Gandhi has ‘minimal’ role in India's independence and gave credit to naval mutinies and with this statement, they concluded the whole freedom struggle.

Wasteland, a colonial legacy, being used to 'give away' vast tracts to Ratnagiri refinery

By Fouziya Tehzeeb* William D’Souza, a 55-year old farmer from Kuthethur, Mangalore, was busy mixing cattle feed when we arrived at his doorsteps. Around 25 km from the bustling city of Mangalore, Kuthethur is a lush green village with thick vegetation. On the way to William’s house the idyllic view gets blocked by the flares and smoke arising from the Mangalore Refinery and Petrochemicals Limited (MRPL).

CAA disregards India's inclusive plural ethos, 'betrays' ideals of freedom struggle: PUCL

Counterview Desk    "Outraged" at the move of the Central government to implement the Citizenship Amendment Act, 2019 (CAA 2019) weeks before the election, the top rights group, People's Union for Civil Liberties (PUCL), has demanded that the law be repealed. 

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara 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".

Invincible, Modi 'taller' than BJP, RSS: An opportunity for Congress beyond 2024?

By NS Venkataraman*  With the announcement of poll schedule for the 2024 parliamentary election, there is palpable excitement and expectation amongst the countrymen  about the shape of things to happen in India after the  results of the election would be announced. There is also speculation abroad about the future course of developments in India.