In­dia’s men­tal health woes

Nearly 150 mil­lion cit­i­zens suf­fer from com­mon men­tal dis­or­ders and need ac­tive in­ter­ven­tions and sup­port

DNA (Daily News & Analysis) Mumbai Edition - - FRONT PAGE - BY IN­VI­TA­TION

Suit­ably, to cen­tre pub­lic dis­course on men­tal health, the WHO iden­ti­fied “de­pres­sion” as the theme for World Health Day (April 7) this year; sim­i­larly, World Men­tal Health Day (Oc­to­ber 10) specif­i­cally fo­cussed on “men­tal health at the work­place” to re­in­force how this is­sue is creep­ing into our daily life. In In­dia, as in many coun­tries across the world, is­sues around men­tal health have been both de­nied and stig­ma­tised. A steep change is needed — start­ing with the ac­cep­tance that the prob­lem ex­ists.

Sev­eral fac­tors con­trib­ute to men­tal health mor­bid­ity (peo­ple suf­fer­ing from a dis­ease, at a given point in time) — stress, break­down of sup­port sys­tems, gap be­tween ex­pec­ta­tions and re­al­ity, eco­nomic in­sta­bil­ity and the com­plex­i­ties of mod­ern liv­ing. As per the Na­tional Men­tal Health Sur­vey 2016 (NMHS), 11 per cent of the pop­u­la­tion suf­fers from com­mon men­tal dis­or­ders like de­pres­sion, anx­i­ety, bipo­lar dis­or­ders etc. This broadly trans­lates to nearly 150 mil­lion In­di­ans who need ac­tive in­ter­ven­tions and sup­port, through cre­at­ing aware­ness, medicines or psy­chother­apy. The NMHS sur­vey in­di­cated that in­di­vid­u­als aged be­tween 40-49 were pre­dom­i­nantly af­fected with psy­chotic, neu­rotic and stress-re­lated dis­or­ders. Sub­stance-use dis­or­ders were high­est in the 50-59 age group at 29 per cent. While more males were af­fected with al­co­hol use dis­or­ders (9 per cent vs 0.5 per cent), more fe­males were suf­fer­ing from de­pres­sive dis­or­ders. Notably, the preva­lence of men­tal dis­or­ders was higher in ur­ban ar­eas and in per­sons from lower in­come groups. While the Dis­trict Men­tal Health Pro­gramme (DMHP) is be­ing im­ple­mented in ru­ral ar­eas through the pri­mary healthcare cen­tres, th­ese find­ings high­light the need for an ur­ban spe­cific men­tal health pro­gramme. ing men­tal healthcare ser­vices. Sim­i­larly, the Rights of Per­sons with Dis­abil­i­ties Act 2016 charts out the roadmap for care and so­cial re­ha­bil­i­ta­tion.

Re­cent com­mu­nity-based work on sui­cide ‘ideators’ and ‘at­temp­tors’ has iden­ti­fied risk fac­tors like gen­der, un­em­ploy­ment, eco­nomic stress, poor ed­u­ca­tional level, along with high lev­els of psy­choso­cial stress, hope­less­ness, re­la­tion­ship dif­fi­cul­ties as risk fac­tors for sui­ci­dal ideation. Men­tal health con­se­quences of dis­as­ters have also been stud­ied at var­i­ous set­tings in­clud­ing the Bhopal Gas dis­as­ter; cy­clones in Orissa; earth­quake dis­as­ters in Ma­ha­rash­tra and Gu­jarat; and the af­ter­math of the tsunami in Tamil Nadu. Th­ese stud­ies have high­lighted that cop­ing in In­dian pop­u­la­tions was strong due to bet­ter co­he­sion among com­mu­nity mem­bers and ac­tive par­tic­i­pa­tion of groups work­ing within th­ese com­mu­ni­ties. Tech­nol­ogy is also step­ping in to of­fer sup­port to par­ents of chil­dren with autism and pa­tients suf­fer­ing from de­pres­sion — th­ese in­clude var­i­ous app-based self-help tools to bridge the gap in low re­source set­tings like In­dia. al con­texts through “im­ple­men­ta­tion re­search”. Last but not the least, the fo­cus of re­search now needs to shift from es­ti­ma­tion of dis­ease bur­den and de­vel­op­ment of tools to deal with men­tal health is­sues.

The cur­rent sit­u­a­tion de­mands di­rect re­search-based in­puts to shape and strengthen men­tal healthcare pro­grammes and pol­icy. This is best done with an open-minded and in­clu­sive ap­proach where gov­ern­ment pro­grammes part­ner with aca­demics, NGOs and af­fected com­mu­ni­ties to de­sign and test in­ter­ven­tions. The ex­pe­ri­ences of or­gan­i­sa­tions like NIMHANS, Tata In­sti­tute of So­cial Sci­ences, In­dian Law So­ci­ety’s Cen­tre for Men­tal Health Law and Pol­icy as well as NGOs like The Banyan, San­gath and Schizophre­nia Re­search Foun­da­tion (SCARF) would be in­valu­able. The Sus­tain­able De­vel­op­ment Goals in­clude spe­cific tar­gets within the health goal: “By 2030, re­duce by one-third pre­ma­ture mor­tal­ity from non-com­mu­ni­ca­ble dis­eases through pre­ven­tion and treat­ment and pro­mote men­tal health and well-be­ing.” Un­doubtMen­tal health is poorly re­sourced. With edly, adopt­ing an in­te­grated ap­proach to fewer than 6,000 psy­chi­a­trists in the both men­tal and phys­i­cal well­be­ing will whole coun­try, it is im­por­tant to plan the be equally im­por­tant for a healthy and pro­vi­sion of men­tal healthcare ser­vices­­duc­tive us­ing the avail­able work­force as well as train more “com­mu­nity-level men­tal health work­ers”. It is also crit­i­cal to eval­u­ate var­i­ous strate­gies and as­sess their ef­fec­tive­ness in lo­cal so­cio-cul­tur- via En­ter­tain­ment) is a stake­holder en­gage­ment ini­tia­tive, un­der which na­tional award-win­ning films like are be­ing screened and dis­cussed at dif­fer­ent pub­lic venues. Sus­tain­ing such ini­tia­tives can help fa­cil­i­tate nu­anced dis­cus­sions with greater sense and sen­si­bil­ity. For­tu­nately, a whole new gen­er­a­tion of youth icons like Yu­vraj Singh and film stars like Deepika Padukone, Lisa Ray, Anushka Sharma are shar­ing their ex­pe­ri­ences to re­in­force that men­tal health is­sues can af­fect any­one and must be dealt with head-on.


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