Updated: October 10, 2021 7:17:12 am
In my adult life so far, I have sought formal medical consultations only twice. Once, with a psychiatrist and the second time, with a general physician. It is not that I don’t fall sick — I do occasionally — but being a doctor, mostly I prescribe for myself or in rare cases, call a doctor friend.
The visit to the physician was a few years ago. I had returned from a five-day-three-city hectic work trip and had fatigue and was feverish. Then and even today, I think all that I needed was good rest. However, my wife forced me to sit in the car and stopped only when we reached a doctor’s clinic. The visit to the psychiatrist was long ago, when I was in the third year of medical school, and completely on my volition. College years can be very distressing — familial pressure, personal issues, studies and much more — things on two extremes that you either you wish to recall often or systematically eliminate from your memory. On that visit, all that the “good shrink” did was to sort of counsel and reassure; no medication was prescribed. It is an old saying that a good doctor is one whom you don’t have to visit again, at least for the same episode of illness. I never needed to visit him again. Years later, I met him at a social function, and thanked him. In hindsight, to consult a psychiatrist was one of the best decisions of my life.
In India, people do not routinely seek mental-health services due to a multitude of reasons which are linked to both demand and supply aspects. One, that “mental illnesses cannot be treated” is an age-old and widely prevalent myth, both in rural populations and urban settings, that urgently needs to be busted. Some mental-health issues are not completely curable, the way all physical illnesses are not curable. However, a majority of physical and mental illnesses can be treated. All we need to do is start seeking care.
Second, in India, when it comes to mental-health issues, the fatalistic belief that “time is the biggest healer” is deep-rooted. Nothing heals with time and each one of us must proactively seek remedies. Though memories may fade over time, there is no conclusive proof that time has healed even a single person in history. Getting expert advice and guidance have worked for most. If we do not pay attention to stress, anxiety or depression in real time, these could precipitate as more serious health issues.
Third, we often hear that there is a major shortage of trained psychiatrists and mental-health facilities in the country. It is true that India needs more mental-health workforce. However, while developing approaches to increase workforce, Indian states also need to utilise the available workforce, efficiently. Every mental-health issue does not need a psychiatrist. Six out of every seven people with mental-health needs can initially be attended by trained non-specialist doctors and mental-health counsellors. Only some would need a referral to a specialist.
The need for mental-health care has become more relevant than ever during the COVID-19 pandemic. Families have lost loved ones; the treatment of the sick has made many poorer; people have either lost their sources of income or had their earnings drastically reduced. Many who have recovered from the infection continue to have post- and long-COVID symptoms. The children have been deprived of education and playgrounds and excessively exposed to computer screens. The levels of stress and the need for mental-health services for many individuals and families have significantly increased. The old approach of not seeking care for mental health issues can be very damaging, both in short and long term.
October 10 is globally commemorated as World Mental Health Day. In India, every year, the Union and state governments customarily commemorate this and other similar days. We, as a nation, seem to have mastered the art of festivals, celebrations and commemoration at the most superficial level. On Dussehra, the dominating thought for most remains where the biggest effigy in the city is. The thoughts about victory of good over evil comes, fleetingly, if at all. Many who go to Rajghat every October 2 may not have practised even one teaching of Gandhi.
This World Mental Health Day has to be different. While governments need to do more for improved mental-health services for every citizen, let’s put more faith in actions at an individual and citizen level. We can commit to start seeing mental illness just like any other physical illness and start a conversation to reduce the stigma around these conditions. We need to start seeking expert advice when needed and early; to encourage and support others to seek care. While the rich and middle class can still manage, for the poor, strengthening government mental healthcare services is the only solution.
In the middle of the pandemic, I advised one of my patients to consult a psychiatrist at the nearby government hospital. He was reluctant as he thought that if his peers learnt about it, that would be a blow to his reputation. Then suddenly he said, “Ameer logon ke liye toh iss desh mein sab kuch aasaan hai, video call par. Aap sarkar se kahiye, dimag ki bimariyon ke doctor online kar dein (For the rich in this country everything is easy and available on video call. Please tell the government that doctors for mental health illnesses should be available online).” How naïve I was to forget that time had stood still for the poor for centuries.
(The writer is a Delhi-based physician and public-health specialist.)
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