WHO says over a billion people living with mental health conditions globally, 1 in 100 deaths is suicide: What are challenges in India?

What are top mental health disorders?

The most common mental disorders are anxiety and depressive disorders, which together accounted for more than two-thirds of all mental health conditions in 2021. Between 2011 and 2021, the number of people living with mental disorders increased faster than the global population. As a result, the global age-standardized point prevalence of mental disorders reached 13.6 per cent, which is 0.9 per cent higher than a decade ago.

Younger adults aged 20–29 years are estimated to have the largest increases (1.8 per cent) in prevalence since 2011. Males are estimated to more commonly have attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, and idiopathic disorder of intellectual development (comprising intellectual disability from any unknown source). Females are estimated to more often experience anxiety, depressive and eating disorders. Anxiety disorders typically emerge earlier than depressive disorders, which are rare before ten years of age. After the age of 40 years, depressive disorders become more prevalent than anxiety disorders, peaking between ages 50 and 69 years.

Can suicide rates go down by 2030?

Suicide is the leading cause of death among young people across all countries and socio-economic contexts. Yet, progress in reducing suicide mortality is too low to meet the United Nations Sustainable Development Goal (SDG) of a one-third reduction in suicide rates by 2030. Given current status, only a 12 per cent reduction will be achieved by that deadline, according to estimates in the report. What is needed are sustained financing, strong leadership and effective implementation of existing schemes, according to Dévora Kestel, Director, Department of Non-communicable Diseases and Mental Health (ad interim), WHO.

Dr Pratima Murthy, Director, National Institute of Mental Health and Neuro Sciences, told The Indian Express that suicides have multi-factorial triggers. “There is an interaction of personal (familial risk), vulnerable temperament and environmental risks such as early exposure to trauma, stressful environment, life events, isolation, lack of support, stigma, poor awareness of help, lack of availability and access to services. A combination of factors increases the risk,” she said.

What are challenges of broad-basing mental health care in India?

Dr Murthy feels that mental health institutions are not enough. “There is a need to have psychiatric beds in general hospitals and tertiary care institutions which can be staffed by well-trained multidisciplinary teams. While acute cases can still be treated at mental health institutions, the model of care must shift from custodial to therapeutic approaches. Bigger tertiary hospitals can even become academic training hubs,” she said.

Psychiatric hospitals are often associated with poor living conditions and ill-treatment, including cruelty, abuse and neglect. This is because of the second challenge, that of scant funding.

The third challenge is a huge scarcity of trained mental healthcare personnel, including nurses, social workers, psychiatrists, psychologists, counsellors and other paid mental health workers. Dr Bharat Vatwani, psychiatrist and Ramon Magsaysay award winner who set up Shraddha Rehabilitation Foundation, said the number of psychiatrists in the interior parts of the country was abysmal. “While the district headquarters may have a few psychiatrists, there are hardly any across towns and villages. Medicines are not available in the interior areas and importantly while family members may have the will to reach out to psychiatrists, their economic condition can prohibit them from travelling long distances and seeking professional help for their loved ones. The loss of daily income for these travels is very tough to bear. This is our ground zero assessment over the years,” he added.

Third, for mental health management to be streamlined, the chain of care must be carefully established. “This means availability of professional help, continuity and availability of treatment and medicines and economic conditions to cope with the financial load. Do not forget that in severe mental health issues (30 million Indians have severe mental health issues as per a NIMHANS report), the patient has invariably become a non-earning member of society,” Dr Vatwani said.