Good mental health is indispensable for holistic well-being of people. Mental illnesses contribute 18.5 per cent of the global disease burden including depression, anxiety, schizophrenia and neuro-psychiatric disorders. India shares disproportionate component of this burden with 56 million cases of depression, 43 million of anxiety disorders besides highest global rate of suicides which claim nearly 700 lives every day. Suicide is the leading cause of death in the age group 15-39. Most suicides are attributed to domestic abuse and violence, unemployment, family disputes, examination pressure, financial distress and chronic illness.
This multi-dimensional societal malaise is preventable. Poor mental health incapacitates communities and societies and erodes productivity of the nation besides imposing huge economic costs. According to WHO, India is likely to suffer an economic loss of staggering USD 1.03 trillion between 2012 and 2030. Mental health is rooted in stigma, behaviour complexes and discrimination within the community and reinforces vicious cycle of disempowerment, social exclusion and coercion.
While poverty, deprivation, job insecurity and social inequities are major determinants, there are barriers like lack of access to mental health care, challenges of delivery in the primary healthcare setting, lack of mental health perspective in public health leadership, gross shortage of trained professionals and lack of adequate funding. The scenario has become grim over the years largely because there is a lack of appreciation of the significant interplay between mental health and the diversity of other health disorders. The national mental health survey has identified large treatment gaps from 28 per cent to 83 per cent across spectrum of mental disorders besides higher infirmities and suicides correspondingly among women.
Developed countries allocate 5-18 per cent of their annual healthcare budget while India allocates roughly 0.05 per cent. We need to build more inclusive and resilient healthcare systems incorporating social protection, access to affordable and quality care based on human rights and with psycho-social approach rather than following the traditional biomedical paradigm. We need to upgrade physical infrastructure and strengthen human resources by training more mental health professionals and skilled Health workers.
Currently, as per WHO, for 1,00,000 population India has 0.3 psychiatrists, 0.12 nurses and 0.07 psychologists and 0.07 health workers. These reflect alarming shortage of human resources and dire need to scale up investment to address the issue. Though Mental Health Act 2017 has granted patients the legal rights to life with dignity without discrimination, coercion and harassment, the endeavour in this segment is too scattered and lacks focus and coordination. Promotion of awareness through campaigns, utilising celebrities and social influencers, sensitisation of elected representatives at all levels, making work environment more conducive, mobilising support of NGOs, deeper engagement of local communities and local governments, enhancing advocacy and galvanising multi-sectoral coordination are some of the measures which could improve outcomes.
The pandemic has had a devastating impact on mental health with the increase of 22 per cent of cases because of persistent fear, anxiety, isolation, grieving for the loss of lives, decline in income and disruption of delivery of services and lock-downs. Society has to play a pivotal role in bringing paradigm change. To overcome shortcomings of domain experts, low-cost interventions like establishment of centres for stigmatisation, rehabilitation and counseling can prove to be therapeutic. Expansion of yoga and meditation centres would also provide enormous relief. Their capacities can be built by civil society in collaboration with community-based organisations, but these initiatives have to be strongly supported by the Government.
It is crucial to deconstruct lingering stigma, through targeted awareness-raising and outreach. The ultimate goal must be to replace the institutional system by a recovery and community-based model which promotes social inclusion and offers rights-based treatments and psycho-social support options.
While we need to have ‘Concerted Suicide Prevention Strategy’ at the National Level, efforts must be made to bring reforms like provision of supplementary Examinations and Repeal of Section 309 of IPC to decriminalize suicide. A study in Tamil Nadu revealed that suicide rates dropped considerably with Supplementary Examinations. The Government deserves appreciation for enhancement of allocation in the budget for 2022 for Mental Health and its initiative to establish Tele-Mental Health Centres for milder illnesses. The government must prioritise to ensure that the most vulnerable groups are well served. More than 14 per cent of the Indian population is overwhelmed by the mental health crisis, the manifestation of which can trigger a huge burden of collateral infirmities in other segments of the health sector.
Pragmatic government policies based on empirical evidence, strong political will, social inclusion, mental health literacy, vibrant media and responsive corporate sector coupled with innovative technologies and crowd sourcing could mitigate this apathy. Synergy of all stakeholders is prerequisite for success. If we do not act on war footing, it would be at our own peril.
(The author is President, Policymakers’ Forums for Mental Health & Global Coalition Against TB.)
This piece is in association with ETI Services.