NEED FOR TRANSFORMING INDIA’S MENTAL HEALTHCARE SYSTEM
Need for transforming India’s Mental Healthcare System
1. CONTEXT OF THE NEWS
Recently, the tragic and unfortunate suicide of a Bollywood actor has brought discussions around mental health in the spotlight in the country.
This article explores the possibilities to invest and transform into India’s Mental Healthcare System.
2. MENTAL HEALTH CONSEQUENCE OF COVID-19
The mental health consequence of the COVID-19 pandemic can be seen as an interplay of two acts, namely ‘Pandemic of Fear’ and ‘Deaths of despair’. Let us understand them:
2.1 Pandemic of Fear
- According to the writer, beginning in March this year, after the COVID-19 epidemic in India, this is the consequence of the uncertainties surrounding our lives today.
- The fear of catching COVID-19 infection and anxiety over the rising number of cases despite a stringent lockdown add to the fear.
- The irritability in waiting for life to get back to pre-COVID-19 times and the uncertainty over economic prospects of oneself and the nation has added up to the existing anxiety.
- Spread of fake new, lack of faith in the media, and journalism has intensified the condition culminating with the above conditions, into that of hopelessness, anxiety, fearfulness, and sleeplessness.
- While a rational mind would give the above-mentioned explanations to the reality surrounding us, for someone who is already coping with mental health difficulties, the COVID-19 experience could be more than overwhelming.
2.2 Deaths of despair
- This is the second and more troublesome act and threatens to morph a more sinister pandemic in the coming months.
- The term, ‘deaths of despair’ was coined Angus Deaton, recipient of the 2015 Nobel Prize in Economic Science, and refers to the reduction in the life expectancy of working-age Americans following the economic recession in 2008.
- The major cause of these deaths was suicide and substance use related mortality.
- The growing inequality, the worsening positions of labour, the deep polarization of society, and bleak prospects for the future only made the situation worse and might have driven the suicides and substance use.
2.3 India’s Position
- In all probability, the economic recession India will be incomparably greater that USA.
- In addition to the many ills of the American society existing in India, India also has to look after the colossal number of absolutely impoverished people and a fragmented, disordered, and limited mental healthcare system.
- To put things into perspective, even before the pandemic, the mental healthcare system in India could hardly cover more than 10% of the population.
3. SITUATION OF INDIA’S MENTAL HEALTH
A 2011 World Health Organisation-sponsored study found that 36% of Indians suffered from a Major Depressive Episode (MDE) within their lifetime. It indicated that India has the most number of people in the world who suffer from some form of depression at some point in their lives.
3.1 Mental Health before that pandemic
- Even before the pandemic, issues related to mental health were a major contributor to the burden of illness in India.
- One-third of all female and a quarter of all male suicide deaths in the world occur in India.
- Most of the mental illness and related death goes unnoticed from the public forums. Celebrity suicides and testimonies garner attention because mental illness is the only plausible explanation for people who are so privileged.
- However, it is the poor, dispossessed, impoverished, and marginalized who bear the greatest burden of mental health problems.
- The plight of the disadvantaged section has historically been dismissed as a natural extension of their socio-economic conditions and it is this vast section of our population that will be disproportionately affected by the economic recession.
3.2 Facts and numbers
- A countrywide National Institute of Mental Health & Neurosciences (Nimhans) study in 2016 showed that at least 13.7 percent of India’s general population suffers from a variety of mental illnesses and 10.6 percent of this requires immediate intervention.
- The report estimated that nearly 150 million Indians are in a need of active medical intervention.
3.3 How COVID-19 has worsened the state of India’s mental health?
- The lockdown experience in the middle of a global pandemic has been overwhelming for some people and has sparked anxiety, nervousness, paranoia, stress, and Obsessive-Compulsive Disorder (OCD), besides panic attacks.
- The recommended practice of self-isolation and social distancing has further complicated the situation.
- Loneliness - While social distancing definitely curbs the spread of coronavirus, but it might also bog down a person mentally leading to loneliness and triggering a depressive episode.
- Anxiety - While the pandemic looming upon us is enough to catch anxiety by itself. The worry of contracting the infection or accidentally infecting the near and dear ones and waiting for normalcy to return can accentuate anxiety.
- Obsessive-Compulsive Disorder (OCD) - The fear of pandemic may drive people to continuously wash hands to get rid of the germs or continuously clean the house. The fear of getting germs and contracting infections added with widespread of negative information can lead to paranoia and being overwhelmed.
4. THE PROBLEMS
4.1 Telemedicine Platforms
- There has been a flourishing of initiatives to tackle the rising tide of mental health problems.
- Telemedicine platforms are the most notable development in this regard.
- These telemedicine platforms rely heavily on mental health specialist providers who are already very scarce in number and are often unaffordable.
4.2 The Digital Divide
- While telemedicine therapy and telephone counseling can be an effective means to cover a large number of population, the problem is compounded with the digital divide in India.
- Low digital literacy and inadequate internet connectivity hamper the prospects of telemedicine therapy in small corners of the country.
- These initiatives nonetheless are a welcome step for demonstration of the feasibility of remote delivery and the value of psychological therapies, which have always played second fiddle to medication.
4.3 Huge treatment gap
- The treatment gap for all mental health disorders with an exception of Epilepsy is more than sixty percent.
- There is a huge economic burden of mental disorders. Families have to spend nearly Rs 1,000-1,500 a month mainly for treatment and to access care.
- Despite being ill for more than 12 months, 80 percent of people suffering from mental disorders do not receive any treatment due to the stigma attached with mental disorders.
- One of the major cause of low outreach is Poor implementation of programmes under the national mental health programme.
- Mental health occupies a very low priority in the public health agenda.
- The health information system itself does not prioritise mental health.
- Not only is there a paucity of mental health specialists, the institutional care in India, too, but has also been found to be limited.
- The researchers suggest that mental health financing needs to be streamlined.
- Interrupted drug supply to treat mental illness is also an alarming cause.
5. SEEKING A SOLUTION
5.1 Rising on innovations
- Frugal innovations ingeniously pioneered and developed by Indian scientists and practitioners hold great promise for a country of our size, diversity, and resources.
- At the helm of these innovations is the deployment of community health workers, who with appropriate training and supervision effectively deliver psychosocial interventions for conditions ranging from autism and depression to drinking problems and psychoses
- Brief psychological treatment for depression developed by one of the leading innovators in the country is now being implemented in developed nations like the US and Canada.
- Forging partnerships with state governments in India to scale up psychosocial interventions through community health workers is the obvious next step for these innovators.
- This will also allow us to reimagine the model of delivering mental health care even in the most under-resourced communities of the country.
5.2 The Government should step up
- India was one of the first countries to develop a national mental health programme in the early 1980s.
- There was no proper study to understand the spread and estimate of mental illness in the state at that time.
- Today, nearly 70 percent of the meager mental health spending goes to mental institutions.
- India needs to invest more at the primary level for a wide-spread reach.
- This will also result in early detection and reduce the need of expensive hospital care.
6. HOW TO MANAGE MENTAL HEALTH
The human mind is a complex and complicated organ. Since our experiences are very intimately intertwined with our unique personal life stories, relationships, and preferences, there is no one-size-fits-all prescription for managing mental health.
6.1 Assessing one’s own mental health
Having said that, there are some general principles that one might take into consideration.
- Giving equal acknowledgment and attention to mental health as one gives to physical health.
- Talk about the situation with one’s confidant. ‘It’s ok to talk’, is a slogan propagating the same idea. Talking and sharing about mental health is not an effective way to feel better but also the most effective strategy to reduce the stigmatization of mental health in the country.
- Do something for others. Empathy is a strong human emotion. It has been scientifically shown that caregiving, and community service make your life more rewarding and longer.
- Remind oneself that we are all in the same boat. We are buffeted by the same rough seas and surrounded by the same clouds of uncertainty, we are in this together. Even if some of us travel in yachts, the overwhelming majority of us will safely reach the shore.
- This too shall pass – Like every other pandemic in the history of the world, this epochal event too shall pass and life goes on.
- And lastly and most importantly, if one’s distress is persistent and comes in way of daily life activities, one must not shy away from seeking professional help.
6.2 Taking care of the near and dear ones
‘According to the Ministry of Health and Family Welfare, one must look out for signs of mental health issues in their near and dear ones. These include
- changes in sleep patterns
- difficulty in sleeping and concentrating
- Worsening of health problems.
- This is a historic opportunity to invest in and transform India’s mental health care system.
- We need financial investment but at the same time, we need to invest it wisely, guided by the best science.
- Mental health care must embrace the diversity of experiences and strategies, which work, well beyond the narrow confines of traditional biomedicine with its emphasis on “doctors, diagnoses and drugs”.
Source: The Indian Express: https://indianexpress.com/article/opinion/columns/sushant-singh-rajput-mental-health-depression-vikram-patel-6467051/