Our current inefficient health-care system is very biased, mainly focusing on physical healthcare needs and not addressing mental health concerns. However, the statistics are presenting a situation that is making it harder to ignore the unexplored mental health crisis in our existing health care system. The National Mental Health Policy of India 2014 defines –
Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which the individuals realize their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and are able to make a positive contribution to their community. Mental health refers to a broad array of activities directly or indirectly related to mental well-being.
With 1.3 billion population, it is estimated that India has a high prevalence rate of mental illness which has been approximated at 10.6% by Bakshy 2016. However, the stigma about mental illness is so deeply entrenched in our society that it results in a significant discrepancy in the supply & demand of mental healthcare needs and only 10% of the people are being treated due to lack of psychiatrists and mental health professionals in our country. To compare, the ratio of psychiatrists in developed countries is 6.6/100,000 people whereas it’s only 0.3 in India. The average rate of psychiatric nurses in India is 0.166/100,000 whereas it’s 5.8 globally. In the global scenario, average number of mental hospitals is 0.04 per 100,000 whereas it is only 0.004 in India.
Due to the lack of mental health services and awareness, the treatment gap is significantly high due to multiple reasons. From the societal end, the majority of people approach faith healers and general doctors instead of mental health professionals which widens this treatment gap. In addition, because of the stigmatization people’s attitude towards psychiatrists and psychiatric treatment is quite negative making things worse. In a recent survey that was conducted in five metropolitan cities it was found that lower age, lower education, and strong religious beliefs are found to be major contributing factors towards this negative attitude. Males are found to be more reluctant to psychiatric medications compared to females. This negative attitude and the stigmatization are one of the main reasons behind the noncompliance of the patients.
The scarcity of mental health care services and the ignorance of the society towards mental health sector also impact the mental health professionals. Oftentimes these professionals don’t see much scope and appreciation in the sector and end up losing the motivation to work. Initiatives have been taken to bridge the treatment gap, however the process has been slow and many programs have failed in achieving the desired outcomes. For instance, National Alliance on Access to Justice for Persons living with a Mental Illness (NAAJMI) and National Association for the Mentally Ill – India (NAMI – India) started off big with a lot of promises but as they embarked on the journey but lost momentum.
There are multiple problems plaguing this sector hence the solution should be multipronged and the reform process must include both individual and group efforts. With new Mental Health Act 2017 coming into the system, the future of mental health looks brighter however there is also a high risk of ineffective implementation. Therefore, it’s important to conduct various mental health awareness and psycho-educational campaigns along with policy actions. Taking direct actions will help the government in facilitating effective implementation of the policies to fill the huge treatment gap and change people’s attitude towards mental health & illness.
One of the examples of Direct Actions is Tata Trusts project UDAAN. This is the very first initiative ever taken in health care sector in India where government has directly collaborated with a private organization to reform the system and processes in order to bring an effective lasting change in the mental health sector. Other examples of the direct actions in the mental health sector are the initiatives taken by these well-known organizations: The MINDS foundations, Schizophrenia Awareness Association (SAA), Schizophrenia Research Foundation (SCARF), and National Institute of Mental Health and Neurosciences (NIMHANS).
Somehow I am surrounded by so many stories which are sometimes incomprehensible and end up leaving me with a barrel full of questions. One question out of the barrel – Why is it so hard to vocalize the demand for mental health care services? –
“Madam mai nahi jati mahila ashram, bachche mere khane me patthar dal dete hai, pani me keede daal dete hai” vented out Sheena (name changed). Sheena who suffers from bipolar disorder has been a long term resident of the government mental hospital. She came to the hospital as a young teenager and now she is in her fifties. She has been in pretty stable condition for a long time yet she stays in the hospital because she has nowhere to go.
Unfortunately, this is not just Sheena’s story but many others who live in mental institutions in India. It’s not unusual for families to abandon the patients in front of the government mental hospitals and never turn their back again.
Now that I work at the grass root level hierarchy and functioning of the system seems way more complicated than I ever envisioned. I guess it will take a while to bridge the gap but I will be optimistic and say that initial steps have been taken and I am grateful to be a part of this process!
Bakhshy, Amrit. Mental Illness and Caregiving: Challenges, Concerns & Complications. Schizophrenia Awareness Association, 2016.
Zieger A, Mungee A, Schomerus G, Ta TM, Weyers A, Böge K et al. Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India. Indian J Psychiatry 2017;59:341-6.