MENTAL HEALTH CARE IN INDIA – SOCIAL ISSUE
News: Mental
health helpline receives 20,000 calls in two months
What's in the news?
● Tele
Mental Health Assistance and Networking
Across States (MANAS), a toll-free
24/7 number which was launched on October 10 on World Mental Health Day by
the Union Government, has received over 20,000 calls to date, reported the
International Institute of Information Technology Bangalore (IIITB).
Mental health:
● WHO
defines mental health as “a state of well-being in which every individual
realizes his/her own potential, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a contribution to her/his
community.”
● The
Mental Healthcare Act, 2017 defines
“mental illness” as a substantial disorder of thinking, mood, perception,
orientation or memory that grossly impairs judgment, behavior, capacity to recognize
reality or ability to meet the ordinary demands of life, mental conditions
associated with the abuse of alcohol and drugs.
● WHO
estimates that about 7.5 percent of
Indians suffer from some mental disorder and predicts that by the end of
this year roughly 20 percent of India will suffer from mental illnesses.
Importance of mental health:
● Emotional
and mental health is important because it’s a vital part of your life and
impacts your thoughts, behaviors and
emotions.
● Being
healthy emotionally can promote
productivity and effectiveness in activities like work, school or caregiving.
● It
plays an important part in the health of your relationships, and allows you to adapt to changes in your life and
cope with adversity.
● Our
mental health encompasses our
psychological, emotional and social well-being. This means it impacts how
we feel, think and behave each day.
● Our
mental health also contributes to our decision-making
process, how we cope with stress and how we relate to others in our lives.
● Global
burden of mental health will be well beyond the treatment capacities of
developed and developing countries.
● The social and economic
costs associated with the growing burden of mental ill health
focused on the possibilities for promoting mental health as well as preventing
and treating mental illness.
Importance of Mental health care in India:
1. Stigma associated with mental health:
● Indian
society has deeper stigma associated with mental health starting from discrimination to alienation making the
victims suffer the most.
● The
stigma against mental health is rising at an alarming rate with the recent
COVID pandemic.
2. Lack of awareness:
● This
growing challenge in dealing with mental health issues is further compounded by
a lack of information and awareness, self-diagnosis, and stigma.
3. Psycho-social factors:
● Institutions
like gender, race and ethnicity, are also responsible for mental health
conditions.
4. Post Treatment gap:
● There
is a need for proper rehabilitation of the mentally ill persons post/her
treatment which is currently not present.
5. Rise in Severity:
● Mental
health problems tend to increase during economic downturns, therefore special
attention is needed during times of economic distress.
Factors
responsible for Mental Health issues:
● Childhood abuse, trauma,
or neglect.
● Social isolation or
loneliness.
● Experiencing
discrimination and stigma, including racism.
● Social
disadvantage, poverty or debt.
● Bereavement
(losing someone close).
● Severe
or long-term stress.
● Having
a long-term physical health condition.
● Unemployment
or losing your job.
● Homelessness
or poor housing.
● Being
a long-term carer for someone.
● Drug
and alcohol misuse.
● Domestic
violence, bullying or other abuse as an adult.
● Significant trauma as an
adult, such as military combat, being involved
in a serious incident in which you feared for your life, or being the victim of
a violent crime.
● Physical causes
- for example, a head injury or a neurological condition such as epilepsy can
have an impact on your behaviour and mood. (it's important to rule out
potential physical causes before seeking further treatment for a mental health
problem).
Government Initiatives:
1. National Mental Health Program (NMHP):
● To
address the huge burden of mental disorders and shortage of qualified
professionals in the field of mental health, the Government has been
implementing the NMHP since 1982.
2. Mental HealthCare Act 2017:
● It
guarantees every affected person access to mental healthcare and treatment from
services run or funded by the government.
3. Rights of Persons with Disabilities Act, 2017:
The
Act acknowledges mental illness as a disability and seeks to enhance the Rights
and Entitlements of the Disabled and provide an effective mechanism for
ensuring their empowerment and inclusion in the society. The key features of
the Act are:
a. Rights of Persons with Mental Illness:
● Right to Access to Health
Care:
○ Every
person shall have a right to access mental health care and treatment from
mental health services run or funded by the appropriate government.
○ The
Act also requires insurance policies to place mental health treatment at par
with physical health.
● Right to live with
dignity:
○ Every
person with mental illness shall have a right to live with dignity.
● Right to Confidentiality:
○ A
person with mental illness shall have the right to confidentiality in respect
of his mental health, mental healthcare, treatment and physical healthcare.
b. Authorities:
● The
Act mandates the government to set up Central
Mental Health Authority at national-level and State Mental Health Authority
in every State.
● Further,
every mental health institute and mental health practitioners including
clinical psychologists, mental health nurses and psychiatric social workers
will have to be registered with the Authority.
c. Mental Health Treatment:
● A
mentally ill person shall not be
subjected to electro-convulsive therapy without the use of muscle relaxants
and anaesthesia. Further, electroconvulsive therapy cannot be used on minors.
● Sterilisation
will not be performed on such persons.
● They
shall not be chained in any manner or under any circumstances
● They
shall not be subjected to seclusion or solitary confinement.
d. Decriminalization of Suicide:
● Until
recently suicide was a punishable offence under IPC Section 309. The Act decriminalizes suicide stating whoever
attempts suicide will be presumed to be under severe stress, and shall not be
punished for it.
4. Manodarpan Initiative:
● An
initiative under Atmanirbhar Bharat Abhiyan aims to provide psycho-social support to students for their mental health
and well-being.
Issues in Provision of Mental Health:
1. High Public Health Burden:
● An
estimated 150 million people across India are in need of mental health care
interventions, according to India’s latest National Mental Health Survey
2015-16.
2. Lack of Resources:
● Low
proportion of mental health workforce in India (per 100,000 population) include
psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers
(0.07).
● Low
financial resource allocation of just over a percent of GDP on healthcare has
created impediments in public access to affordable mental healthcare.
3. Loss to Economy:
● Due
to delayed or non-treatment of mentally ill persons there is loss in terms of human capital and an
overall loss to the economy in the form of lost man-days, plus the poor is
stressed as most of mental healthcare is in urban areas and are unavailable in
primary healthcare centers in rural areas, this increases out of pocket
expenditure.
4. Demographic Dividend:
● According
to WHO, the burden of mental disorders
is maximal in young adults. As most of the population is young (India has
more than 50% of its population below the age of 25) so it requires a special
focus in mental health of youth by the Government to reap the benefits arising
out of the demographic dividend in India.
5. Post-Treatment Gap:
● There
is a need for proper rehabilitation
of the mentally ill persons post his/her treatment which is currently not
present.
6. Lack of Awareness:
● Poor
awareness about the symptoms of mental illness, social stigma and abandonment
of mentally ill especially old and destitute leads to social isolation.
7. Reluctance on part of family members
to seek treatment for the patient has resulted in a massive treatment gap,
which further worsens the present mental illness of a person.
8. Rise in Severity:
● Mental
health problems, tend to increase during economic downturns, therefore special
attention is needed during times of economic distress.
9. Prone to Abuse:
● Mentally
ill patients are vulnerable to and usually suffer from physical abuse, sexual
abuse, wrongful confinement, even at homes and mental healthcare facilities
which is a cause of concern and a gross human right violation.
WAY FORWARD:
1. Open dialogue:
● The
practice of open dialogue, a therapeutic practice that originated in Finland,
runs through many programmes in the guidance.
● This
approach trains the therapist in de-escalation of distress and breaks power
differentials that allow for free expression.
2. Increase investment:
● With
emphasis on social care components such as work force participation, pensions
and housing, increased investments in health and social care seem imperative.
3. Network of services:
● For
those homeless and who opt not to enter mental health establishments, we can
provide a network of services ranging from soup kitchens at vantage points to
mobile mental health and social care clinics.
4. Early Interventions:
● There
is a need to create living conditions and environment that support healthy
mental health. It is important to develop a society that respects and protects
basic, civil, political, and cultural rights
● It
is important to aim at child development by early childhood interventions like
preschool psychosocial activities, nutritional and psycho-social help
● To
reduce the burden of mental disorders in women, there is need to ensure
socio-economic empowerment and safety of women.
5.
It is important to generate public
awareness about the commonness of mental disorders, understanding of mental
disorders as illnesses, treatment and the importance of acceptance by the
family and the community.
6. Coordinated efforts from all stakeholders
(government, medical fraternity, civil society, educational institutions,
family, peer group and community) are needed to address the growing concern of
mental health in India.
Persons
with mental health conditions need a responsive
care system that inspires hope and participation without which their lives
are empty.