Mental health in India: a perspective
mental disorders are now among the leading causes of disease burden worldwide, with no evidence of global reductions since 1990. In 2017, an estimate of the burden of mental health problems for the States of India revealed that as many as 197.3 million people needed care for mental health problems. This included approximately 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders. The situation has been exacerbated due to the Covid-19 pandemicmaking it a serious concern worldwide.
The staggering numbers, however, are empty of millions more directly or indirectly affected by the challenge and those who dealing with deep-rooted stigmaoften making them unable to ask for help.
This growing challenge to deal with mental health problems is further aggravated by a lack of information and awareness, self-diagnosis and stigma. It is important to understand that the determination of mental illness can only be done by setting benchmarks for screening. There is an urgent need to counter the idea that mental health exclusively means the absence of mental illness. The World Health Organization defines mental health as a state of well-being, where an individual realizes their abilities, can cope with the normal stressors of life, work productivelyand is able to contribute to his community.
Mental illness is an amalgamation of biological, social, psychological, hereditary and environmental stressors. The social determinants of health predispose individuals and populations to poor physical and mental health, increased risk of many physical and mental illnesses, and poorer outcomes from these illnesses, when they occur. In a genome-wide linkage study published in the Nature diary the heritability of depression is estimated at around 40%. This increases to around 70% when biological twins with recurrent and severe major depression are examined. Thus, social factors and institutions, such as gender, race and ethnicity, are responsible for mental health problems.
We understood that the social gradient affects not only the risk of disorders, but also access to services. The ability to cope effectively also depends on social arrangements – such as family structures and earning capacities. There are people diagnosed mental illness who experience periods of well-being and those who are not diagnosed with an illness, but have poor mental health, making it a wide range. Access to mental health services is not limited only to people with mental disorders, but also to those who face challenges of lesser intensity, but find them affecting their daily activities.
Mental health literacy is the gateway to mental health interventions in India. There is a lack of awareness which can lead to overlooking, misjudging or dismissing the signs that someone needs help. The terminologies used related to mental illness can have a profound psychological impact and are experienced as condescending, isolating and stigmatizing.
In India, according to data from NIMHANS, more than 80% of people do not have access to care services for a multitude of reasons, ranging from lack of knowledge, stigma and high cost of care. The actual problem could be more complicated, but a start has been made. The Union budget 2022-2023 took into consideration the issue of mental health, and announced India’s national tele-mental health program, for free 24/7 tele-counseling services. While the parliamentary announcement is a welcome change, there is a need for more investment in mental health needs across India. To date, the allocated budget is around INR 932.13 crore, but this is hopelessly below the estimates provided by mental health experts.
Long-delayed conversations and measures to meet the challenge of access and mental health care, have now slowly made their way into the mainstream. As this important issue draws attention, multi-stakeholder engagement is needed to address the various challenges, on all fronts. Careful mapping and research must be undertaken to produce quality data, which is essential to understanding the extent of the problem. This in turn should be used to implement a comprehensive approach, supported by increased political commitment, scientific understanding and a citizen movement.
(Dr. Virander Singh Chauhan, Emeritus Professor, International Center for Genetic Engineering and Biotechnology (ICGEB); Dr. Sukriti Chauhan, Founder, ETI Services)