ON THE OCCASION OF WORLD MENTAL HEALTH MONTH 

STRONG NEED FOR MENTAL HEALTH IN INDIA

The WHO faces yet another crisis with Depression that tends to be one of the major non-communicable killer diseases by 2020. In India, as of 2017, WHO estimates that around 20 percent of the entire population is affected by mental health problems. The age-adjusted suicide rate per one lakh population is 25.2, with the majority being the young adults (age 18-25 years), women followed by the elderly (age above 60 years). The financial burden due to mental health conditions in the last two decades in India is around 2 trillion US Dollars at the present value. More than 75 percent of the population in the developing countries (including India) DOES NOT have access to proper sources of care.

Exclusive Article for Indian Observer Post

By Dr. Debanjan Banerjee

BANGLORE, Oct 12, 2019:

“The knowledge of mind is as abstract as its existence” (Carl Jung)

Through the decades, the definition of ‘good’ or ‘ideal’ health has kept changing. One constant dimension that has survived the test of time is ‘mental or ‘psychological’ well-being. Starting from the ancient scriptures that led to the development of an indigenous system of Indian medicine (like Ayurveda), to the archeological remains of Harappa and Mohenjo-Daro and finally to the advent of modern medical science, the concepts of ‘mind’ and ‘illness of mind’ have been vital for the preservation of health

The sciences related to mental health namely Psychiatry and Psychology themselves have been baffled since ages in conceptualizing the ‘problems of mind’. We can easily relate to the brain, heart, lungs, kidney, etc and think about a specialist dealing with them. However, when it comes to ‘mind’ or ‘thoughts’ they tend to evade us as ‘abstract’ concepts not only because they are invisible but also in being highly subjective and can vary widely among different cultures, sects, religions and political boundaries.

One thing, however, stays universal: ‘brain’ or ‘nerves’ cannot be equated with the ‘mind’. The ‘Mind-Brain dichotomy’ has always been debated. The mind is a complex sum-total of our physique and its constant interaction with our environment based on our ability to think, process, judge and act. This resultant ‘human consciousness’ is the result of evolution and makes us stand out perhaps as an ‘intelligent species. So naturally, when this ‘mind’ gets affected by any reason, the results can shake the foundations of existence.

THE PROBLEM STATEMENT

In the olden days, mental disorders were thought to be caused by divine curses, witchcraft, supernatural influences, and magical powers. Then came the field of Freudian psychoanalysis and humanistic psychology. Subsequently evolved the understanding of the brain and its functioning in the 1900s, and finally the emergence of ‘biological’ understanding of psychiatric disorders, various forms of psychotherapy and the new medicines in the field of mental health.

Here it is vital to understand that ‘mental health’ does not mean ‘mere absence of mental illnesses. It includes a broad spectrum of domains that directly or indirectly related to the mental well-being, satisfaction with life, prevention and treatment of mental disorders as well as rehabilitation of chronically ill patients.

Considering the worldwide burden of mental illness (mainly schizophrenia, depression, anxiety disorder, autism, bipolar illness and dementia: the five main ones), the World Health Organization (WHO) urged the member countries to include mental health in individual National Health policies when it declared the theme of World Health Day, 2001 as “Mental Illness: Stop Exclusion, Dare to Care”.

More than a decade later, the WHO faces yet another crisis with Depression that tends to be one of the major non-communicable killer diseases by 2020. Thus, recently in 2017, the World Health Day theme was declared as “Depression: Let’s talk” to sensitize the public about the prevalence of depression, the signs of it, that it can be treated, how and when to seek appropriate help and above all to fight stigma related to depression as well as suicide.

Based on the WHO and UNESCO data,India is among the countries heavily affected with mental disorders, compounded by emerging economy and population burst.

Each of these factors contributes to human stress and ‘existential competition’, aided by social factors like poverty, unemployment and biological factors like genetic vulnerability and personality.

Even though, a lot of changes have come in the field of mental health research and treatment in India over the passing decades with separate National and District mental health policies and a very recent controversial Mental Health Care Bill, 2017 (which revoked the last one of 1987), majority of the population still suffers from poor mental health, staying far from detection or treatment due to lack of awareness, myths, scarce resource facilities and training, and most importantly stigma.

INDIAN SCENARIO

In India, as of 2017, WHO estimates that the burden of mental health problems is around 2700 DALY (1 DALY here means 1 DAY spent being mentally ill) per one lakh population, with around 20 percent of the entire population being affected. The age-adjusted suicide rate per one lakh population is 25.2, with the majority being the young adults (age 18-25 years), women followed by the elderly (age above 60 years).

It is also estimated that in India, the financial burden due to mental health conditions in the last two decades is around 2 trillion US Dollars at present value. The WHO Mental Health-gap Action Programme (mhGAP) in 2018 mentioned that 15 percent of global disease burden is attributable to the mental, neurological and substance use disorders but more than 75 percent of the population in the developing countries (including India) DO NOT have access to the proper source of care.

This program is being implemented in India under the current National Mental Health Policy (NMHP) where it targets to provide adequate medical and psycho-social care for depression, schizophrenia, alcohol abuse and epilepsy thereby attempting to save tens of millions from suffering and untimely death.

It is worthwhile to mention here that India was one of the first countries to sign the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), which includes mental illness and mental retardation and thus strives to deliver right-based approach care to people with mental disorders.

The NMHP also decentralizes service to the individual states and districts for the training of general physicians, suicide prevention, mental health promotion, and alcohol/tobacco de-addiction. India acknowledges the inclusion of ‘mental well-being’ in the Sustainable Developmental Goals (SDG) of the UN and since 2017 the implementation data are being collected, supervised and analyzed.

The National Institute of Mental Health and Neurosciences (NIMHANS) at Bangalore, All India Institute of Medical Sciences (AIIMS) at Delhi and Post-Graduate Institute of Medical Education and Research (PGIMER) at Chandigarh are the apex institutes of the country involved in academics, training, treatment, research and coordination of mental health care services nation-wide. Women’s mental health especially related to motherhood, adolescents, developmental disorders like autism and elderly mental health (dementia and depression) form the major target groups for intervention.

The National Mental Health Survey (NMHS) conducted by NIMHANS in 2015-16 is a milestone in understanding the mental disorders of the country. It clearly states three important facts: “every SIXTH Indian needs mental help”, “low income and over-crowding are linked to mental illness” and “the urban areas are the most affected”.

With over 20 percent of this huge population affected with mental and substance abuse disorders (highest being depression and alcohol use), the resources at hand are alarmingly short.

The NMHS shows three psychiatrists and one psychologist per ten lakhs population, which the majority being concentrated in city institutes. As a result, the ‘treatment gap’ (untreated patients with mental disorders) stays at 70 to 90 percent for most disorders, with depression and schizophrenia being highest. Consequently, suicide rates are increasing, with the metropolitan cities (Bangalore and Delhi) ranking highest at the present times. India is termed as the ‘Suicide capital’ of South-East Asia with ‘suicides’ being the fourth-leading cause of death in young adults.

The treatment-gap is never-ending, and resources cannot be blamed alone. Social factors like awareness, stigma and education play an immense role in early detection and treatment of these problems. The willingness on our part to train at the grass-root level, community awareness campaigns, motivation of the policymakers and multiple levels of remediation involving all forms of media can probably make some difference. As mentioned before, mental health is not about preventing illness.

Uncontrolled medical illnesses (like diabetes, chronic pain, high blood pressure), personal or professional stress, domestic violence, family discord, unemployment, social or political mishaps, loneliness, grief and failure of personal relations are equally important factors that can increase the vulnerability to mental disorders and chances of suicide. Even one day spent in poor mental health can affect the entire human body, his/her surroundings and family.

The modern-day research has opened multiple new dimensions of our understanding of the ‘mind’, the ‘consciousness’, the genesis of mental disorders and drug research. However, as abstract, the mind is, a part of its treatment will always be elusive if we do not treat the ‘individual’ but focus only on the illness.

The prime goal of treatment is to send the ill person back to society to lead a healthy life rather than be ‘feared of’ as a ‘lunatic’. The olden day norm of segregating the mentally ill is redundant. However, laws and policies stay confined to papers and closed doors if not implemented in the correct way.

India has always been positively dynamic in the World-Map and hence can probably live up to the promise of delivering ‘mental health’ to its residents in days to come, aided by the WHO and all the other supporting countries. For sure, this is a global ‘issue’ and hence ‘collective mental health’ is the need of the hour. The statement of eminent Philosopher Descartes “I think, therefore I am…” perhaps best emphasizes the truth that “There can be NO Health Without Mental Health”!

(Author Dr. Debanjan Banerjee is Geriatric Psychiatrist, National Institute of Mental Health and Neurosciences, Bangalore, INDIA).

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