Mental health has become quite a buzzword on social media these days & synonymous with terms like anxiety, depression or stress which people often experience due to troubling dynamics with the family or due to work. The World Health Organisation (WHO) defined mental health, “ is a state of well-being in which an individual realises his/her own abilities, can cope with normal stressors of life, and can work productively & fruitfully.” Therefore, one can imply that feeling well mentally is as important as feeling well physically.
Where does India stand on this aspect? It took a pandemic to make everyone realise how all of us can get impacted mentally, mostly due to the lockdowns imposed by the countries across the globe to curb the spread of virus. This resulted in loneliness, sadness, grief, social isolation, physical & emotional abuse, job & economic based losses, shift in modes of education for students & all in all, extreme uncertainty about future holds since no one knows for how long will this last & when & how will the world function normally post the pandemic.
To answer the question in the topic- Is India undergoing a mental health crisis? Atleast, the reports related to mental health & pandemic suggests- Yes. Job losses, uncertainty about life, fear of isolation due to testing COVID positive has led to suicides.
In a study published in International Journal of Mental Health, India’s COVID-19 lockdown has led to 369 suicide & suicide related behaviour in 2020, in comparison to 269 cases in 2019. As per the study, this was attributed to the way suicide cases were reported in media, journalists’ awareness of the issue of suicide & a false indication of suicides in communities. All this indicates the fact that despite our claims of being a modern and progressive society, mental health, especially in a country like ours, is heavily stigmatized.
Additionally, mental health in India also experiences problems with regards to lack of knowledge about symptoms which are signs of poor mental health or hesitancy in seeking help. Subhra Sarkar, a researcher on mental health in the country, talks about the lack of vocabulary for official diagnosis related to mental health disorders such as depression, somatization disorders. These disorders manifest into symptoms like pain, for which the person will approach a general health centre for treatment rather than a mental health professional. Sarkar also mentions how those who lack knowledge & awareness about mental health often fail to express their stress-related issues, low mood & hesitate to seek help.
Even if the individual might realise that they require help,the question arises where do they go. Who can they approach in the wake of a distress going out of control? According to the World Health Organisation (2017), for one lakh people in India, there are only 0.19 psychiatrists in the country & 0.15 psychologists. Although the number of psychiatrists in 2019 has risen to 0.75 psychiatrists, National Institute for Mental Healthcare & Neurosciences (NIMHANS) in a letter to Indian Journal of Psychiatry suggested that we’d require 2700 more psychiatrists if we’re to fulfil the deficit till 2029.
According to Vijay Nallawala, founder of support group Bipolar India, services related to mental health are mostly restricted to cities & those belonging to rural areas have to travel far & wide to ensure adequate services for themselves. One way through which this problem can be alleviated is through the government's involvement to ensure awareness & accessibility towards health. In the 2017 report by the United Nations, there’s mention of a school-based anti-stigma campaign in the country.
Other such awareness programs include Vidarbha Stress & Health Programme (VISHRAM) which began in 2011 to increase awareness about mental health in rural Vidarbha region of Maharashtra. In a survey done in 2013-15 in the same region,people developed awareness about mental issues such as depression & were willing to seek help from mental health professionals.
From 2007 to 2012, UNARV, a district mental health programme based in Kerala provided psychosocial & pharmacological help to students facing issues such as poor scholastic performance, viewing pornography, alocohol abuse, smoking, skipping classes etc. This programme helped in reintegrating students to avoid their suspension from school. School teachers were trained as primary counsellor & expert interventions were provided.
There is a similar community based programme in rural Maharashtra called Atmiyata which was set up amidst the lack of mental health facilities & overburden on public health workers. The ayurvedic doctors & social workers provided necessary counselling & therapy sessions to cater to the needs of those suffering from anxiety & depression. Through the Atmiyata mobile app, the users had to watch a film & answer a questionnaire to an Atmiyata mitra, a group of trained volunteers to identify signs of mental distress. Then the user was connected to a trained professional for further help. This programme proved to be a major success.
Even during the lockdown institutes like NIMHANS, Lokopriya Bordoloi Regional Institute of Mental Health & Central Institute of Psychiatry offered mental health helpline services during the initial lockdown period, as a part of a necessary mandate under the Ministry of Health & Family Welfare, Govt. of India.
One of the factors influencing the same is the lack of expenditure towards health- both physical & mental. According to the National Health Profile, 2019, India has spent about 1.28% of the annual budget towards health care. Out of this, only 0.05 percent is spent towards mental health care. The National Mental Health Care programme which was started to ensure accessible mental healthcare for all, saw a decrease in their budget from 50 crores in FY 2018 to 40 crores in FY 2019. But over the years, only 5 crore rupees were spent. This highlights another problem of how ensuring increased budgets is not enough. It is equally important to supervise whether the funds have been utilised well.
The dismal picture of mental health institutions & awareness also translates to not just producing less mental health professionals but also creates problems for budding psychologists. Psychology, as a discipline, is offered in selected colleges. In an esteemed university like University of Delhi, Psychology is available in less than 10 colleges out of which more than 50 percent colleges are only for female students.
As the student completes their graduation & reaches the post-graduate level of study or MPhil (post which a license from Rehabilitation Council of India (RCI) ensures freedom to practice independently), again there are selected institutes offering the subject with few seats. For a college offering less than 50 seats, there will be more than a hundred students giving competitive exams to enroll into an institute. This ensures less students are trained as mental health professionals, in a country where more than 100 million people are suffering from mental illness, as per a survey report published in 2015-16 by NIMHANS.
Going back to the definition of mental health by WHO, all of us need an optimal mental health to be fruitful & productive. This will not only benefit the person concerned but also the economy & the nation at large. Through various awareness programmes & community based interventions, we’re surely taking baby steps which are clearly not enough. Such interventions should be spread across the country catering to every demographic of the country so that the country is not only physically healthy but also mentally healthy.