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| CONCEPT ARTICLE |
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| Year : 2018 | Volume
: 15
| Issue : 1 | Page : 58-60 |
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Mental Health Issues in India: Concerns and Response
Mala Kapur Shankardass
Associate Professor, Department of Sociology, Maitreyi College, South Campus, University of Delhi, India
| Date of Web Publication | 10-Jul-2019 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | 5 |
DOI: 10.4103/2231-1505.262509
How to cite this article:
Shankardass MK. Mental Health Issues in India: Concerns and Response. Indian J Psy Nsg 2018;15:58-60 |
Mental health problems are a cause of great concern in India as per the WHO statistics (2017) and the recent survey (2015 - 2016) conducted by the Bengaluru-based National Institute of Mental Health and Neuro Sciences (NIMHANS) in 12 states, covering 34,802 people. The NIMHANS study reveals 10 per cent of the population has common mental disorders and 1.9 per cent of the population suffers from severe mental disorders. Schizophrenia, bipolar affective disorder (BPAD), depression, anxiety disorders, psychoses, phobia, suicide, mood disorders, neurotic or stress related disorders, post traumatic stress disorder, marital disharmony, sleep disorders, alcohol dependence and substance misuse, and dementia are becoming common problems in the general population. The report warned that with urbanisation, the burden of mental health problems on the society is expected to increase. The prevalence of mental morbidity, a disturbing scenario, the report suggests could be due to fast-paced lifestyles, experiencing stress, complexities of living, a breakdown of support systems and challenges of economic instability. WHO in a recent report (2017) recommends immediate expert intervention since mental health statistics in the country may rise up and affect about 20 percent of the population by 2020 from 2015 estimate of roughly 7.5 percent of India’s population suffering from some form of mental illness (major or minor).
The NIMHANS report indicates lifetime prevalence of mental disorder as 13.7 per cent with 10.6 per cent of them requiring immediate interventions. Extrapolating the results of the 12 states to entire country would mean at least 150 million Indians are in need of intervention for mental health. This National Mental Health survey shows urban areas to be most affected, the problems being 2–3 times higher in Metros. It is observed that almost 1 in 20 suffer from depression, being higher in females in the age-group 40-49 years. 22.4 per cent of the population above 18 years suffers from substance use disorder, with the highest contributed by tobacco and alcohol use disorder and detected more among males. While prevalence of mental illness is higher among males (13.9 per cent) as compared to females (7.5 per cent), certain specific mental illnesses like mood disorders (depression, neurotic disorders, phobic anxiety disorders etc) are more in females. Neurosis and stress related illness is also seen to be more in women. Prevalence in teenagers aged between 13 and 17 years is seen to be 7.3 per cent.
Despite growing incidence and prevalence of mental disorders as the report suggests currently only 30 million Indians have access to mental health facility. Some studies indicate that only 10 percent of Indians with mental health problems receive evidence-based treatments. Treatment gaps greater than 70 percent exist due to insufficient funding of mental, neurological, and substance use disorders. India’s spending on mental health care has consistently been inadequate even though the number of individuals affected by mental illness is enormous. In spite of the large burden of mental illness in 2011 only 0.06 percent of 4.16 percent of the gross domestic product on health in the country was allocated at a national level for outpatient psychiatric care. India’s number of mental health beds was found to be well below average with only 2.15 beds per 100,000 compared to the global figure of 6.5. Thus a major concern in the country is that despite three out of four persons experiencing severe mental disorders, there are huge gaps in treatment. Apart from epilepsy, the treatment gap for all mental health disorders is more than 60 per cent. In fact, the economic burden of mental disorders is so huge that affected families have to spend nearly Rs.1,000 - Rs.1,500 a month mainly for treatment and to access care.
It must be realized that in some parts of the country, available mental health resources are still severely lacking. Rural areas do not have a practicing psychiatrist, psychologists, or social workers. Where practitioners are there, quality of services and their qualifications may be questioned. It is observed that for non-drug therapies, a lack of minimum standards and professional guidelines creates difficulty when determining whether treatments are both safe and effective. Further, coordination between different care facilities is often absent to give the best care possible. Also there is scarcity of well- trained clinical mental health counsellors besides the ability and opportunity to work with a team of functionaries to reach out to the affected people.
Many researchers indicate that often those suffering from mental health problems may not receive needed treatment either because of stigma or a lack of access to help. The NIMHANS study reveals that due to the stigma associated with mental disorders, nearly 80 per cent of those with mental disorders had not received any treatment despite being ill for over 12 months. Poor implementation of schemes under the National Mental Health Programme is largely responsible for this. In addition as the report states there is also a paucity of mental health specialists as well as mental disorders being a low priority in the public health agenda. The health information system itself does not prioritise mental health and further mental health financing is not streamlined.
Not only is the number of individuals affected by mental illness enormous, the burden on the country is of grave concern. Certain estimates indicate that in 2013, just under 31 million disability-adjusted-life-years (DALY) were due to mental, neurological and substance misuse disorders. This had an impact on affected individuals and their families in addition to major implications for India’s productivity, since males in the 30-49 age group, that is, part of the working age population, have the highest prevalence of mental morbidity. This brings increasing employee absenteeism, lower rates of productivity and increased costs to organizations (Shankardass, 2017). Major depressive disorder is the leading cause of years lived with disability and anxiety. These common occurring mental conditions are impacting quality of life and requiring societal attention and health care response.
The central government has responded to addressing mental health concerns with coming out with much needed Mental Health Bill in 2016 which was a year later cleared as The Mental Healthcare Act 2017, replacing the earlier Mental Health Act 1987. The Mental Healthcare Act 2017 was notified on 29 May, 2018 after an expert committee of mental healthcare professionals framed rules and regulations as is the standard protocol for the states to adopt. This acts as a reference point to manage persons with mental illness. Significantly only Gujarat and Kerala have a standalone mental health policy. The Act, 2017 ensures healthcare, treatment and rehabilitation of persons with mental illness from mental health services run or funded by the appropriate government in a manner that does not intrude on their rights and dignity. It ensures that the person affected with mental illness has the right to live a life with dignity by not being discriminated against on any basis or harassed. It assures free treatment for such persons if they are homeless or belong to Below Poverty Line, even if they do not possess a BPL card. The Act promises a person with mental illness the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare. It also specifies the process and procedure to be followed for admission, treatment and discharge of mentally-ill individuals. It clearly states that a person with mental illness shall not be subjected to electro-convulsive therapy without the use of muscle relaxants and anaesthesia. Also, electro-convulsive therapy will not be performed for minors. Further, sterilisation will not be performed on mentally ill persons. They shall not be chained in any manner or form whatsoever under any circumstances. A person with mental illness shall not be subjected to seclusion or solitary confinement. Physical restraint may only be used, if necessary. Importantly, suicide is decriminalised
A remarkable feature of the Act, 2017 is the introduction of advance directives which should be certified by a medical practitioner or registered with the Mental Health Board. It gives people suffering from a mental illness the right to choose their mode of treatment, and by nominating representatives who will ensure that their choices are carried out. Another laudable feature is of empowering the government to set-up Central Mental Health Authority at national-level and State Mental Health Authority in every State. Every mental health institute and mental health practitioners including clinical psychologists, mental health nurses and psychiatric social workers will have to be registered with this Authority, which will also train law enforcement and mental health professions on the provisions of the act, and advise the government on all matters relating to mental healthcare and services.
In addressing mental healthcare concerns the government needs to recognize the roles of counsellors and psychologists besides psychiatrists and the fact that not every person diagnosed with mental illness needs institutionalization. As it is there is shortage of mental health professionals and care facilities in the country, besides their concentration mainly in metropolitan cities, it leaves many in rural areas and in districts without appropriate and adequate medical attention. WHO report reveals that for every million people in India, there are just three psychiatrists, and even fewer psychologists, 18 times fewer than the commonwealth norm of 5.6 psychiatrists per 100,000 people. The basic problem or rather the biggest impediment to providing appropriate mental health care services and provisions in the country is due to inadequate allocation of funds for mental health care facilities. India spends 0.06 percent of its health budget on mental healthcare. Most developed nations spend above four percent of their budgets on mental health research, infrastructure, frameworks and talent pool, according to WHO data. India will have to start spending more on mental healthcare (and health sector in general) since mental health diseases constitute up to 13 percent of the total health burden. The central government needs to allocate a larger chunk of the budget to incur the expenditure in providing adequate medical infrastructure at district and sub-district levels and reduce the burden of the state governments. A significant aspect of the mental healthcare legislation is that it mandates insurance companies to provide medical insurance to the mentally ill on the same grounds that they would issue insurance for physical illnesses. It however does not cover counselling services.
Many experts are of the opinion that a National Commission on Mental Health comprising professionals from mental health, public health, social sciences, the judiciary and related backgrounds should be constituted to oversee, support, facilitate, monitor and review mental health policies. While suggestions such as these can bring about an appropriate national response to address mental health concerns in the country and make provisions for facilities and services to deal with problems, we need a better societal response to stop the stigma and discrimination of a person labelled as mentally ill. We as a nation definitely need to respond with changing our attitude towards mental illness, not only look at it as a biomedical problem but also as a social concern with a healthier and a human rights perspective to deal with mental health issues. The health care system in India is a far stretch from perfect, and some of the toughest challenges belong to the mental health industry. However, with the continued efforts of mental health professionals and policymakers, improvement is possible.
| References | |  |
| 1. | Shankardass, Mala Kapur, 2017 –Mental Healthcare: Facing a number of challenges, The Asian Age, 9 October, New Delhi.  |
| 2. | NIMHANS, 2016 - National Mental Health Survey of India, 2015-16: Prevalence, Pattern and Outcomes, National Institute of Mental Health and Neuro Sciences, Bengaluru. |
| 3. | WHO, 2017 - Depression and Other Common Mental Disorders - Global Health Estimates, World Health Organization, Geneva. |
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