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Mental health in India: Few miles travelled, many more to go

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Dr Ambrish Dharmadhikari , Psychicatrist & Head – At Mpower -The Foundation, gives an insight on how mental health issues can be tackled by synchronised efforts from policy-makers

We have come distance in terms of awareness about mental health issue. Few decades ago, talking about mental health was taboo and full of stigma. But today, we see a lot of conversations going around mental health. Not only common people but celebrities are also coming out and talking about their mental health issue and suffering openly. This has shattered the stigma and paved way for conversation around mental health. Frequently newspapers, magazine cover bit surround mental health issue and experts give their tips to readers. There is action from the Government of India as well. The three-year-old Mental Healthcare Act 2017 was finally reformed. The government also gave directives to schools for having mental health professionals catering to children. Many steps were taken to combat problem of mental health issue. But, is it enough? Are we on right path? To answer these, we need to understand what problem we are dealing with.

Mental health problem

In India, WHO estimates that the burden of mental health problems is of the tune of 2,443 Disability Adjusted Life Years (DALYs) per 100,000 population, and the age-adjusted suicide rate per 100,000 population is 21.1. It is estimated that, in India, the economic loss, due to mental health conditions, between 2012-2030, is 1.03 trillions of US dollars. To combat this gigantic problem, we have very small workforce. Mental health workforce in India include psychiatrists (0.3 per 100,000 population), psychiatric nurses (0.12 per 100,000 population), clinical psychologists (0.07 per 100,000 population) and Psychiatric social workers (0.07 per 100,000 population).

We also needs to understand that mental health, like other aspects of health, can be affected by a range of socioeconomic factors that need to be addressed through comprehensive strategies for promotion, prevention, treatment and recovery. Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, living standards, working conditions, and community social supports. Poverty and low education levels are the key amongst these factors. Specific psychological and personality factors also contribute towards the vulnerability. Genetic factors also play role.

To tackle multi-causation problem, there is need for synchronised efforts from policy-makers to grass root common people. Along with interventions, focussing on raising awareness of mental health issues and mobilising efforts in support of mental health, treatment of mental health disorders is of utmost importance. Policy makers should be encouraged to promote availability of and access to cost-effective treatment of common mental disorders at the primary healthcare level. This all will be possible if we take steps to remove roadblocks between person with mental illness and mental health services.

Areas of intervention

Policy area

Mental Healthcare Act 2017 is a milestone step taken by Government of India to reform mental health in India. However, there is poor implementation till now. Proper steps and faster implementation by the government is a must. Currently, a majority of the service providers are in confusion due to lack of funding and necessary infrastructure to implement MHCA 2017. This act also places obligation over insurance provider to provide insurance for mental illness at par with physical illnesses. Although, Insurance Regulatory and Development Authority of India (IRDAI) issued circular dated August 16, 2018, directing insurance provider offering health insurance to cover mental illness as well.

The problem is two way; due to lack of awareness and stigma there is non-disclosure of mental illness and keeping the insurance holder out of ambit of insurance. Insurance companies face challenges of lack of insurance data to accurately estimate the risk cost of the mental health insurance; making premium costly. Lack of adequate provider that deliver mental health services add further to problem.

Infrastructure

India lacks far behind in terms of infrastructure to provide services of mental health as per global standards. Provision of infrastructure is government responsibility, but public-private partnership will serve India better. More and more private players come front and invest in mental health, especially in mental health hospitals, community services. Further, we need more of capacity building of community leaders to become gatekeeper of mental health. Enabling them form local programs to serve community. This model will create need for mental health services; which compel government to increase workforce of mental health service provider. Lastly, same as insurance provider; government should take mental health service delivery at par with physical health delivery. Mental health issues should get focus at par with other non-communicable diseases like diabetes, hypertension.

Organisations and Industry

In the organised sector, implementation of mental health reforms should be ideally fast paced. However, we are struggling in this as well. Organisations are slow to take up mental health as priority and often team building activity, soft skill training and motivational seminars are boxed under name of mental health promotion. Organisations need to shed stigma and embrace mental health in totality. Organised sectors should organise regular workshop on various topics of mental health to create more awareness and many might be doing it. The second step is vital, encouraging employee to seek help. For the same, organisation take few steps like allowing leave on grounds of mental health issue. When was last time you heard someone took leave as he/she was feeling stressed? Normalisation of dialogue around mental health would start when an organisation make policy changes. The other step is providing mental health services in campus. Many stay away fearing, no one utilises due to stigma. If we don’t fight stigma at the organisation level then it would keep troubling every individual. Schools and colleges commonly now have mental health professionals on campus. This should serve inspiration to all organisations to follow the suite and provide services at workplace.

Schools and colleges

Prevention is better than cure. If prevention in mental health is to start, school and colleges are best places to start. Many schools and colleges now have in house counsellors to serve mental health needs of children and adolescent. However, this is neither prevention not sufficient. We need to go one step further and teach mental health hygiene, resilience, healthy coping mechanism, early identification signs of adult mental health issues, etc. To implement this; all schools must introduce mental health curriculum to secondary and higher secondary classes and use activity-based promotions for primary students. As we learn about civic and moral issues; students should study mental health. It will be the foundation for mentally healthy and resilient adults.

We all need to come together and act in direction to achieve our objective of mentally healthy society!

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