An India Spend report has stated that the number of Indians suffering from mental illness exceeds the population of South Africa. At present, the mentally ill account for nearly 6.5 per cent of the country’s population and it is estimated that by 2020 this number will increase to a staggering 20 per cent. The World Health Organisation (WHO) estimates that nearly 56 million Indians, that is 4.5 per cent of India’s population suffer from depression.
Thirty-eight million Indians or 3 per cent of India’s population suffer from anxiety disorders.. Many people suffer from both illnesses The abysmal state of mental health care in the country is a cause for great concern. Hence the nation cannot afford to ignore the stark realities. There are only some 43 mental hospitals in the country.
Most of them lack essential infrastructure and treatment facilities. Visiting private clinics and sustaining the treatment – usually a long drawn out affair – is an expensive proposition for most families. India ranks 11th in a list of 15 countries of the Asia-Pacific region in a study done to evaluate various indicators of mental health care.
According to a Ministry of Health and Family Welfare report, India faces a treatment gap of 50-70 per cent for mental healthcare. This implies that more than half of the population does not get the required treatment and medical facilities. Government data highlights the dismal number of mental healthcare professionals in India — 3,800 psychiatrists and 898 clinical psychologists. A large number of them are in urban areas.
The WHO reports that there are only three psychiatrists per million people in India while in other Commonwealth countries, the ratio is 5.6 psychiatrists for a million. By this estimate, India is short of 66,200 psychiatrists. Mental health accounts for 0.16 per cent of the total Union Health Budget, which is less than that of Bangladesh, which spends 0.44 per cent.
The developed nations’ expenditure amounts to an average of 4 per cent. The National Mental Health Survey 2015-16 conducted by National Institute of Mental Health and NeuroSciences (NIMHANS) estimates that 13.7 per cent of the Indian population above the age of 18 suffers from mental morbidity, requiring active intervention. It also suggests that one in every 20 Indians suffers from depression. Nearly 1 per cent of Indians suffer from high suicide risks. Almost 9.8 million children in the age group of 13-17 years are suffering from mental health concerns and require active intervention.
A recent study published in the Asian Journal of Psychiatry based on a survey of more than 700 randomly selected students found that almost half of them (53 per cent) were suffering from either moderate or severe form of depression. A 2016 survey of 6,000 youth conducted by Lokniti Centre for the Study of Developing Societies (CSDS) reveals that around one in every eight Indian youth reported feeling depressed very often and around four out of 10 who are currently studying felt regular or occasional depression/tension during the last couple of years. The World Bank has recently identified mental health as a Global Development Priority. This recognizes the critical impact mental health has on economic development and wellbeing. The economic consequences of poor mental health are equally significant.
A World Economic Forum/Harvard School of Public Health study estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to $16.3 trillion between 2011 and 2030. In India, mental illness is estimated to cost $1.03 trillion (22 per cent of economic output) between 2012-2030. A majority of these illnesses can be cured; individuals can lead fulfilling lives including going to school, working, raising a family, and being productive citizens in their communities.
Although mental illness is experienced by a significant proportion of the population it is still seen as a taboo. These barriers deprive people of their dignity. To make dignity in mental health a reality, it requires every member of society to work and take action together. In an effort to curb mental illness and create a conducive environment to address the mental well-being of the public, the Government of India repealed the archaic 1987 Act and passed the Mental Health Care Bill, 2016. Along with the promise to provide an international standard of care, the bill seeks to address the underlying social stigma and taboo attached with this disease.
A field-based research study in the prestigious medical journal The Lancet (by Pandit et al) concludes, “Most Indians do not have community or support services for the prevention of suicide and have restricted access to care for mental illnesses associated with suicide, especially access to treatment for depression, which has been shown to reduce suicidal behaviours.” Counseling has a great role to play in alleviating stress and helping depressed people improve their self-esteem and their ability to cope with despair. There have been some encouraging innovations in India led by voluntary organizations that are both impactful and replicable.
Dr Vikram Patel, who is a professor at the London School of Hygiene and Tropical Medicine and co-founder of Goa-based mental health research non-profit Sangath has been in the forefront of community mental health programmes in central India. The programme is designed to establish sustainable rural mental health support to address issues relating to stress and tension that abet suicide, alcohol abuse and depression in the rural community.
It deploys health workers from within the community, some with no background in mental health. These workers are trained to raise mental health awareness and provide “psychological first-aid”. The program also includes counselors who are imparted mental health literacy. The third line of workers consists of expert psychiatrists, who are qualified to provide medications for more serious mental health disorders. The programme uses Primary Health Centres for screening and feeding people with mental illnesses. Dr. Patel’s vision has been the provision of superior mental healthcare to low-resource communities. He argues that 90 per cent of people affected by mental illnesses go untreated owing to the paucity of psychiatrists.
Importantly, his research has effectively demonstrated that evidence-based treatments for mental illnesses can be delivered in low-income countries by non-specialist healthcare workers. His work has been applauded by TIME magazine which featured him in its annual list of annual list of the 100 most influential people in the world.
A lot of good programmes got their start when one individual looks at a familiar landscape in a fresh way. We increasingly have the tools; but we need to summon the will in the manner game-changers like Patel are doing. People like him have shown there are solutions if we think out of the box. And don’t accept limits on how the world works.
(The writer is a Nagpur-based scholar and author of Village Diary of a Heretic Banker. He can be reached at moinqazi123@gmail.com)