You must have come across the account of the Gurgaon boy who took the drastic step of climbing the stairway to heaven, marred by depression and pressure due to the boys locker room scandal. We will all miss watching Sushant Singh Rajput on the theatre screens too. And these are not one-off stories. Mental health cases are shooting up. Flooded social media and people’s unfortunate accounts, followed by quarantine and how. An average 8 week lockdown across the globe has chained people inside their 4 walls and deprived them of basic mental health facilities, triggering the talk. And to those who do not bat an eye, no this is not being overstressed, and yes, this is the need of the hour.
WHERE DO WE STAND?
As we often incorrectly associate, mental health is not just about being sad/happy. Schizophrenia, bipolar affective disorder (BPAD), anxiety disorders, phobias, suicides, and mood, neurotic, stress and sleep related disorders fall under the umbrella and are becoming common problems in India.
The atmosphere in India to address the issue has never been receptive. With governments busy in puking allegations at each other, healthcare is thrown out of sight. Mental health facilities are accessible to only 30 million people, out of as many as a massive 150 million suffering from the problem. Suicide levels are sky high, around 8 million a year. The work force is also extremely low – there are 0.3 psychiatrists, 0.12 nurses, 0.07 psychologists and 0.07 social workers per 100,000 population, 18 times fewer than the norm.
India-US relations have strengthened over time, but what may have got buried under the rubble is that India and the United States recently reached an agreement to help each other in the sphere of mental health, exposing each to the other’s medical techniques and developing innovative methods to combat the same. That may sound good, but the intent of the Indian government looks bleak as it spends just 33 paisa($0.004) on a mental health sufferer throughout the year. Shocking statistic? Take this. The state has spent only 0.05% (50 million) of its healthcare budget (528 billion) on mental health, lower than the average spending of low-income countries (0.5%), despite being the 5th largest economy. That is equal to what Mukesh Ambani makes in 3 hours, or half the 1-day cost of running a parliament session.
The neglect is real. The awareness is on the rise. But is there any backing? Laws and Legislations? Policies?
National Mental Healthcare Act
After understanding the demand supply chasm and global pressures by international organisations, India finally came up with an unprecedented plan, the National Mental Health Policy in October 2014. Then came the subsequent Mental Healthcare Act, passed in April 2017 and came into effect in May 2018, which is aimed at bolstering human rights of mentally ill people and providing better access to facilities.
Some noteworthy bullets for the act are -
1) First and foremost, it decriminalizes suicide, a major cause of death.
2) Two key features—a rights-based approach to mental health and recognition of the close inter-relationship between social disadvantage and mental health.
3) The District Mental Health Programme (DMHP), to increase access to mental health care by training general physicians and health-care workers at the district level to provide this care, will have to be expanded to all 648 districts from the present 182.
4) Major benefits like Advanced Directives, Nominated Representatives and the Mental Health Review Board
5) Every insurer shall make provisions for medical insurance for the treatment of mental illness on the same basis as is available for treatment of physical illnesses.
These points, just few among the many, depict that a thought has been spared for mental health, and a good one. They trickle down to the grass roots, and facilitate an equitable environment for treatment. Organised structures can help formalise the issue and ensure efficient implementation. Therefore, there are no second thoughts that the policy in the pipeline had to come out as soon as possible. It has, and with laudable measures.
Is it enough; Loops
While the move was welcomed with open arms as a first of its kind by everyone, some health experts had their opinions on how things could have been laid out differently. The review boards at the national and district levels would have autonomy over the professional conduct of psychiatrists, while a ‘guidance document’ will define the treatment and assessment decisions, leaving little in the hands of doctors. Lack of financial provisions for upgrading resources is also a big gaping hole. Unclear processes and lack of transparency in licensing and registration of wards only has a detrimental impact.
Unfortunately, India accounted for nearly 15% of the global mental, neurological and substance abuse disorder burden. WHO also predicts that by 2020, roughly 20 per cent of India will suffer from mental illnesses. Definitely, proper implementation and efficient management is required to ensure these measures do not fall short.
The Role of Society
Making matters worse is the fact that the menace of mental health is often dealt with denial and hesitation in our country. The mammoth stereotypes related to it are horrendous. People vent out hatred and annoyance towards the mentally ill. They strip them of off respect and dignity. There is a strong notion that by health, the physical aspect is what is being talked about, and this is only the all important thing to keep you on your feet. Staying mentally proactive is considered ‘easy’ and a ‘given’.
In poor households, conditions are adverse, be it in terms of work, food or social circles. A lot of savings flutter away in buying medicines for various diseases they encounter. In such deplorable conditions, mental health is bound to deter, but is not even considered. Common Mental Disorders are twice as prevalent among the poor as among the rich, depression being 1.5-2 times more frequent.
In the corporate sector, people find it hard to attain an optimum work life balance. Putting in excessive hours of work due to sharp deadlines has caused deep distress, with around 8% even having suicidal tendencies. Companies are to be blamed for this. Relationships and studies often take a toll on millennials. If not addressed well, these can go on to aggravate in the years to come. Media also plays a big role. In the news, high profile cases are often sensationalised and privacy is compromised. Statements are made that make the person look weak, bound to succumb. Social media trials, things going ‘viral’ and a pessimistic approach without authentic knowledge does not help.
Such taboos need to be smashed, and smashed hard. Everyone must take in their hands to propagate the importance of mental health, and break these barriers for a more sensitive society.
A multifaceted approach is the prime requirement. Along with the tranche of health infrastructure, there needs to be a comprehensive plan in place to sensitize the nation about how dangerous the evil is. More specialized and skilled professionals need to be inducted. Research and trials need to be carried out extensively to comprehend things better.
A basic cog in the machine is the link between the private and public sector. An enhanced and an inclusive role of the private sector is required, with corporates, businesses, startups and non-governmental organisations chipping in. Insurances equalling physical illnesses must be provided for mental health as well. Only HDFC Ergo explicitly states this in their policy well. The Supreme Court has recently asked the Centre and IRDAI to make insurance companies provide mental illness coverage, as stated in the act.
More programs and workshops from small primary schools to large companies should come into the picture, igniting a movement for mental health. Harvard Business Review reports that some companies, like Verizon Media, Johnson & Johnson, and RetailMeNot, are taking their efforts a step further and implementing employee resource groups as a part of their DEI (Diversity, Equity and Inclusion) strategies, and looking to change mental health cultures, top-down. These are of course little steps of a much larger initiative.
Karan Johar, speaking about his battle, said “I thought I am getting a cardiac arrest. I felt it in the middle of a meeting two and a half years ago, after which I left the meeting in between saying I have something urgent to do and rushed to the doctor. He then said I am having an anxiety attack.”, which points to the fact that you might gain all the laurels in life, but its okay to have bouts of feeling low and seek treatment. India is among the most depressed countries in the world, plummeting to 144 in the list of 156 countries. Economy, defence, business, we want to rise in all lists. Why not this. All must commence at the micro level. Provide your peers with a secure environment so they talk about their inhibitions. Seek professional help. Celebrate the Mental Health Day like Diwali. Instill optimism. Never demean, for you do not know the state of the other person. It’s high time we turn our attention to mental health and move towards a pleasant joyous life. Here’s to assisting the mental health sufferers. Here’s to making a difference in the society’s perception. And most importantly, here’s to spreading love.
Sarthak is an undergraduate student at Hansraj College, University of Delhi, pursuing economics and is currently Summer Associate- social media content development.
He is a writing enthusiast, with a will to delve into political and social issues. He appreciates the subtle art of poetry. Previously worked with content at various organisations, count him in for a sports columnist job :)