Mental health and suicide should be treated as a public health crisis. Mental health is rooted in stigma, behaviour complexes and discrimination within the community and reinforces vicious cycle of disempowerment, social exclusion and coercion.
The covid pandemic has had a devastating impact on mental health with the increase of 22 per cent of cases because of persistent fear, anxiety, isolation, grieving for the loss of lives, decline in income and disruption of delivery of services and lock-downs.
Unfortunately, mental health in India has never been given any attention .Mental health may not be an issue in any election and has rarely found mention in the election manifesto of any political party in India, but providing good health to its citizens is a fundamental right guaranteed by the constitution.
The “right to Iife” has been interpreted by the Supreme Court as not just safeguarding the mere act of breathing or existing but ensuring the quality of life and human dignity.
World Health Organisation (WHO) estimates that mental illnesses contribute 18.5 per cent of the global disease burden including depression, anxiety, schizophrenia and neuro-psychiatric disorders. India shares disproportionate component of this burden with 56 million cases of depression, 43 million of anxiety disorders besides highest global rate of suicides which claim nearly 700 lives every day. Suicide is the leading cause of death in the age group 15-39.
A recent report published in the medical journal the Lancet warns that a range of mental health concerns from anxiety and anger to sleep disturbances, depression, and post-traumatic stress disorder (PTSD) are likely to increase in the days ahead due to the psychological impact of quarantined population during covid .
Currently, as per WHO, for 1,00,000 population India has 0.3 psychiatrists, 0.12 nurses and 0.07 psychologists and 0.07 health workers. These reflect alarming shortage of human resources and dire need to scale up investment to address the issue.
The pathetic state of mental healthcare in the country coupled with government’s apathy is a cause of great concern. A plausible reason is the sheer scale of the problem. Hence, nobody wants to discuss the white elephant in the room. However, the nation cannot afford to ignore the stark reality. There are only about 43 mental hospitals in the country, and most of them are in disarray. Six states, mainly in the northern and eastern regions with a combined population of 56 million people, do not have a single mental hospital. Most government-run mental hospitals lack essential infrastructure, treatment facilities and have a sickening ambience. Visiting private clinics and sustaining the treatment, which is usually a long, drawn-out affair, is an expensive proposition for most families.
Poor mental health incapacitates communities and societies and erodes productivity of the nation besides imposing huge economic costs. According to WHO, India is likely to suffer an economic loss of staggering USD 1.03 trillion between 2012 and 2030.
Developed countries allocate 5-18 per cent of their annual healthcare budget while India allocates roughly 0.05 per cent. We need to build more inclusive and resilient healthcare systems incorporating social protection, access to affordable and quality care based on human rights and with psycho-social approach rather than following the traditional biomedical paradigm. We need to upgrade physical infrastructure and strengthen human resources by training more mental health professionals and skilled health workers.
While poverty, deprivation, job insecurity and social inequities are major determinants for mental health there are barriers like lack of access to mental health care, challenges of delivery in the primary healthcare setting, lack of mental health perspective in public health leadership, gross shortage of trained professionals and lack of adequate funding.
The scenario has become grim over the years largely because there is a lack of appreciation of the significant interplay between mental health and the diversity of other health disorders.
Society has to play a pivotal role in bringing paradigm change.
To overcome shortcomings of domain experts, low-cost interventions like establishment of centres for stigmatisation, rehabilitation and counseling can prove to be therapeutic.
Expansion of yoga and meditation centres in the country would provide enormous relief. Their capacities can be built by civil society in collaboration with community-based organisations, but these initiatives have to be strongly supported by the government.
( Dr Naresh Purohit is Executive Member, Federation of Hospital Administrator. He is also advisor to the National Communicable Disease Control Programme. Dr. Purohit is also Advisor to six other National Health Programmes. He is visiting Professor in five Medical Universities of Southern India including Thrissur based Kerala University of Health Sciences) (The views and opinion expressed in this article are those of the author)