Introduction
“Mental health is an integral part of health; indeed, there is no health without mental health”.
- In recent years, there has been increasing acknowledgment of the important role mental health plays in achieving global development goals, as illustrated by the inclusion of mental health in the Sustainable Development Goals.
- Across the country, suicide ideation, self-harm, and relapses have all risen.
- Depression is one of the leading causes of disability.
- Suicide is the second leading cause of death among 15-29-year-olds.
- People with severe mental health conditions die prematurely – as much as two decades early – due to preventable physical conditions.
- Despite progress in some countries, people with mental health conditions often experience severe human rights violations, discrimination, and stigma.
- Many mental health conditions can be effectively treated at relatively low cost, yet the gap between people needing care and those with access to care remains substantial.
What is Mental Health?
- Mental health is a state of well-being in which an individual realizes his or her abilities, can cope with the normal stresses of life, can work productively, and can make a contribution to his or her community.
- Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.
- Mental health is important at every stage of life, from childhood and adolescence through adulthood.
- Mental health is more than just the absence of mental disorders or disabilities.
What are the symptoms?
- Feeling sad or down.
- Confused thinking or reduced ability to concentrate.
- Excessive fears or worries, or extreme feelings of guilt.
- Extreme mood changes of highs and lows.
- Withdrawal from friends and activities.
- Significant tiredness, low energy, or problems sleeping.
What are some of the disorders?
- Depression, Bipolar disorder, Schizophrenia, and other psychoses, Dementia and Developmental disorders, including autism
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What are the determinants of mental health problems?
Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time.
- Social factors-For example, violence, and persistent socio-economic pressures are recognized risks to mental health. The clearest evidence is associated with sexual violence. Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, physical ill-health, and human rights violations.
- Psychological factors-There are specific psychological and personality factors that make people vulnerable to mental health problems.
- Biological factors- Biological risks include genetic factors, such as genes or brain chemistry.
- Other factors- Stress, genetics, nutrition, perinatal infections, and exposure to environmental hazards are also contributing factors to mental disorders.
The magnitude of mental disorders in India
- In India, the World Health Organization estimates that the burden of mental health problems is of the tune of 2,443 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 2010 dollars.
- The suicide rate in India in 2015 at 15.7/100,000 is higher than the regional average of 12.9 and the global average of 10.6.
- Suicide is the leading cause of death among those aged 15–29 in India.
WHO on suicides in India
- According to the World Health Organization, India had the highest number of suicides in the world in 2012 with 258,000 of 804,000 suicides worldwide.
- Indian youths between the ages of 15 and 29 years committed suicide with 35.5 deaths per 100,000, while suicide became the leading cause of death of young Indian women also.
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Status of Mental Healthcare in India
- Poor spending: India spends 0.06% of its health budget on mental health care, which is significantly less than what Bangladesh spends (0.44%).
- Most developed nations spend above 4% of their budgets on mental health research, infrastructure, frameworks, and workforce, according to a 2011 WHO report.
- India's first-ever National Mental Health Policy, announced in 2014, aims to provide universal psychiatric care to the population by 2020, despite a relatively small health care budget per capita compared with other developing nations.
COVID and mental health
- The coronavirus outbreak risks sparking a major global mental health crisis, the United Nations warned, calling for urgent action to address the psychological suffering brought on by the pandemic.
- The COVID-19 pandemic has disrupted or halted critical mental health services in 93% of countries worldwide while the demand for mental health is increasing.
- Children and adolescents are struggling to manage their urges to be outdoors and with their friends. For many, the continuing virtual classes are leading to virtual fatigue.
- There are cases of increased clashes with family members, particularly in the context of the presence and utilization of social media and related platforms.
Who are the most vulnerable?
- Children- According to the National Crime Records Bureau (NCRB) statistics, more than one student commits suicide in India every hour, with about 28 cases reported every day. A lot of behavioral issues are noted in children and they are getting aggressive and there is a lot of anxiety about the virus and performance in their studies.
- Health-Care workers- The health workers are working relentlessly in fighting this pandemic. Their mental health like all of us is fragile in the given conditions as they are also equally affected by this pandemic.
- Elderly- The elderly population is mostly affected by the fact that the fatality rate amongst them is higher and they need to be extremely careful.
- Women- They also face a heightened risk of domestic abuse as people spend lengthy amounts of time cooped up at home.
- People with pre-existing issues-And people with pre-existing psychological issues could see them exacerbated, while accessing their usual treatment and face-to-face therapy may no longer be possible.
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Mental Health and international practices
- 181 countries have committed to establishing policies & laws that align with the UN CRPDMental health in the workplace.
- An increasing number of countries are seeking to reform their laws and policies to promote the rights to community inclusion, dignity, autonomy, empowerment, and recovery for all people with psychosocial, intellectual, and cognitive disabilities.
UN Convention on the Rights of Persons with Disabilities (CRPD)
- It was adopted in 2006.
- WHO also works with countries to develop and implement progressive mental health and related policies and laws in line with international best practice and human rights standards including the UN Convention on the Rights of Persons with Disabilities (CRPD).
WHO’s Mental Health Action Plan 2013-2020
It was endorsed by the World Health Assembly in 2013, recognizes the essential role of mental health in achieving health for all people. The plan includes 4 major objectives:
- more effective leadership and governance for mental health
- the provision of comprehensive, integrated mental health and social care services in community-based settings
- the implementation of strategies for promotion and prevention
- strengthened information systems, evidence, and research
WHO's Mental Health Gap Action Programme (mhGAP)
- Launched in 2008, it uses evidence-based technical guidance, tools, and training packages to expand services in countries, especially in resource-poor settings.
- It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care.
WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health
- In 2019, WHO launched this initiative to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.
- World Mental Health Day
- WHO commemorates October 10 as World Mental Health Day.
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Mental Health and the areas of studies
1. Workplace and the Mental Health
- Changing working environments undoubtedly bring opportunities, for professional development, expanding networks, and innovation.
- The extent and pace of change can, however, when coupled with a working environment that doesn’t take account of people’s mental well-being, lead to physical and mental health problems, harmful use of alcohol or other substances, absenteeism, and lost productivity.
- Bullying and psychological harassment are well-known causes of work-related stress and related mental health problems.
2. Women and Mental Health
- The patterns of psychiatric disorder and psychological distress among women are different from those seen among men.
- Symptoms of depression, anxiety, and unspecified psychological distress are 2–3 times more common among women than among men; whereas addictions, substance use disorders, and psychopathic personality disorders are more common among men.
- Depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men.
3. Mental Health and Children and adolescents
- Children and adolescents (CAA) has been exposed and experience intense trauma in form of wars, displacement, disability, and disruption of childhood. In this way, they are especially vulnerable.
4. Mental health and the elderly
- Elderly people suffer from the dual medical problems of both communicable as well as degenerative diseases.
- The two commonest mental disorders are depression and dementia. There is a need for prevention (control of diabetes, hypertension, etc), early identification, treatment, and rehabilitation.
5. Mental Health and Special groups-refugees, disaster-affected populations
- Refugees, disaster-affected populations represent a group of persons with special emotional needs.
- This is because of the extreme disruption that they have experienced and the lost opportunity for a normal life.
6. Mental Health and Persons in institutional settings (prisons, orphanages, etc)
- Persons in institutional settings have special needs for mental health care. Generally, these institutions have a greater proportion of individuals with mental health needs.
- These can be in the form of acute and chronic psychoses, mental retardation, dementia, and drug dependence.
- Solutions to these problems have to found by recognizing the emotional needs of the persons; sensitizing the staff of institutions to emotional aspects of the residents; training the medical staff in mental health care; providing coping skills to the residents; creating opportunities for emotional fulfillment through education, hobbies, entertainment, forming relationships, etc.
7.Conflict areas and Mental health
- WHO estimates show more people are living with mental disorders in areas affected by conflict.
- One person in five is living with some form of mental disorder, from mild depression or anxiety to psychosis.
- Worse, almost 1 in 10 is living with moderate or severe mental disorder.
- These people desperately need to be able to obtain treatment and care. Their disorders often impair their ability to function.
National Mental Health Programme
- The Government of India has launched the National Mental Health Programme (NMHP) in 1982.
The objectives
- to ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population
- to encourage the application of mental health knowledge in general healthcare and social development
- to promote community participation in the mental health service development and to stimulate efforts towards self-help in the community
Approaches
- Diffusion of mental health skills to the periphery of the health service system; appropriate appointment of tasks in mental healthcare; and integration of basic mental healthcare into general health services and linkage to community development and mental healthcare.
- The service component will include three sub-programs—treatment, rehabilitation, and prevention.
What are the costs due to Mental Health problems?
- Monetary Cost- According to the world economic forum 'the global cost of mental illness at nearly US$2.5Trillion (two-thirds in indirect costs) in 2010, with a projected increase to over US$6T by 2030.' Mental health costs stand the highest in terms of burden.
- Resources lost- Loss of productivity due to morbidity and mortality: Illness would mean decreased activity and performance or be absent from work.
- Violence and crime-related costs: Severe mental illnesses are known to be associated with violence and crime in the form of homicide, suicide (self-inflicted violence), sexual offenses, violence against family members, at the workplace, elderly and child abuse.
- Reproductive Health- Mood and behavioral changes have been observed to be associated with the menstrual cycle since ancient times.
- Societal Costs- Stigmatized attitudes and beliefs towards individuals with mental health and drug use disorders are often in the form of social stigma, which is structural within the general public.
- Indirect costs- These are more than direct costs with regards to mental illness. The costs of care (like medication, clinic visits (fees), hospitalization, diagnostic services, residential care, community services, rehabilitation, and non-medical costs like transportation for treatment and care) are direct costs.
Mental Health Awareness Methods
- For the large Indian population to be involved in its mental health, the only way forward is through enhancing mental health awareness which will generate its demand.
- With rising awareness, it can be expected that early recognition and access to treatment will follow, as will the adoption of preventive measures.
- It can also be expected that with enlarging awareness in a democratic society, advocacy, leveraging of political will, funding, and cross-synergies shall follow.
- It is envisaged that the bulk of the awareness contributions shall flow from the following six platforms
Models of Mental Health Treatment
Based on the review, most innovations are broadly summarized into five categories:
- quality improvement mental health programs
- community-based mental health programs eg. accredited social health activist (ASHA)
- non-specialist mental health programs
- mobile-technology based mental health programs
- tele-mental health programs such as a mobile phone for mental health risk identification.
Mental Healthcare Act 2017
In 2017, the government introduced the Mental Healthcare Act to guarantee citizens' access to government-funded mental healthcare and treatment. The new Mental Healthcare Act 2017 rescinds/revoked the existing Mental Healthcare Act 1987 which had been widely criticized for not recognizing the rights of a mentally ill person.
- Rights of persons with mental illness every person will have the right to access mental healthcare services. Such services should be of good quality, convenient, affordable, and accessible. This act further seeks to protect such persons from inhuman treatment, to gain access to free legal services and their medical records, and have the right to complain in the event of deficiencies in provisions
- Advance Directive: This empowers a mentally ill person to have the right to make an advance directive toward the way she/he wants to be treated for the requisite illness and who her/his nominated representative shall be. This directive has to be vetted by a medical practitioner.
- Mental Health Establishments: The government has to set up the Central Mental Health Authority at the national level and the State Mental Health Authority in every state. All mental health practitioners (clinical psychologists, mental health nurses, and psychiatric social workers) and every mental health institute will have to be registered with this authority.
- Decriminalizing suicide and prohibiting electroconvulsive therapy-It decriminalizes suicide attempt by a mentally ill person.
- It also imposes on the government a duty to rehabilitate such a person to ensure that there is no recurrence of a suicide attempt.
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What are the solutions?
Some of the specific ways to promote mental health include:
- Early childhood interventions, for example, providing a stable environment that is sensitive to children’s health and nutritional needs, with protection from threats, opportunities for early learning, and interactions that are responsive, emotionally supportive, and developmentally stimulating
- Support to children, for example, life skills programs, child and youth development programs
- Socio-economic empowerment of women, for example, improving access to education and microcredit schemes
- Social support for elderly populations such as befriending initiatives, community and day centers for the aged
- Programs targeted at vulnerable people, including minorities, indigenous people, migrants, and people affected by conflicts and disasters e.g. psycho-social interventions after disasters
- Mental health promotional activities in schools e.g. programs involving supportive ecological changes in schools
- Mental health interventions at work e.g. stress prevention programs
- Violence prevention programs e.g. reducing the availability of alcohol and access to arms)
- Community development programs e.g. integrated rural development
- Poverty reduction and social protection for the poor
- Anti-discrimination laws and campaigns
- Promotion of the rights, opportunities, and care of individuals with mental disorders
- Education, training, and interventions targeting the social and physical environment are crucial for addressing women's mental health
Conclusion
Mental health situation in India demands active policy interventions and resource allocation by the government. To reduce the stigma around mental health, we need to measure to train and sensitize the community/society. This can happen only when we have a persistent nationwide effort to educate society about mental diseases. We also need steps to connect the patients by forming a peer network, so that they could listen and support each other. Moreover, people experiencing mental health problems should get the same access to safe and effective care as those with physical health problems. Additionally, mental illness must mandatorily be put under the ambit of life insurance.
