Mental Health Care: A Dire Necessity for India

On the occasion of World Mental Health Day, which is celebrated every year on October 10, this article aims to highlight India’s capacity to deal with the critical situation and advocate the cause of mental health and create awareness.

Mental health, though negated for long, is an essential part of human health. It is more so important when the WHO statistics show that a suicide is being committed every 40 seconds. India accounts for one-sixth of the suicide rate among women in the world and 17% of the 800,000 suicides reported worldwide every year, are from India. As per the Mental Health Atlas released by the WHO (2017), India witnesses a rate of 16.3% suicide per 100,000 people. This has been further exacerbated on account of the recent pandemic, leaving India to ponder, if as a country, it is ready to deal with such a catastrophe. And to add to it is the way Indian society has been conditioned to deal with mental illness – it is still a clandestine issue to be hushed up. In India, persons with mental health problems, face stigma and discrimination in many ways. It is high time that as a society, we understand that mental health is more than the absence of mental illnesses. It is not a character flaw or a stigma to be criticized.

Mental health is the foundation for the well-being and effective functioning of individuals, and has the following 3 important aspects: (i) emotional, (ii) psychological, and (iii) social well–being.  Determinants of mental health include individual attributes such as the level of an individual’s personality, genetics, and emotional intelligence – an ability to manage one’s thoughts, emotions, behaviours, and interactions with others. In addition, the mental health of an individual is also affected by social, cultural, economic, political, and environmental factors.

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The significance of mental health can be understood from the point that the promotion of mental health and the prevention of mental health conditions were highlighted in the Sustainable Development Agenda adopted at the United Nations General Assembly in September 2015. And Sustainable Development Goal 3, specifically aims to ensure healthy lives and, among other targets, to promote mental health and well-being.

Mental health is the foundation for the well-being and effective functioning of individuals, and has 3 important aspects: (i) emotional, (ii) psychological, and (iii) social well–being.

Though the care and treatment of persons with major mental disorders are included in national health insurance or reimbursement schemes in our country, the majority of persons with mental disorders pay for mental health services and medicines out of their pocket. Above that, India lacks the basic resources and infrastructure as well to deal with the problem. The Mental Health Statistics in terms of resources show grim figures in terms of India’s capacity to handle the situation (Refer to Table 1)

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Given the statistics, it becomes quite imperative to raise awareness and mobilize efforts in support of mental health for addressing the grave situation that India is currently facing, or might face in the coming years. But thankfully, India has realized that the national health authorities have a major role to play in the treatment and promotion of mental health and the prevention of mental health conditions in all sectors and across the life course. Major initiatives taken by the Indian Government to create a conducive “Mental Health Environment” including the following:

• The Mental Health Policy, 2014 is to promote mental health and prevent mental illness enable recovery from mental illness, promote de-stigmatization and desegregation, and ensure socio-economic inclusion of persons affected by mental illness. It endorses a participatory and rights-based approach to quality services.
• The Mental Healthcare Act, 2017 provides the legal framework for providing services to protect, promote and fulfill the rights of people with mental illnesses. These are in line with the United Nations Convention on the Rights of People with Disabilities (UNCRPD).
• The National Mental Health Programme and Health and Wellness Centres (HWCs) are efforts to provide quality care at the primary health care level.
• Ministry of Education has launched many programs to cater to the mental health of children and adolescents. One of its most prominent initiatives is, “Manodarpan”- the mirror of the mind, which provides wide activities for providing psychological support to students, teachers, and families for mental health and emotional well-being. In addition, it has come up with a handbook on psychological support which carries advisory; Dos and Don’ts, and FAQs related to mental health. It also offers a national-level database and directory of counsellors at the school and university levels.

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We need to realize that the demanding situation cannot be met by the health sector alone; it is only when there is a collective effort made by the other sectors, such as education, employment, housing, and social care, that we would be able to provide an “ecosystem” for nurturing mental well being.

Way Forward

The issue of mental health can be dealt with through a two-pronged approach of the 2 P’s- Prevention and Promotion.

1. Prevention: Mental health prevention involves creating awareness about mental illness and providing measures for accessible, affordable, and quality health care to all persons throughout their lifespan
2. Promotion: Mental health promotion involves creating an environment, which promotes healthy living and encourages people to adopt healthy lifestyles.

Enabling the environment through national mental health policy and legal frameworks is imperative for the effective management of mental health disorders and for providing overarching directions for ensuring mental health promotion. This calls for a multi-dimensional approach and multi-sectoral engagement- what is being referred to as, – “The Entire Life Course Approach”. There is a dire need for collaboration within the health sector i.e. between the specialist mental health and general health services. At the same time, we need to realize that the demanding situation cannot be met by the health sector alone; it is only when there is a collective effort made by the other sectors, such as education, employment, housing, and social care, that we would be able to provide an “ecosystem” for nurturing mental well being.

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