The Global Burden of Disease Study (1990–2017) says, one in seven Indians were affected by mental disorders of varying severity in 2017 and the proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990.
By Sonali Maheshwari
The COVID-19 has set the tone for a new normal of “health & wellbeing”. Well-being is not just the absence of illness — it is the active presence of wellness. It’s a worldwide known fact that mental health is a critical component of overall wellness. There is no denying the fact that intervention at the earliest possible time / stage is crucial to save lives from any disease. And the same is true for people living with mental disorders too.
However, in countries like India, mental health issues continue to be mired in deep rooted stigma and fear of ostracization. Often, also because of misconceptions / myths about mental health and mental fitness, as well as lack of access, affordability, and awarenesspeople often suffer in silence and their conditions go untreated.Hence, one major problem that exists in Indian mental healthcare is the treatment gap, or the number of individuals with an illness who need treatment but do not receive it.” As a result the gap worsens the issue / disorder / disease so much so that at times it becomes chronic, requiring lifelong management.
Lancet studies suggest that India’s contribution to global suicide deaths increased from 25·3% in 1990 to 36·6% in 2016 among women, and from 18·7% to 24·3% among men. The Global Burden of Disease Study (1990–2017) says, one in seven Indians were affected by mental disorders of varying severity in 2017 and the proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990.
The Lancet in its study “State-wise burden of mental health” has reported that nearly 45 million people suffered from mental health disorders, and most Indian states that housed a large part of the population showed a low progress performance in the index. It says that on average, 14 percent of Indians suffer from variations of mental health disorders in the country. Report also says that the mental disorders which have their onset predominantly during childhood and adolescence, the highest disease burden was caused by idiopathic developmental intellectual disability (IDID), followed by conduct disorder and autism spectrum disorders. Among the mental disorders that manifest predominantly during adulthood, the highest disease burden in India was caused by depressive and anxiety disorders, followed by schizophrenia and bipolar disorder.States like Maharashtra and several northeastern states bear a heavier burden of mental health issues amongst their citizens than the country’s central and northern states. Kerala, Karnataka, Telangana, Tamil Nadu, Himachal Pradesh, Maharashtra, Andhra Pradesh, Manipur, and West Bengal have the highest prevalence of anxiety disorders.
While the above data shows the mental health status of the nation. Its positive correlation with the nation’s economic growth is also an established fact. Projections show that India will suffer massive economic losses owing to mental health conditions. According to the World Health Organisation, the burden of mental health problems is to the tune of 2,443 disability-adjusted life years per 100,000 population. And the economic loss, due to mental health conditions, between 2012 to 2030, is 1.03 trillions of 2010 dollars.The National Mental health Survey (NMHS) also says that mental health disorders disproportionately affect households with lower income, less education, and lower employment. These vulnerable groups are faced with financial limitations due to their socioeconomic conditions, made worse by the limited resources available for treatment.
In order to curb the leading causes of non-fatal disease burden in a nation where persons with mental illness and their situations are being aggravated by socioeconomic and cultural factors strategies of all sorts i.e. promotion, prevention and early intervention will produce the greatest impact on people’s health and well-being.
To address this increasing and already grave issue, GoI has taken important steps like introducing Mental Health Policy, 2014 and rights based Mental Healthcare Act, 2017. Keeping mental health as one theme in initiatives like National Adolescent Health & Development Program, 2016 and initiative of Ayushman Bharat,2018.
For the successful implementation of MHA 2017 Act, aspects such as primary prevention, reintegration, and rehabilitation are more crucial and need constant strengthening with dedicated efforts. Hence, dedicated focus is needed towards building robust infrastructure including registration of mental health practitioners and implementing service-delivery norms while acknowledging the extent of the issue. Secondly, while the new Mental Healthcare Act 2017 is supposed to change the fundamental approach on mental health issues including a sensible and sensitive patient-centric health care yet it seems to missthe desired attention towards the elements of prevention and early screening. Also thematic integration of issues in the key programs will surely contribute to bringing awareness on the issue.
But seeing the seriousness of the issue (in a nation of 1.3 billion people, 10 % have one or more mental problem, as per NIMHANS mental health survey findings) mainstreaming the topic with holistic approach is of paramount importance especially in a scenario where treatment gap is largely due to stigma and myths associated with the issue. To make the Indian population involved in its own mental health, it is pertinent to address demand side barriers by enhancing their mental health awareness.
Further strengthening the entire ecosystem, with right information and awareness mental health should grow from one theme to mainstream topic for classroom study. From the earliest possible age, children must know the concepts of anxiety, stress and most importantly that there are chances in everyone’s life to experience it and which is normal. Along with this,they should be taught about its management. Importance of sharing, listening, expert services, and counseling should be told to them. They should be taught with age appropriateness about the causes and symptoms of stress and its management, they need to be taught about the life skills needed to speak about the symptoms, seek help and not feel shame. Most importantly they need to be aware that mental health issues are curable. These learnings will also refrain them from indulging into substance abuse, suicidal thoughts and other life threatening activities.
Apart from this, caregivers / parents also need to be oriented about the concept of self-awareness, mental health, and seeking help. They too shall be encouraged to break the cycle of shame and stigma associated with mental health.Lastly seeing the paucity of data investment on research and systemic studies will help in conceptualizing more informed & robust interventions to facilitate prevention where possible and to provide affordable treatment, care, and rehabilitation.
With all these integrated efforts, awareness rising at all levels of the ecosystem can be expected further leading to early recognition of the symptoms and access to treatment as well as the adoption of preventive measures.
(Author is a social development professional. She has extensive experience in advocacy and strategic implementation of community interventionsfor developmental themes such as- Child Sexual Abuse, Adolescent Health & Development, Gender Equality, Women Empowerment, WASH, Livelihood &Maternal Child Health & Nutrition. Views expressed are personal and do not reflect the official position or policy of Financial Express Online. Reproducing this content without permission is prohibited).