Mental health is an investment
[ Dr Pakha Tesia ]
World Mental Health Day (WMHD) is a programme of the World Federation for Mental Health (WFMH). It was first held on 10 October, 1992, and is observed annually all over the world.
Each year, a mental healthcare theme is chosen, and for 2020 the theme is ‘Mental health for all – Greater investment, greater access’. The WFMH has membership of many countries across the globe and with the help of this programme annually raises awareness within the global community about the mental health challenges, gaps and priorities through collaborative and unifying voices aimed at taking actions, and addressing and creating lasting changes towards restoring the dignity of all those living with mental illness.
The observation of this day provides an opportunity to invite the attention of governments, donors, policymakers and all stakeholders to ensure action for greater investment and commitment for mental health.
In 2014, the National Mental Health Policy was launched in India. The same year, the national mental health survey (2014-2016) was conducted by the NIMHANS, Bangalore, which gave us important data.
Prevalence of mental illness
” Total population: 138 crore
” Psychiatric morbidity: 10 percent (13.8 crore)
” Severe mental disorders: 0.8 percent (1 crore)
In a vast country like India, such is the magnitude of psychiatric problem among our people. The above figure just gives the patient count.
Add to it the many families who suffer in silence along with their patients. That number is huge and challenging due to the lack of adequate mental health professionals (MHP) and mental healthcare facilities.
This brings our attention to the question of treatment gaps. Around 15 percent of the mentally ill get timely help, which shows that the majority of our population don’t have timely access to treatment for their psychiatric ailments. When we discuss psychiatric treatment, we definitely have many issues which hinder the help seeking/treatment, including ignorance and lack of awareness about psychological health aspect. Even the so-called educated public shy away from seeking mental health professionals’ help because of stigma and perceived discrimination.
Awareness among other health professionals is lacking also, and patients are often wrongly advised to stop psychiatric medications and are rarely referred for psychiatric consultation in spite of visible psychological distress.
Many unexplained physical symptoms (all reports normal) can be attributed to some psychological causation/factors. Besides, there is a genuine deficiency of MHPs in smaller towns and villages and thus, many can’t have access to specialist help. In many district hospitals, there is no regular supply of psychotropic medicines, which further hampers the management of mental illnesses.
All these factors describe the need for greater investment in the area of mental health. As practising psychiatrists, we try to spread awareness and education regarding mental illness and treatment, one patient/family at a time. We know that many of the psychiatric illnesses are treatable and manageable with timely help. Medicines and psychotherapy are the two main treatment arms.
the national survey on the extent and pattern of substance use (2019) conducted by social welfare & justice ministry and the AIIMS, New Delhi, gave alarming figures related to the magnitude of substance use in our country.
Alcohol use in India
16 crore use alcohol; 5.7 crore are problematic users; 2.9 crore are dependent/addiction patients.
Cannabis use in India
3.1 crore use cannabis; 72 lakhs are problematic users; and 25 lakhs are dependent/addiction patients.
Opioid/heroin use in India
2.3 crore use opioids; 77 lakhs are problematic users;
and 28 lakhs are dependent users.
Other substances:
10 lakhs use cocaine; 18 lakhs are in the amphetamine group; 12 lakhs use hallucinogens drugs; 7 lakhs use volatile substances.
People might wonder why substances like alcohol and drugs statistics are given here. De-addiction psychiatry is a specialized branch of psychiatry, dealing with use of alcohol and other substances. Many addiction patients do not come in time for help to mental health professionals. Many of them get treated for gastritis, liver or pancreas problem, without addressing the root issue of substance abuse, eg, alcohol problem,
Suicide is the silent epidemic among our young population. The National Crime Records Bureau (NCRB), 2019, data reported 1,39,123 suicide cases in India. The number of attempted suicide and deliberate self-harm (DSH) is 20 times more for every completed suicide which is reported around 28 lakhs affected persons.
All the above numbers are reported, but that is just the tip of the iceberg. Moreover, we need to remember the loss incurred, where whole families are deeply affected.
From an economic aspect, the World Economic Forum, 2018, noted that mental health disorders are on the rise in every country and it could cost the global economy upto 16 trillion US dollars between 2010-2030 if mental health needs are not addressed.
The current worldwide pandemic arose against an already dire mental health landscape that saw mental health conditions on the rise. Mental illness is on the rise in all the states, including Arunachal. Daily reports in various media speak volumes about rampant addiction, and broken families and suicides are on the rise in every town/village. There is deficiency of specialist doctors, hospitals, rehabilitation centres, halfway homes and old-age homes in most states.
With the available data, the government of India came out with a far-reaching judgment – the Mental Health Act, 2017, which respects the dignity of persons and families afflicted with psychological issues and have far-reaching legislation/obligations. Section 18 speaks about the right to access mental health for all. This statement talks about the access to mental health. Section 18 (4) deals with the range of services to be made available, like a) outpatient and inpatient services; b) support family of person with mental illness; c) rehabilitation services; d) child and geriatric (old age) service; and e) free medicine (essential drugs).
Section 18 (6) – Community health centres in the public health system, district mental health programme (DMHP). Section 18 (5) F – the government shall make rules regarding reimbursement of costs of treatment (compensation clause for not providing services).
Such groundbreaking legislation is adopted for the overall welfare of those needing mental health care. Now it is the duty of the state governments to make sure they follow them in the true spirit with actions on the ground.
Mental health is an investment and not an expense for any community/state. If we relook at the figures, one can imagine what far-reaching consequences we have to pay for our future if we neglect the facts and numbers of mental illness. Imagine the lost lives (suicide), accidents and cost incurred by government/families in the treatment of addiction. With the onset of Covid-19, harsh and drastic lockdown measures, containments still persisting, large-scale socioeconomic disruption, job losses, business going bankrupt – almost everyone has experienced anxiety, depression and sleep disturbance. We still do not know what the future holds for the majority in terms of long-term psychological impact.
In these bleak times, we have to help each other to fight back and rebound to the good days ahead. On this day, let us pledge to give our brothers and sisters and those with mental illness the right to live with dignity. I pray that the government, policymakers and philanthropists contribute greater investment towards mental health. (Dr Pakha Tesia is MD, Psychiatry, NIMHANS, Bangalore, and consultant psychiatrist and de-addiction specialist at the Mind & Wellness Clinic, Shillong and Guwahati)
