The Mental Block!
The National Mental Health Survey (2015-16) paints a stark picture: close to 150 million Indians require mental health interventions, yet a treatment gap of 70 to 92 per cent persists
In the intricate weave of human existence, health concerns form a tapestry that extends beyond mere physical well-being to encompass the delicate threads of mental well-being. Mental health, entailing the intricate interplay of thoughts, emotions, and behaviours, stands as an indispensable pillar of holistic wellness. Yet, within the vibrant canvas of India's diverse populace, the narrative of mental well-being often remains veiled, obscured by the tumultuous rhythms of daily life. Nonetheless, within this silence lie stark truths that beckon to be unveiled and addressed.
Unveiling the Neglect:
In the heart of India's bustling cities and serene villages, millions grapple silently with mental health challenges, obscured by stigma and societal taboos. The National Mental Health Survey (2015-16) paints a stark picture: close to 150 million Indians require mental health interventions, yet a treatment gap of 70 to 92 per cent persists. However, the actual impact is likely much higher considering the “hidden burden” on individuals and their families - a situation which is further aggravated by the uncertainties of the COVID-19 pandemic.
Mental disorders have surged to the forefront as one of the primary contributors to the non-fatal disease burden in India. Shockingly, one in seven (197 million) Indians grappled with varying degrees of mental health disorders in 2017 alone. What's even more alarming is that the proportional impact of these disorders on India's overall disease burden has nearly doubled since 1990. Despite these staggering figures, there's a critical gap in understanding their prevalence, burden, and associated risk factors, particularly at the State level.
WHO's statistics reveal a concerning reality - in India alone, the weight of mental health problems amounts to an astounding 2443 disability-adjusted life years (DALYs) per 100,000 individuals, coupled with an alarming age-adjusted suicide rate of 21.1 per 100,000. The economic fallout? A jaw-dropping USD 1.03 trillion between 2012 and 2030.
Recognising Mental Health as Integral:
Just as physical health is vital, mental health plays an equally essential role in overall well-being, addressing psychological, emotional, and social aspects of an individual's wellness. Mental health is not merely the absence of mental illness; it is the cornerstone of well-being and effective functioning. From the ability to manage thoughts and emotions to the intricate interplay of social, cultural, and environmental factors, mental health encompasses a spectrum of dimensions.
In India, the disparity in mental healthcare resources is striking with just 0.75 psychiatrists per lakh population, predominantly clustered in urban regions, while nearly 70 per cent of India's populace dwells in rural areas. This glaring inadequacy falls far short of the recommended threshold of 3 psychiatrists per lakh population. At the current rate of psychiatric education, bridging this gap would necessitate a staggering 42 years. Besides this harsh reality, challenges surrounding mental health often revolve around eradicating stigma, inevitably amplifying the demand for services, or enhancing service quality through the scarce resources of psychiatrists. A study highlighted the state of the hospital infrastructure deficit and revealed that despite India's vast population, a meager 56,600 public psychiatric beds were available. This included 35,000 beds in mental hospitals, a mere 10 in 723 district hospitals, and just 30 in 479 medical colleges. The estimated requirement for psychiatric beds startlingly soared to a staggering 6.5 lakh, highlighting a severe inadequacy in mental healthcare infrastructure.
Moreover, poverty and discrimination play an insidious role in exacerbating the treatment gap, with affordability posing a formidable barrier to care. Expenses related to mental disorders pushed nearly 20 per cent of Indian families into poverty. Households are forced to allocate over 18.1 per cent of their total monthly budget towards caring for a member with a mental disorder. This underscores the pressing need for enhanced accessibility to mental health services and systemic reforms to address the crisis at hand.
Steps Towards Change:
Amid the shadows, glimmers of hope emerge. Over the last decade, the Government of India has spearheaded a transformative journey in mental health care. With the introduction of the National Mental Health Policy in 2014 and the enactment of the Mental Healthcare Act in 2017, India has demonstrated a resolute commitment to addressing mental health challenges. The National Mental Health Programme (NMHP) and the District Mental Health Programme (DMHP) are pivotal in expanding mental healthcare access, with significant strides made in increasing coverage across districts. Integration with broader health services under the National Health Mission ensures coordinated planning and resource allocation. The Ayushman Bharat initiative aims to transform Aarogya Mandir (Health & Wellness Centres) into mental health hubs, while the Pradhan Mantri Jan Arogya Yojana (PM-JAY) offers health insurance coverage to underprivileged populations. The Ayushman Bharat Digital Mission (ABDM) facilitates care continuity through digital health records, fostering research and enhancing service delivery.
Further, leveraging technology for improving mental health in India is gaining traction as a potent tool to address mental health care challenges. A study conducted in 2018 explored the effectiveness of Project ECHO, a Hub and Spokes tele-mentoring model, to bridge the urban-rural divide in mental health and addiction care within a developing country context like India. Results suggest promise in the NIMHANS ECHO tele-mentoring model for capacity-building in mental health and addiction for remote and rural areas by leveraging technology. Telehealth, including platforms like WhatsApp and video calls, has emerged as a viable option for mental health support, especially during the COVID-19 pandemic, demonstrating the potential of telepsychiatry practice.
Utilizing online platforms and telecommunication methods enables easier access to mental health services, particularly for those in remote areas or with limited online counselling options. In India, various mobile apps offer mental health support, including self-assessment tools, meditation exercises, and access to professionals. Wearable technology such as smartwatches track indicators like heart rate variability and sleep patterns, aiding in the early detection of mental health issues. Additionally, AI-powered chatbots provide personalised support to individuals uncomfortable with human therapists, further broadening mental health assistance options.
In this landscape, Emoneeds, an initiative spearheaded by acclaimed psychologist Dr. Neerja, serves as an exemplary demonstration of private sector commitment. Emoneeds endeavours to bridge the rural-urban and gender divide in mental health by standardizing treatment for critical and chronic ailments like OCD, schizophrenia, drug addiction, and bipolar disorders. Using digital technologies, Emoneeds delivers mental health services to patients in the comfort of their homes, highlighting the transformative potential of technology in addressing mental health disparities in India.
Charting the Path Forward:
Enshrined in the preamble of the Mental Healthcare Act (MHCA) is a profound commitment to safeguarding the rights of individuals grappling with mental illness. It sets forth a compelling mandate for the state to ensure the provision of accessible and affordable mental healthcare services to all citizens. Historically, mental health has languished as a secondary concern on the national agenda, both for policymakers and the public. However, with the advent of the MHCA, there emerges a pivotal opportunity to redefine our approach, placing mental well-being at the forefront of our collective consciousness.
In a world where mental health challenges are on the rise, it's time for policymakers to take bold strategic action:
1. Elevate mental health policy to the forefront of the agenda and invest significantly in transforming healthcare systems. Without proper prioritisation and funding, the gap in mental healthcare will only widen.
2. Design a sustainable model for mental healthcare that ensures no one is left behind. Accessibility and affordability should be non-negotiable principles in this framework, guaranteeing that every individual can access the support they need. Ensuring that mental health services (both OPD & IPD including tele-mental health services) are covered under insurance is a critical need in that direction.
3. Embrace collaboration and tailor interventions to the unique needs of communities. One size does not fit all in mental health, and a context-specific approach is essential for driving real change.
As India navigates the post-pandemic landscape, unified action becomes imperative to realize Sustainable Development Goal 3, which places a spotlight on mental health. It's time to heighten awareness, shatter stigma, and prioritize mental health as a cornerstone of overall well-being. As we commemorate the 76th World Health Day, it is crucial to not only recognize the theme "My Health, My Right" but to internalize its profound message: every individual's right to health encompasses both physical and mental well-being. Through collaborative endeavours, innovative strategies, and evidence-based policies, India can forge a path towards a future where mental health is universally accessible and diligently attended to.
The author is CEO and Co-founder Primus Partners
