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Time to Empower the Invisibles: India Awaits a Mental Health Revolution

Mental health is an inherent and the most paramount aspect of our well being, without it a qualitative life is barren to imagine. These ‘Covidnary Times’ are extremely turbulent, where ‘Normality’ will be more sidelined with ‘Abnormality.’ The side-effects of Covid-19 will keep hunting our World for ages to come. Surging mass layoffs, transcendental change in our social and community relations, deterioration of physical and financial health, lives being lost and even the right to ‘Rest In Peace’ has been violated by Coronavirus disease.

Covid-19 has made our society multiple times vulnerable and an easy prey to Mental illness like never before.

“Life is a tregedy when seen in close-up but a comedy in long shot”. There is nothing more tragic in human life than someone anguished from a chronic disabling disease and at the same time is forced by the society at the receiving end of Ignorance, mockery, exploitation, abuse (physical, Sexual) and socio-economic exclusion.

It’s quite atrocious, that in our society a person who suffers from mental illness is put on ‘Twin Jeopardy’ where the person suffers from within the body and at the same time is stigmatized, excluded and discriminated by the community in which they dwell.

In case of mental illness ‘Ignorance is a Sin’ whereas timely intervention with community and family support holds the key to bring life back on track.

Mental illnesses are treatable just like diabetes, but a long run comprehensive approach needs to be applied as pointed out by many. Medication, cognitive behavioural therapy with other social supporting factors plays a huge role in recovery. According to WHO, people suffering with Severe Mental illnesses can recover significantly by providing them through supportive Employment programs with family and community support where they are given a productive and inclusive life. Employment programs can work wonders in empowering and integrating them with the mainstream.

Two Golden principles related to Combating mental illnesses are Timely Treatment and their Inclusion. These two principles are supposed to be followed by the State as well are the Civil Society.

Simply put Mental illness acts as a detriment in the individual capacity and capabilities to work, where his ability to communicate, socialize and express gets hampered. When an individual stymies to comprehend reality. Where the individual goes through Vicious cycle of emotional booms and busts. Tiny day-to-day problems seem unmanageable. And the person gets engulfed in his or her own imagined set of World, the perception about reality does not remain real anymore.

Countering Mental illness is a challenging task and a multi-dimensional approach is required. Cynically it’s still missing in Indian society. People with Mental disorders are more at a risk of other deadly diseases like for instance the cardiovascular disease, obesity which increases the risk of premature mortality among them.

Also the diagnosis of mental illness is not a universal and uniform test, psychiatrist evaluation of mental health is only based on the behavioural symptoms of the patient or his family member interviews. The evaluation may differ plus there is no one size fit all approach for Treatment.

But our major obstacle is lack of mental health Awareness, Education and Stigma associated with Mental disorders. In our society the Psychosocial awareness is too ground zero that mental illness is often linked with some paranormal aspect rather than being provided treatment the sufferer is often taken to bogus self proclaimed faith healers, this is especially true for our rural settings. Even in our educated and informed Urban pockets people perceive and equate mental illness with depression or being sad.

What is more Heart-Breaking is that despite having all the required legislations in place, derogatory remarks are often used openly and brazenly against the mentally ill like retard, mad and crazy. What’s even more daunting is that studies suggest that even health workers were found to be misbehaving and have discriminating attitudes against the Mentally ill. The ‘Sensitisation’ and robust training of Mental health Workers, Personnel is needed on an emergent basis.

Gloomily in the present scenario most of our discussion and debate around Mental health is more centered around Depression only, other Severe mental illnesses like Schizophrenia, Bipolar disorder are not given the needed attention. According to the National Institute Of Mental Health the real burden of mental illness is particularly concentrated among those who suffer from Serious mental illness. Globally 45 million suffer from Bipolar disorder and 20 million from Schizophrenia.

Moreover the stigma attached to mental health is real and the problem is not confined to India alone. One will be surprised to find that even in a highly developed Nation like in Canada, mental illnesses are also Stigmatised. Around 43 per cent Canadian are reluctant to socialize with a friend having mental illness and 27 per cent of them are afraid to be with someone having serious mental illness.

And an individual who is mentally ill with severe mental illness are more likely to remain unemployed than others. They certainly are the most exploited and vulnerable group, multiple times prone to abuse, sexually and physically by the community and particularly within given households.

Almost all age groups, gender and socio-economic classes are at the risk of getting affected by mental illness. But evidence suggests that almost 50 percent of all the mental illness begins by the age of 14 years and almost 75 per cent by the age of 24. It’s not difficult to grasp that mental illness is nobody’s fault and it’s not a crime either, it’s an illness and anyone can fall victim to it. Hence, once for all, the community should “Stop Harassing and Stigmatising the Mentally ill.”

Various studies suggests that Mental illness is not caused by any single set of factors, numbers of interconnected factors like genetics, environment, social, economic factors play a role.

According to a recent study done by Lancet Psychiatry 2019, 1 in every 7 indian was found to be affected by mental disorder in the year 2017 and the proportion of mental disorders almost doubled since 1990. With a significant 10.5 per cent or more of the Indian population suffering from mental illness and India is among the most depressed Countryside Worldwide. Also our first National Mental Health Survey 2016, stated that the Treatment gap in India for any Mental Disorder is at a shockingly higher percentage of 83. It’s highly alarming for us at these Covidnary times to initiate focusing on Mental Well being. Otherwise, It’s now or never!

Mental health related information, reporting and surveillance systems play an extremely important role in delivering efficient and effective mental health care services. Our Mental health surveillance system remains more or less non-existent. With only an exception of Gujarat which monitors health indicators regularly and publishes reports on Mental health indicators.

Mental illnesses are not only underreported in India but are not reported at all. Still whatever data is available, it clearly depicts the dreadful stage that we have reached in terms of our Mental health. A total of 197.3 million people in India are estimated to be suffering from any mental disorder. In our case maximum load of mental illness is coming from Depression and Anxiety disorder with a striking 45.7 million and 44.9 million being prey to it respectively. Whereas 7.5 million are suffering from Bipolar and 3.5 million from Schizophrenia. And we also need to understand that people having mild depression may report and seek help more easily than someone having Severe Mental illness.

The discrimination, exploitation and underreporting is multiple times higher in Severe Mental illiness.

With such a horrific state of mental health, our counter mechanism to deal with it lacks significantly. Although the Government of India has taken a number of commendable measures, but unfortunately having Law codes and Policies on paper doesn’t really help much if the implementation at ground-level is not ensured by all the concerned actors, especially State level Government and Civil society need to work together with uniformity.

We have a dismal status in mental health care resources. With a population of more than 1.3 billion only around 9000 psychiatrists exist. A mere 0.75 Psychiatrists cater to about one lakh population in India whereas the desired number is above 3, in US and Europe there are 16 and 10 Psychiatrists to serve 100000 population respectively. US has almost 30 percent of World’s total Psychiatrists. At State level only Kerala has 1 psychiatrist per 1 lakh population.

The National Mental Health Survey, 2016 statistics revealed that in terms of Mental Health, only Gujarat and Kerala have performed well. Gujarat and Kerala are only Indian States that separately report the Budgetary allocation to Mental Health in their State Budget. But the total budgetary allocation for mental health remains below 1 per cent in all the Indian states. And whatever is allocated, mostly it is spent only in paying salaries of staff. Majority of the Budget rests unutilized. Mental Rehabilitation facilities for mentally ill are also absent with only exception of West Bengal. No Indian State other than Gujarat and Kerala were found to be having State specific policy on mental health. The social welfare schemes associated with mentally disabled such as pension schemes were almost negligible & non-existent. Limited mental disability certificates were issued due to which reservation based jobs to mentally ill are missing with only exception being Gujarat.

And we should always remember that our Indian Constitution upholds the dignity, rights and equality of every Citizen including the Mentally ill. It’s our Indian Constitution that laid the very foundation of an inclusive society. Article 41, directs the State to make effective provisions to secure right to work, education, public assistance in case of any disablement. Article 21, Right to life & liberty bestows the right to dignified life which is Fundamental Right of every person including the Mentally ill as noted by Supreme Court.

Thus exclusion of mentally ill is not only a social Evil or Sin it’s also Unconstitutional in nature.

But the Government of India in recent years has taken a number of appreciably sweeping measures, for instance the Right of Person With Disability Act 2016 has included persons with Mental illness as a disability, the section 92 of this act discuss the provisions of imprisonment along with fine in case of atrocities against Persons With Disability including mentally ill. The provision for 1 per cent reservation to Mentally ill is also dictated by this phenomenally empowering act but neither the disability certificates are issued to mental ill nor they are made aware of their legal rights. Moreover the very recent Mental Healthcare Act 2017 for the very first time has made the right to mental health care as Justiciable right. This legislation is a ray of hope amid the darkness, it gives rights to the most vulnerable group of Mentally ill, it speaks against their human rights violations and has various provisions for a dignified living. Both these acts are in consonance with the United Nations Convention on the Rights of Persons with Disability, 2007 (UNCPWD) . According to the Art 27 of UNCPWD, recognise the right to work and participate in labour market that should be open, inclusive and accessible to persons with disability which after passing of RPWD ACT 2016 includes mentally ill as well.

Finally it can be concluded that the moment of realisation in the name of ‘Covid 19’ has knocked our door. It has exposed our vulnerability with respect to Mental Health. Time is Ripe & Right to Empower, Acknowledge and Address the Mentally ill who are certainly the most vulnerable and marginalized section of our Society.

References and Data Source (web links).

https://dsq-sds.org/article/view/3275/3108

Mental Healthcare Act 2017

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482682/

https://enabled.in/wp/every-person-with-mental-illness-shall-have-a-right-to-live-with-dignity-sc-judgement/

National Mental Health Survey, 2016

https://www.psychiatrictimes.com/view/too-few-psychiatrists-too-many

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278227/

https://www.nationalheraldindia.com/opinion/worlds-most-depressing-country-is-facing-a-mental-health-epidemic

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30475-4/fulltext

https://www.nami.org/Learn-More/Mental-Health-Conditions

https://www.google.com/url?sa=t&source=web&rct=j&url=https://thelivelovelaughfoundation.org/downloads/TLLLF_2018_Report_How_India_Perceives_Mental_Health.pdf&ved=2ahUKEwiw24ik5b_qAhXSXSsKHWZrCVoQFjAAegQIAhAB&usg=AOvVaw1YjYly31IGmGZs1Y7M5a5m

https://www.google.com/url?sa=t&source=web&rct=j&url=https://thelivelovelaughfoundation.org/&ved=2ahUKEwiw24ik5b_qAhXSXSsKHWZrCVoQFjAJegQICBAB&usg=AOvVaw1JaXs0iOAwFulBfwA34G3s

https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics

https://ourworldindata.org/mental-health

https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia

https://www.brainyquote.com/quotes/charlie_chaplin_102081

Right of Person With Disability Act 2016

https://www.google.com/search?q=rajya+sabha+mental+illnesses&client=tablet-android-lenovo&prmd=niv&sxsrf=ALeKk01ZNofI-kfwh5LuaF2HnUdZe2gFCQ:1594930391954&source=lnms&tbm=vid&sa=X&ved=2ahUKEwijtdDbytLqAhVtxzgGHWFCDBgQ_AUoA3oECAwQAw&biw=600&bih=960&dpr=2#

https://www.psychiatry.org/patients-families/what-is-mental-illness

https://www.mentalhealth.gov/basics/what-is-mental-health

https://www.google.com/url?sa=t&source=web&rct=j&url=https://discovery.ucl.ac.uk/1516876/1/Khalifeh_Recent_physical_sexual_violence.pdf&ved=2ahUKEwiIip6t2NfqAhXpwTgGHY6dBHcQFjAEegQIAxAH&usg=AOvVaw0scceznfLgNiJ0hq3ml9Oz

https://medicaldialogues.in/icmr-releases-disease-burden-due-to-mental-disorders-in-india-key-findings

https://www.dw.com/en/mentally-ill-suffer-a-horrible-fate-in-india/a-17007499

https://schizophrenia.org.in/mental-health-other-laws/mental-health-act/

PRIYANKA SINGH is an Economics Assistant Professor, in Delhi University’s College, based in India. Can be reached at pinku029singh@gmail.com SUJEET SINGH is an Educator based in India. Can be reached at sujeetsinghh123@gmail.com

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