Need to focus on Mental Health

Context

• There is a need for an urgent and well-resourced ‘whole-of-society’ approach to protecting, promoting and caring for the mental health of people.

About

• Data on Suicide: 
  • Suicides rates in India are amongst the highest when compared to other countries at the same socio-economic level. 
  • India’s suicide rate in 2019, at 12.9/1,00,000, was higher than the regional average of 10.2 and the global average of 9.0. 
  • Suicide has become the leading cause of death among those aged 15–29 in India.
• Male v/s Female: 
  • Across the world, the prevalence of some mental health disorders is consistently higher among women as compared to men.
• COVID impact:
  • The pandemic has further exacerbated the problem. 
  • Globally, it might have increased the prevalence of depression by 28 per cent and anxiety by 26 per cent in just one year between 2020 and 2021. 
  • Younger age group is most impacted: The large increases have been noted among younger age groups, stemming from uncertainty and fear about the virus, financial and job losses, grief, increased childcare burdens, in addition to school closures and social isolation.
• Digital media and stress: 
  • Increased use of certain kinds of social media is also exacerbating stress and mental ill health for young people. 
  • Reduced face to face interactions: Social media detracts from face-to-face relationships, which are healthier, and reduces investment in meaningful activities. 
  • It erodes self-esteem through unfavourable social comparison.
• Mental ill-health has larger socio-economic implications: 
  • Poverty: 
    • People living in poverty are at greater risk of experiencing mental health conditions. 
    • On the other hand, people experiencing severe mental health conditions are more likely to fall into poverty through loss of employment and increased health expenditure. 
    • Stigma and discrimination often further undermine their social support structures. 
    • Countries with greater income inequalities and social polarisation have been found to have a higher prevalence of mental ill-health.

Determinants of Mental Health

• Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. 
• For example, violence and persistent socio-economic pressures are recognized risks to mental health. The clearest evidence is associated with sexual violence.
• Poor mental health is also associated with 
  • rapid social change, 
  • stressful work conditions, 
  • gender discrimination, 
  • social exclusion, 
  • unhealthy lifestyle, 
  • physical ill-health and 
  • human rights violations

Causes of Mental Illness 

• Individual psychological and biological factors such as emotional skills, substance use and genetics can make people more vulnerable to mental health problems.
• Exposure to unfavourable social, economic, geopolitical and environmental circumstances – including poverty, violence, inequality and environmental deprivation – also increases people’s risk of experiencing mental health conditions.
• Over the past two years, the pandemic-led lockdowns and the uncertainties associated with them have had a detrimental effect on mental well-being
• Early adverse life experiences, such as trauma or a history of abuse (for example, child abuse, sexual assault, witnessing violence, etc.)
• Use of alcohol or drugs
• Having feelings of loneliness or isolation.

Issues and Concerns 

• Mental health problems have been growing rapidly over the last few decades.
• In 2015, the GOI carried out a National Mental Health Survey — 2015-16 to assess the prevalence of mental health in the country. 
  • The report showed mental disorders at 10.6 per cent among above 18-year-olds, 16 per cent among the productive age group of 30-49-year-olds — and lifetime morbidity affecting 150 million people with one per cent reporting high suicidal risk. 
• The human resources and treatment facilities are woefully low.
• For policymakers, mental health is a low priority. Such poor policy attention is often ascribed to indifference among bureaucrats and politicians. 
• Designing a policy is the most challenging piece of policy-making. 

Government of India Initiatives 

• National Mental Health Programme (NMHP) in 1982
  • To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population.
• Mental Healthcare Act, 2017
  • It was passed in 2017, came into effect in May 2018 and replaced the Mental Health Act of 1987. 
  • To the joy of most Indian medical practitioners and advocates of mental health, the act decriminalised suicide attempts in India. 
  • It also included WHO guidelines in the categorisation of mental illnesses. 
  • The most significant provision in the act was “advanced directives”, which allowed individuals with mental illnesses to decide the course of their treatment and also appoint someone to be their representative. 
  • It also restricted the use of electro-convulsive therapy (ECT), and banned its use on minors, finally introducing measures to tackle stigma in Indian society.
• Rights of Persons with Disabilities Act, 2017
  • The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide effective mechanism for ensuring their empowerment and inclusion in the society
• Manodarpan Initiative
  • An initiative under Atmanirbhar Bharat Abhiyan, aims to provide psycho-social support to students for their mental health and well-being.
• Kiran Helpline
  • The helpline is a giant step towards suicide prevention, and can help with support and crisis management.
  • The helpline aims to provide early screening, first-aid, psychological support, distress management, mental well-being, and psychological crisis management and will be managed by the Department of Empowerment of Persons with Disabilities (DEPwD).

Suggestions

• There is a need for an urgent and well-resourced whole-of-society approach to protecting, promoting and caring for the mental health of our people, like we did for the Covid pandemic. This should be based on the following four pillars:
  • Stigma: 
    • Killing the deep stigma surrounding mental health issues which prevents patients from seeking timely treatment and makes them feel shameful, isolated and weak. 
    • Stigma festers in the dark and scatters in the light. There should be a mission to cut through this darkness and shine a light on the fact that most mental health conditions are very treatable.
  • Making mental health an integral part of the public health programme: 
    • It will help to reduce stress, promote a healthy lifestyle, screen and identify high-risk groups and strengthen mental health interventions like counselling services. 
    • Special emphasis will need to be given to schools. 
    • Pay special attention to groups that are highly vulnerable to mental health issues such as victims of domestic or sexual violence, unemployed youth, marginal farmers, armed forces personnel and personnel working under difficult conditions.
  • Creating a strong infrastructure for mental health care and treatment: 
    • Lack of effective treatment and stigma feed into each other. 
    • Currently, only 20-30 per cent of people with mental illnesses receive adequate treatment.
    • Less than two per cent of the government health budget, which itself is the lowest among all G20 countries, is devoted to mental health issues. 
    • There is a severe shortage of mental health professionals, with the number of psychiatrists in the country being less than those in New York City.
    • Substantial investments will be needed to address the gaps in the mental health infrastructure and human resources.
  • Affordable Services: 
    • Improved coverage without corresponding financial protection will lead to inequitable service uptake and outcomes. 
    • All government health assurance schemes, including Ayushman Bharat, should cover the widest possible range of mental health conditions. 
    • Currently, most private health insurance covers only a restricted number of mental health conditions. 
    • Similarly, the list of essential medicines includes only a limited number of WHO-prescribed mental health medications. 
    • A comprehensive review of these policies will be needed to ensure that financial and other barriers do not prevent people from using services or push them into poverty.

Source: IE