Friday 23 February 2018

The Nation's Mental Health.

Anwesha Saha.

On the 30th of December, 2017, President Ram Nath Kovind warned that the country is possibly facing a mental health “epidemic.” Delivering the 22nd convocation address at the National Institute of Mental Health and Neuro Sciences (NIMHANS), he said that the number of people affected by mental health issues in India is larger than the population of Japan.

Student suicides

The latest data sent to the Ministry of Home Affairs by all Indian states and union territories shows that over 26,000 students killed themselves in India in the three years since 2014. The number for 2016 alone stood at 9,474, that is one suicide every 55 minutes. Hansraj Gangaram Ahir, minister of state for home affairs wrote that the onus largely falls on each state. However the central government has approved implementation of the District Mental Health Programme in some of the districts of the country with added components of suicide prevention services, work place stress management, life skills training and counselling in schools and colleges.

Inadequate workers
The President pointed out that there were just about 5000 psychiatrists and less than 2000 clinical psychologists in the country, while nearly 10% of Indians had one or the other mental health problem. The suicide rate in India in 2015 at 15.7/100,000 is higher than the regional average of 12.9 and global average of 10.6. Suicide is the leading cause of death among those aged 15-29 in India. There remains a massive unaddressed need within the population.

A National Mission

The President put forth a “national mission” that by the time India celebrates its 75th year of Independence in 2022, at least those suffering from severe mental disorders have been diagnosed and have access to treatment facilities. Despite some cavilling about the quantum, the government remains the biggest single spender in the mental health sector. While most new interventions remain isolated and confined to urban areas, it is only the public health system through large programs which can reach the rural masses.

Social stigma and denial

The president also said that the biggest obstacle that the patients of mental and neurological problems face was stigma and denial. This leads to the issue being ignored or simply not discussed. In some cases it leads to self-diagnosis that could worsen the situation. The President called upon the society to fight this culture of stigma and said, “We need to talk about mental health issues and treat ailments such as depression and stress as diseases that can be cured – not as guilty secrets to be pushed under the carpet.” Mental health awareness campaigns have yielded positive outcomes in the country. Some of the strategies undertaken to target awareness and address stigma around mental illness include participation by family members, sensitization to treatment and social inclusion.  Lack of knowledge about the mental illnesses poses a challenge to mental healthcare delivery system. Awareness and health literacy go hand in hand. Stigma and discrimination are negative consequence of misinformation and ignorance.  One study found mental health literacy among adolescents to be very low, i.e. depression was identified by 29.04% and schizophrenia/psychosis was recognized only by 1.31%. Stigma was noted to be present in help seeking. The impact of sigma has led to the institution of various programs worldwide to challenge the stereotypes and discrimination that generate social disability.

Towards a better equipped future

Union Health and Family Welfare Minister J. P. Nadda said his Ministry was focussing on increasing the number of psychiatrists, clinical psychologists, psychiatric nurses and psychiatric social workers in the country to provide both clinical and ancillary services. Medical Education Minister Sharanprakash R. Patil said Karnataka was the first state in the country to monitor the DMHP through a web-based system, which was possible because of a software developed by NIMHANS along with IIT Bombay.  

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