Mental Illness in India
Mental illness has become a serious concern in India. How can this crisis be tackled?
Introduction: (up to 30 words) Give introduction to mental health, its importance, the illness and statistics if possible
Body: (up to 100 words) Outline the Mental Health Act, 2017, the issues and challenges surrounding the issue and some measures which may be taken to tackle this problem.
Conclusion: (up to 30 words) Write about the importance of tackling Mental Health and failure to do so, results in ignoring a ticking time Bomb
Mental illness contributes to 31% of the global disease burden, but only receives 1% or less funding from national health budgets worldwide. In India, there is a 90% treatment gap for those living with mental illness. 10-12% of persons living with mental illness experience long term care needs and these individuals are languishing in mental hospitals, beggar homes and therefore experience poor quality of living, poor mental health outcomes and significant human rights violations.
Further, World Health Organisation (WHO) reports that 20% of Indian population will be suffering from at least one mental-health problem by 2020. India now has the highest rate of suicides in the 15-29 age category, 42.5% of people working in the private sector are battling either depression, anxiety or some form of similar issue according to a report by Associated Chambers of Commerce and Industry of India (ASSOCHAM).
Mental Healthcare Act, 2017:
The various provisions under the Mental Healthcare Act are as follows:
- Rights of Persons with Mental Illness: Every person will have the right to access mental healthcare services. Such services should be of good quality, convenient, affordable, and accessible. This act further seeks to protect such persons from inhuman treatment, to gain access to free legal services and their medical records, and have the right to complain in the event of deficiencies in provisions
- Advance Directive: This empowers a mentally ill person to have the right to make an advance directive toward the way she/ he wants to be treated for the requisite illness and who her/his nominated representative shall be. This directive has to be vetted by a medical practitioner.
- Mental Health Establishments: The government has to set up the Central Mental Health Authority at national level and State Mental Health Authority in every state. All mental health practitioners (clinical psychologists, mental health nurses, and psychiatric social workers) and every mental health institute will have to be registered with this authority.
- Decriminalizing Suicide and Prohibiting Electroconvulsive Therapy: It decriminalizes suicide attempt by a mentally ill person. It also imposes on the government a duty to rehabilitate such person to ensure that there is no recurrence of attempt to suicide. A person with mental illness shall not be subjected to electroconvulsive therapy (ECT) without the use of muscle relaxants and anesthesia.
- Responsibility of certain other Agencies: The Act also imposes a duty on the police officer in the charge of a police station to take under protection any wandering person; such person will be subject to examination by a medical officer and based on such examination will be either admitted to a mental health establishment or be taken to her/his residence or to an establishment for homeless persons.
- Insurance: The Act requires that every insurance company shall provide medical insurance for mentally ill persons on the same basis as is available for physical illnesses.
Implementation of Mental Healthcare Act, 2017:
- Presently, India spends less than 1% of its health budget on mental-healthcare. Most of the developed nations spend above 4% of their budgets on mental health research, infrastructure, frameworks and talent pools. There is a requirement of 13500 psychiatrists but only 3827 are available. Against the requirement of 20250 clinical psychologists only 898 are available. Similarly, there is an acute shortage of para– medical staff also.
- There is issue regarding availability of mental healthcare to prisoners. It is an obligation of the State governments under Section 103 of the Mental Healthcare Act, 2017 to provide mental healthcare facility to prisoners.
- The Centre has been very proactively engaged with the task of improving the mental healthcare system in the country for which the cooperation of states is also needed. The state authorities are supposed to register and regulate all mental healthcare facilities and publish their details online. It is also required to register all clinical psychologists, mental health nurses and psychiatric social workers. More than two years after the Mental Health Act, 2017 was passed; only 19 states have managed to get the State Mental Health Authority in place, as required under the new Act.
- The Act mandates the states to have a functional authority within nine months of the law coming into force but most of the states have missed the deadline. The states are also yet to draft the rules of the Act. There is a lack of understanding among states about how to make rules. They need a bit of legal guidance and handholding. With the lack of new rules, the rules of the old Mental Health Act (1987) are still being followed.
Issues and challenges:
- Most strongly associated factors with mental disorders are deprivation and poverty.
- Individuals with lower levels of education, low household income, lack of access to basic amenities are at high risk of mental disorder.
- Generalized anxiety disorder, specific phobia and substance use disorders is found to be highest among illiterate and unemployed persons.
- Suicidal behavior was found to have relation: working condition, independent decision making, premarital sex, physical abuse and sexual abuse. Living alone and a break in a steady relationship within the past year were also significantly associated with suicide.
- Work environment, school environment and family environment plays important role in pathogenesis of mental disorders.
Stigma related to mental disorders, lack of awareness in common people, delayed treatment seeking behavior, lack of low cost diagnostic test and lack of easily available treatment are the main hurdles in combating the problem of mental health in India. In addition factors pertaining to traditional medicine and beliefs in supernatural powers in community delays diagnosis and treatment.
Need of the Hour:
- India needs to aim at improving early childhood interventions like preschool psychosocial activities, nutritional and psycho-social help to give roots for a healthy community.
- To reduce the burden of mental disorders in women, there is need for socio-economic empowerment of women by improving access to education and employment opportunities.
- Society needs to be free of discrimination and violence. Reducing discrimination against sex, caste, disability and socioeconomic status is an important aspect to reduce mental disorders.
- Social support for elderly people needs to be strengthened. More community and day centres for the aged should be developed. Programmes targeting towards indigenous people, migrants and people affected by disasters need to be established.
- Programme could be implemented through school like programmes supporting ecological changes in schools or at work place like stress prevention programmes.
- The need of the hour is to sensitize and educate individuals about the signs and symptoms of mental illness while normalizing the idea of seeking support for themselves and their loved ones.
- There is a need to be more open discussion and dialogue with the general public, and not just experts on this subject, which will in turn help create a more inclusive environment for people with mental illness.
- Interventions, focusing on raising awareness of mental health issues and mobilizing efforts in support of mental health, are necessary for addressing the situation.
- Increase in spending in establishing more institutes, training centres and treatment facilities, running large scale awareness campaigns to eliminate social stigma, providing affordable facilities and cover by insurance is what India needs urgently.