Mental Health is a very important issue that we should all talk about. I say this for two main reasons- 1. For protecting the rights of the people who have mental health problems and 2. To break the taboo around mental health.
Here are the things that could improve the quality of our existing mental health services-
1. Insurance should cover mental health
“The Mental Healthcare Act, 2017, by making it compulsory for insurers to cover such disorders, took the first step to ease the financial stress.” “A hurdle for insurers is lack of data related to mental diseases and treatment costs that could help them access the risk. Without that, pricing becomes tricky.” “If mental disorders are covered as part of basic health insurance policies, overall premium may increase for everyone.” “The new law defines care as analysis, diagnosis, treatment, care and rehabilitation of the afflicted person.” (Bloomberg Quint)
“While government hospitals mostly don’t charge for it, Shetty said a single session with a private psychiatrist costs up to Rs 2,000.” “Cases not requiring a hospital stay are 27 times more than when a patient is admitted, according to a report by a panel on mental health constituted by the National Human Rights Commission.” “That’s why Kersi Chavda, consultant psychiatrist at Hinduja Hospital, suggests that an ideal mental illness cover should include out-patient expenses.” (Bloomberg Quint)
“The Indian government’s current health strategy referred to as the National Health Protection Scheme or Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) – has a limited focus on and budget allocation for primary care through its investment in Health and Wellness Centres, and a much greater focus on and budget allocation towards providing health insurance for secondary and tertiary care.”(blogs.lse.ac.uk)
Although Indian Government is focusing towards health insurance, insurance companies are finding it problematic to access the risk due to lack of data and definition of the term mental illness (The Mental Healthcare Act, 2017) “The new law defines care as analysis, diagnosis, treatment, care and rehabilitation of the afflicted person.”
2. Breaking The Taboo
“People are quick to dismiss treatment for mental health problems as its results are not as tangible as for a wound being bandaged,” said Sharda. They, she said, are unwilling to spend on therapy of the mind as they would on a heart problem.”(Bloomberg Quint)
“As a result, a robust mental care support system is missing. The ratio of psychiatrists to population in India is worse than Nepal, Pakistan, Iraq and Brazil, according to the World Health Organisation’s 2014 data—the latest available numbers. Expenditure on mental health accounts for just 0.2 percent of the nation’s public health spend.”(Bloomberg Quint)
“My family refused to even address it as a health concern; they merely sent her to Mumbai for a change,” she said. “I haven’t told them about the counselling sessions. It’s looked down upon in our family.”(Bloomberg Quint)
It is not a surprise that in our country, India, superstitions and taboos are found in abundance but this needs to change. It’s not about religion or ideologies anymore. It’s about the mental health of living breathing people who are made of flesh and blood. It could be your brother or sister or mother or grandfather. Everyone is prone to mental illness to some varying degree.
It is similar to chicken pox or dengue fever or cough and cold. You don’t stigmatize the disease, you fix it.
“Roughly 30 km from Geeta and Jija’s house, in Kundi village, Bappu Rao Pinder, a cotton farmer bent and wizened with age, credits volunteer Surekha Vikhal Choudhury for teaching him to take care of his schizophrenic son.
“Eight years ago when Pradeep first fell ill, he used to lash out at his father, wander the streets at night and pick fights with people. Pinder took him to a local faith healer. He even sacrificed chickens on his instructions. When his son’s condition didn’t improve, he went to private clinics in Yavatmal even though the town was too far for regular visits for treatment.”(IndiaSpend)
“Like an ASHA, Kinake spends the first half of every day visiting families in Mangurda. Unlike an ASHA, however, Kinake doesn’t just refer patients to counsellors or psychiatrists; she counsels them herself when possible. “I tell families not to refer to mental illness sufferers as paagal (mad),” said Kinake. “I have to tell them not to laugh at them or get angry with them.”
Instead of paagal, villagers are taught to say ‘maansik tanaav’ (mental illness). The term “mentality ka patient” has slowly penetrated in villages scattered across the districts, chipping away at deep-rooted stigma.”(IndiaSpend)
“Moreover in villages and small towns, this was earlier considered as witch craft or a taboo, people hide it and let the inside demon kill them little by little every day.”(franchiseindia.com)
Again there is the issue of shame and embarrassment. We need to think about the mind in terms of a real thing that is equally prone to illness as the body. Just because we cannot see and touch the mind, doesn’t mean that it and its illnesses are not real.
3. Suicide prevention
“Over 15,000 farmers have committed suicide in Maharashtra between 2013 and 2018, an RTI data has revealed.”(Business Today)
“Baby Kinake, 39, did not recall anything odd or amiss in her husband’s behaviour in the days before he took his life 12 years ago.
“Her husband, Shatrugan, a cotton farmer responsible for a joint family of 10 members in the adivasi (or tribal) village of Mangurda in eastern Maharashtra’s Vidarbha region, showed no change in mood and spoke to everyone politely. No one, least of all Baby Kinake, had an inkling about the stress he was under that would make him, one day in 2007, walk to his fields and swallow poison, leaving his young wife to take care of their two children and their debts.
“It was only after Shobha Kinake, a volunteer health worker in Mangurda, started counselling Baby Kinake a few years ago, that she understood how hidden depression might have led Shatrugan to take his life. If she had known what to look out for, she feels, she would have helped him in some way.” (IndiaSpend)
Suicide is a very serious issue and I feel that the fact that it is affecting our farmers means that we are failing in our duty to India as a country and our mother land. India is seen as an agricultural nation and to hear that our farmers are committing suicide is a shame on our part.
Also suicide is related to mental health. It is not just the circumstances but a result of untreated mental illness.
“Mental health comes along with stigma which operates in society, is internalized by individuals, and is attributed by the health professionals. This ethics-laden issue acts as a barrier for individuals to seek professional treatment. The CIMBS study stated that 43 percent of the sample size had knowledge about a person with Mental Illness within in their family or friends, yet 35 per cent of people felt that mental health issues are uncommon, which suggests lack of awareness despite exposure.
“Similarly, 28 per cent of the sample size thought that suicides are not associated with mental health. While, India’s suicide rate-17.8 per 1,00,000 which is 70 per cent higher than the global suicide rate- 10.7 per 1,00,000. WHO estimated, in India, the economic loss, due to mental health conditions, between 2012-2030, is 1.03 trillions of 2010 dollars.”(timesnownews)
Ultimately it boils down to mental health awareness. And it is our duty to be aware of mental health and if we are not aware of it, at least we need to accept responsibility for our ignorance.
4. Improve Infrastructure
“In India, there are only three psychiatrists per 1,00,000 people, the total number of psychiatric nurses are just 0.04 per 1,00,000 people and much fewer psychologists. As per a recent study conducted in seven North Indian states by Cosmos Institute of Mental Health and Behavioural Sciences (CIMBS) along with World Federation of Mental Health, it revealed that 26 per cent of the sample size (10,233 participants) reported no mental health facility within a radius of 50 km.”
“Psychiatry is an emerging field in India and anecdotal reports suggest that there are not more than 5,000 psychiatrists in India, which means there is just one psychiatrist for 200,000 to 300,000 people.”(franchiseindia.com)
5. Train more professionals
As Dr Harish Shetty, psychiatrist, LH Hiranandani Hospital explains, “With over one in eight people in India suffering from mental health issues and with a marginal number of qualified doctors, the demand for psychiatrists is growing. Since physical illnesses often lead to mental disorders, qualified professionals have good scope in India.” (franchiseindia.com)
Here are a few other reasons, which make this field very demanding:
1. Social awareness- “Many celebrities have opened up about their lives, when they had to deal with mental depression and anxiety, on camera.”
2. Increasing suicide rates- “Suicide is the second biggest cause of death in India, among those between 15 and 29 years (after road accidents for men and childbearing for women).”
3. Social Competitions- “There is competition in schools to come first in the class, to top the board exams, to get the best college, to get the best job, best life partner, to get the best of everything is what driving people to push their limits and before they can realize their time gets over.” People will need more mental health services and more trained professionals will be in demand.
6. Promote Mental Health Rights
“Considering issues related to mental illness, the Mental Health Care Act 2017 was passed on April 7, 2017, which came into force w.e.f May 29, 2018, thereby superseding the previously existing Mental Health Act, 1987.”
“The act effectively decriminalized attempted suicide which was punishable under Section 309 of the Indian Penal Code (IPC).”(Business Standard)
7. Free Mental Health Care
“At the time when India is reeling under an unprecedented crisis in the mental health scenario, with around 13.7% of the population diagnosed with some mental health issue or the other – Dr Manoj Kumar from Kerala is giving a new ray of hope to economically backward patients who cannot afford quality mental health care, through Mental Health Action Trust (MHAT).”
“Mental health care should not be something which only specialists can deliver. Everybody can be involved in it. You don’t need to be a professional to provide mental health care,” says Dr Manoj Kumar. He insists that certain changes should be achieved to provide mental health treatment on a large scale to poorer people. “Firstly, treatment should be free of cost. Secondly, we need to make a transition from institution-based treatment to community-based care. We should shift the focus from medication to a complete recovery, and start actively including non-professionals as well.” Then only, he feels, a positive change can happen to the mental health situation in India.”(The Logical Indian)
It is because of visionaries like Dr. Manoj Kumar that the world progresses forward through Free Mental Health Care. In fact I think that Mental Health and every other health service should be free even if we don’t see that possibility sitting around the corner.
8. Community-based health care
“Vikram Patel helps bring better mental health care to low-resource communities — by teaching ordinary people to deliver basic psychiatric services.”
“In towns and villages that have few clinics, doctors and nurses, one particular need often gets overlooked: mental health. When there is no psychiatrist, how do people get care when they need it? Vikram Patel studies how to treat conditions like depression and schizophrenia in low-resource communities, and he’s come up with a powerful model: training the community to help.”
“This comprehensive work empowers healthcare workers in under-resourced and developing communities to build much-needed mental health care into all aspects of existing services.”- Amazon.com review of “Where There Is No Psychiatrist”(YouTube.com)
First, mental health is not over-reaction or over-thinking.
Second, we need to talk more about it.
Third, we need to become more aware of the things in the world that we don’t understand.
Fourth, we need to accept ourselves and the world as it is.
So this is my research on Why We Need Better Mental Health Services. Please comment how has this article changed your perspective on Mental Health? And do your part of showing acceptance for Mental Health.