Mental Health in India and why we must fight social stigma
A number of recent studies have investigated the impact of the “Blue Whale Challenge Game,” in India. The “game,” if it can even be called that, is an application that works by strengthening and affirming suicidal ideation in people with depression, and has gained popularity worldwide. The extent of the impact of the “Blue Whale Challenge” in India is unclear but the result of the media phenomenon has been to put a spotlight on the burden of psychiatric disease in India. Words like ‘depression’, ‘pressure’, ‘stress’, and ‘suicide’ have become part of the public discourse. Yet the gravity of the situation is rarely grasped from a social or economic perspective. Psychiatric disease is often co-morbid with substance use disorders, and tends to have a major impact on patients’ socio-economic status-and sometimes the economic situation of those around them.
Just to give some sense of the scale of the problem: according to a WHO report, about 56 million people suffer from mental illness in India. This about equals the population of South Africa. India witnesses fifteen suicides every hour. Worryingly, there are only three psychiatrists per million people in India. India spends less than 1% of the public health budget on mental health although mental health problems constitute nearly 13% of the overall healthcare burden. Accessibility is a major challenge. Largely, psychiatric care is a privilege reserved for the rich, who can afford private hospitals.
The problem cuts deeper than statistics. Indian society has antiquated, and sometimes unsympathetic perceptions of people with mental illness. They are seen as possessing the ability to burst into violence at any point. Social stigma and discrimination have worsened the country’s mental health problems and has trapped people in a cycle of illness. Overlapping social problems including social isolation, poor housing, unemployment and poverty, all amplify the consequences of poor access to mental healthcare.
India’s Mental Healthcare Bill of 2016 promised to improve access and services to people with mental illness. First, the bill seeks to de-criminalize attempted suicide. Instead of viewing persons with mental illness as objects of fear, pity and charity, the new Bill recognizes them as citizens with health rights, including the right to quality mental health care. The bill also ensures those needing psychiatric care receive medical attention at hospitals. These laws have been implemented at the district level, through the public health system. The bill makes it compulsory for private insurance companies to develop policies for treating mental illness.
However, the bill has not yet been fully implemented by state governments. My view is that the state governments should spread the mentally health services at the district and county levels by hiring more mental health professionals and encouraging retired mental health professionals to serve in the public and private sectors. There is a great need for campaigns to spread awareness, identify problems and reduce stigma. Establishing a mental health hotline would help alleviate the burden for patients with common mental illnesses such as depression, anxiety/phobias, eating disorders and stress. Such a hotline could operate continuously with trained psychologists with clinical protocols for counseling on depression, psychological distress, and suicide prevention. There is also a need for additional Inpatient beds for those with serious mental illnesses .
India will have to start spending more on mental healthcare (and, likely, the entire health sector), and spend a proportional amount given the burden of mental illness. A national commission or body should be formed tasked with better understanding mental illness in the country and to review the possibility of implementing some of the policies suggested above.
Originally published at https://www.linkedin.com.