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Invisible, But Devastating

Invisible, But Devastating

Yes, mental illness is invisible but devastating.

The bitter truth is that one out of every seven Indians suffer from a mental health disorder ranging from depression, anxiety disorders, schizophrenia, bipolar disorders, idiopathic developmental intellectual disability, conduct disorders to autism.

A recent study by the Indian Council of Medical Research shows that in 2017, 197 million Indians were suffering from mental disorders of whom 46 million had depression and 45 million had other anxiety disorders. That the contribution of mental disorders to the total disease burden has doubled between 1990 and 2017 should serve as a wakeup call to act fast.

That more than 264 million people worldwide are depressed is a cause for serious concern. Depression, the most common mental illness, is devastating because it robs individuals of their energy, sleep, memory, concentration, vitality, happiness, besides their ability to love, work, play, and even their will to live. When left untreated, depression can lead to  substance abuse anxiety and  suicide.

It is important for maintenance of records in respect of mental illness. Remember Seung-Hui Cho who shot 32 people and injured 17 others on Virginia Tech Campus in April 2007?  He was prohibited from purchasing a firearm under the Federal Law because of a history of mental illness. But the state’s failure to report mental health records enabled the unstable gunman to purchase fire arms through two licensed dealers after two background checks. While law at that time required that some mental health records be submitted to the databases used for background checks, it did not require reporting of all people prohibited from possessing firearms for mental health reasons.

A recent study in Canada found that, on average, a person has 14 stressful episodes per week. The same study found that hypertension (high blood pressure) is the number-one reason why people go to see their doctor in the first place. As per the National Mental Health Survey 2016, the prevalence of mental disorders in Indian adults over the age of 18 years is about 10.6%.

It is sad that one person in the world commits suicide every 40 seconds. India has the highest suicide rate in South East Asia as well as the third-highest rate of suicide among women in the world. 17% of Global Suicides Happen in India. Are we doing enough about mental health?

The case of Café Coffee Day founder V. G. Siddhartha is an example how depression can drive an individual to suicide. The only son of a wealthy father, Siddhartha became an entrepreneur from a small-time stockbroker. His investment of Rs 5 lakh in Karnataka’s coffee growing Malnad region, in early 1990s took him to great heights. He went on to build a massive coffee emp­ire with over 12,000 acres of plantations, around 1,700 cafes, nearly 48,000 vending machines, 532 kiosks and 403 ground coffee selling outlets. His net worth was Rs 8,200 crore in 2015. However, four years later, unable to withstand competition, among other problems, he committed suicide. As of March 2019, Coffee Day’s total debt stood at Rs 6,547.38 crore. With the balance sheets of the holding company and its 51 subsidiaries, associate companies and joint ventures in deep red, Siddhartha went missing in July. His body was found ashore Netravati river near Ullal in Mangaluru by fishermen.

According to the World Health Organisation, one in five working Indians suffer from workplace depression. The overall numbers are also threatening -- an estimated 56 million suffer from depression and 38 million from anxiety disorders. Studies indicate that depression among women in the country largely goes undiagnosed or untreated due to lack of public understanding of the condition. Women’s risk of developing depression is higher during their child-bearing years, manifesting in postpartum depression.

To address the challenge of mental illnesses, the National Mental Health Programme is under implementation since 1982 in 655 districts of the country. The focus is on community awareness, prevention, health promotion and mental healthcare through augmenting institutional capacity in terms of infrastructure, equipment and human resource for mental healthcare. There are 41 Mental Health Hospitals run by State Governments and Union Territories that provide mental healthcare services in the country.

Well, for a vast population, much needs to be done. With India spending barely 1.3 per cent of its GDP on public health, of which the expenditure on mental health is a minuscule 2-3 per cent, how does one handle mental illness?  As these disorders are not easily discernible and the stigma attached to mental illness being so acute, fearing an adverse impact on one’s job and marriage prospects, the problem is usually kept under wraps within the family instead of consulting a professional.

It is a daunting task to provide respite. But part of the problem is non-availability of trained mental health professionals. There are just 0.3 psychiatrists, 0.07 psychologists and 0.07 social workers per 100,000 people in India when compared to developed countries where the ratio of psychiatrists is 6.6 per 100,000. More specifically, the country needs at least 13,500 mental health professionals but has only 3,827 of them. Where treatment is available, cost is at times rather prohibitive and 80 per cent of patients do not have health insurance or even if they have, feel mental care is not covered.

Private mental care comes with its own cost which many poor people cannot afford. Reports indicate that the average cost of counselling session (psychiatric consultation) in metro cities is in the range of around Rs 1500/- an hour to Rs 4000/- an hour. Similarly, a monthly psychiatric consultation with medicines can go up to Rs 8,500/ on an average.

The average number of mental hospitals globally is 0.04 per 100,000 while it’s only 0.004 in India. It is a challenge to deal with the mental distress as many primary care centres even basic facilities. India’s National Mental Health Programme has been allocated Rs 50 crore budget this year, an increase of Rs 15 crore from the previous year, which is a meagre 0.06% of India’s health budget.

Beyond government schemes, there is an urgent need to strengthen mental health services, integrate these with general healthcare besides remove barriers such as stigma and access to treatment by roping in the private sector. Since there is a financial constraint in terms of Government funds, a way forward is to motivate private companies involved in CSR activities to adopt a cluster of villages in rural areas to bring mental health at the forefront and thereby augment funds.  Planning, monitoring and control of such mental healthcare units under CSR can ensure the funds are spent for the purpose for which they have been provided.

Since mental disorders are the leading cause of non-fatal disease burden in India, which is growing, it is all the more important to tackle this deadly malaise in the right earnest.

(Published on 06th January 2020, Volume XXXII, Issue 01)