Picture this. A man yelling at his wife for not taking care of their child while he is at office. A student inhaling drugs, as he could not score the desired marks for getting a seat in his favourite college. A school-going child telling a series of lies, just to avoid the rage of anger her parents may get into if they get to know the truth. A labourer beating up his wife for want of money to drink. A farmer attempting to commit suicide because of the huge pile of loan he has to repay.
The above scenarios are terrifying, to say the least. But what do you think must be the underlying cause for such behaviour? Do you think the man in question yelled at his wife merely for not taking care of the child? Or, there could be some other reason? What about the student, the school-going child or the labourer and the farmer? The situation does not seem to be as simple as it might appear to be.
If one goes deep, one may find that most of the people described above are suffering from mental health issues. In fact, such issues have taken the form of a silent pandemic. A well-settled happy-go-lucky person may look healthy on the face of it. One cannot even imagine the kind of mental health issues the person might be suffering from. The suicide of popular Bollywood actor Sushant Singh had raised an alarm on mental health concerns. But the debate fizzled out, sooner than later.
Be it the film industry, IT sector, manufacturing or the services sector, there have been ample stories of people suffering from mental health issues. A 2019 World health Organisation (WHO) report estimated that one in every eight people in the world live with a mental disorder. The pandemic has only accentuated the problem. A rough estimate shows an increase of 26 percent in anxiety and 28 percent in major depressive disorders. India is not aloof from the rest of the world.
As per the National Mental Health Survey 2016, around 14 percent of our population needs active mental health intervention. Clearly the numbers might have increased manifold in the wake of the pandemic, subsequent inflation, reduced incomes and so on. Yet, mental health issues are considered a taboo in India despite many efforts to normalise it.
A few Bollywood films have portrayed mental health issues in a very realistic manner. One is Alia Bhatt starrer “Dear Zindagi". The movie may not have a dramatic storyline but it shows how a young girl, Kiara, who is not aware of issues she is faced with, accidentally meets a therapist, who helps her in unravelling her problems, the way she looks at them, as well as leads her to finding a new meaning in her life. Anxiety, insomnia, unresolved familial issues, failure in relationships, finding fault with oneself in everything that goes wrong, the movie deals with it all. It tries to normalise taking therapy and the difference it can make in the patient’s life.
Another classic movie, which deals with issues like dissociative identity disorder or schizophrenia, is Farhan Akhtar’s “Karthik calling Karthik”. The movie shows Karthik, an introverted, under-confident boy, who has blamed himself for his brother’s death for years together. He is being constantly abused by his boss. So much so that he decides to commit suicide. His life changes when he suddenly gets a call from a voice resembling his own. The man promises to change his life. When he finds his lady love and tells her about this unknown voice, he realises the need for therapy and counselling.
Be that as it may, India Inc may need more time to accept this crucial aspect of life. However, this time could be shortened, if concerted efforts are made at all fronts by the Central and state governments. The legislative and executive wings have to work in tandem to address this issue.
If we speak about the legal aspects, India had promulgated a law on mental health issues, way back in 1987. The law could not bring much change as it was custodial in nature. And mental health issues continued to be a matter of stigma and shame, forcing isolation of the patient.
It was replaced by a new law in 2017. The law is not without flaws either. In fact, it has a fundamental flaw, where diagnosis of such mental health issues will be done by the medical staff, in view of the internationally accepted mental health standards. It implies that standards determined by the medical fraternity would ultimately decide whether a person is entitled to benefits under the Mental Health Act, 2017.
It certainly negates the right of an individual to find out whether he/she needs a mental health intervention. Section 86 of the Act puts a condition of medical certification for treatment of mental health issues. Unlike the movie, “Dear Zindagi”, where Kiara seeks therapy on her own, a person in real life, may not be in a position to avail of such benefits, especially under the government schemes, unless a medical officer is satisfied that he/she is suffering from severe mental illness. Now what about people suffering from problems such as anxiety, depression, etc. We are not aware what sort of standards exist to establish the existence of such problems in a person!
Not only this, Section 2(s) defines mental illness as “substantial disorder of thinking, mood, perception, orientation or memory …..” The definition itself is vague. What would be termed as “substantial” is not clear.
The Act also provides for setting up of mental health review boards, which will have the power to adjudicate complaints regarding deficiencies in care and services, inspect mental health establishments, cancel their licences and impose penalties in case they are found to be non-compliant.
Unfortunately, several states have not formed these review boards, even after five years of the implementation of the Act. Many states have not yet notified the rules governing the law nor have constituted state mental healthcare authority for registering mental health establishments, clinical psychologists, nurses, psychiatric social workers etc.
It is a pity that we have only three psychiatrists and psychologists for every 1,00,000 people. Yet, we don’t have the paraphernalia to register more medical personnel to tackle this ever-growing problem, which is silently affecting more and more people with every passing day. The recent data on suicides published by the National Crime Records Bureau is a case in point. The report shows that 1,64,033 people lost their lives due to suicide in 2021, which is 7.2 percent more than in the year 2020. This writer had raised concerns over increasing number of suicides through the columns of this journal. We are yet to see a substantial move from the government in this direction.
Yes, the government did recognise the problem when the Union Finance Minister, Nirmala Sitharaman, announced the setting up of a national-level tele-mental health programme with a toll-free number during her budget speech for the current year. However, it is still "work in progress".
The helpline could be a game-changer. It needs swift action. Not only this, it will be equally important to create adequate awareness, deconstruct and delineate stigma associated with mental health issues and simultaneously create adequate provision in the Union as well as state government budgets for tackling this issue head on before this silent pandemic takes over our lives gradually. The government must also review the implementation of the Mental Health Act and invite suggestions for making appropriate amendments.
(The writer, a company secretary, can be reached at email@example.com)