Mental Health Care

Context

• Recently, the Supreme Court asked the government to ensure that patients in mental health institutions are tested for COVID-19 and vaccinated.

Mental health disease

• Definition: World Health Organization (WHO) defines mental health as a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and can make a contribution to his or her community.
  • The WHO stress that mental health is “more than just the absence of mental disorders or disabilities.”
  • Peak mental health is about not only avoiding active conditions but also looking after ongoing wellness and happiness.

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Challenges of mental healthcare in India

• Severity: According to The Lancet report published in February 2020, there were 197.3 million people with mental disorders in India in 2017.
  • WHO estimates: Mental health illness makes about 15% of the total disease conditions around the world.
  • In 2018 the WHO labeled India as the world’s ‘most depressing country’.
• Lack of access to mental healthcare resources:
  • Human resources for healthcare: Low proportion of the mental health workforce in India (per 100,000 population) includes psychiatrists (0.3), nurses (0.12), psychologists (0.07), and social workers (0.07).
  • Poor budgetary allocation: India is barely spending 0.5% of the health budget on the mental health sector, creating further impediments in public access to affordable mental healthcare.
  • Poor health infrastructure and lack of mental healthcare facilities: even available mental healthcare institutions have an inadequacy in terms of quality mental healthcare professionals and other infrastructural facilities.
  • According to estimates, nearly 92% of the people who need mental health care and treatment do not have access to any form of mental health care.
• Rural-urban divide: most of the mental healthcare facilities and professionals are located in urban areas.
• Lack of awareness and sensitivity about mental health issues: leading to the high prevalence of social stigma and abandonment of being mentally ill in India.
• Post-treatment gap: in terms of proper rehabilitation of the mentally ill persons post his/her treatment which is currently not present.
• Health (COVID-19) and Economic disasters: they further intensify and enhances the numbers and severity of the mental health problem.
  • For example, Practo (a healthcare company) reported a 665% jump in the number of mental health consultations. Further, more than two-thirds of these consultations belong to the age of 21-40.

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Impact of Mental health conditions:

It has disastrous impacts on the suffering individual, economy, and society as shown by WHO data. For example-

• Depression: is one of the leading causes of disability.
• Suicide: is the second leading cause of death among 15-29-year-olds.
• People with severe mental health conditions die prematurely-as much as two decades early – due to preventable physical conditions.
• Limits the achievements of national and global developmental goals (including Sustainable Development Goals).
• Leads to low self-confidence and societal neglect of the suffering individuals.
• Loss of economy: as the youth population (most productive) is most affected by mental health disease, leading to loss of individual/national productivity and economy.

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Steps taken to improve mental healthcare

• Globally:
  • WHO:

1. 1. 1. launched ‘Mental Health Atlas’ in 2017.
      2. WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.

• • Target 3.4 and 3.5 of the Sustainable Development Goals (SDGs) talk about reducing mental health illness for the global community.
• Indian government:
  • National Mental Health Program (NMHP), 1982: to improve the status of mental health in India, focusing on three main components:

1. 1. 1. Treatment of the Mentally ill,
      2. Rehabilitation and
      3. Prevention and promotion of positive mental health.

• The Mental Health Care Act (MHCA) 2017: repealed the Mental Health Act, 1987. It seeks to ensure the person’s rights with mental illness to receive care and live a life with dignity.
  • Decriminalizes suicide under section 309 of the Indian Penal Code: by presuming a suicidal person to be “suffering from severe stress’’. The person will also not subject to any investigation or prosecution.
  • Right to mental healthcare: is provided under the Act to ensure access to mental healthcare facilities to suffering individuals.

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Way forward:

• Improving the supply side: by ensuring adequate mental healthcare facilities, professionals, and funds for treatment and care of mentally ill individuals.
• Sensitization: of medical professionals and people, in general, to eliminate stigma against mentally ill persons and re-integration in the broader society.
• Awareness campaign and community partnership: by forming their self-help groups of carers families and NGOs, which brings community participation and helps reduce social stigma associated with mental illness.
• Center-states cooperation: as health is a state subject, will help in effectively eliminating the mental health challenge from India.

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