India’s mental health disability crisis

The National Institute of Mental Illness defines mental illness as a condition that impacts a person’s thinking, feeling or mood and may affect his or her ability to relate to others and function on a daily basis.

According to the WHO mental disorders are generally characterised by dysregulation of mood, some combinations of abnormal thoughts, emotions, behaviour and relationship with others. These include depression, anxiety disorders, schizophrenia, bipolar affective disorders among others.

For a country that has 75 million people suffering from and being disabled by mental diseases India has an abysmally low level of awareness and understanding about mental health. Our perception around mental health is almost non-existent. From being shrugged off as a ‘phase’ that someone is going through to being blamed for ‘not having the will and courage to face life’, the stigma and lack of understanding around mental health prevents many from getting the right help and a support system.

Mental health care in India continues to be slogged down not only by a lack of awareness but also by a lack of resources like mental care clinics and hospitals and adequate mental health care professionals.

Take a look at the dismal statistics:

For every 100,000 people living in India, there are only:
Psychiatrists- 0.3
Clinical Psychologists- 0.07
Psychiatric Social Workers- 0.07
Psychiatric Nurses- 0.12
Mental Hospital Beds- 2.1

As a result, people with mental disorders in India do not receive needed treatment. India has shown renewed commitment through national programmes for community-oriented mental health care, but progress in achieving coverage is still lagging.

Here is a look at the mental health crisis we are facing:

According to the WHO, India’s mental health care is grossly underfunded. India spends a mere 0.06 percent of its health budget on mental care. In comparison the United States, spends 6.2 percent of GDP on mental health, and England spends 10.82 percent. Even Bangladesh trumps India on its mental health expenditure budget.

According to the India’s health ministry, 6-7 percent of India’s population suffers from mental disabilities — roughly 75 million people. Yet India has only one psychiatrist for every 343,000 patients.

mentally challenged person
A mentally challenged woman chained to a cement post outside a dargah, in Barabanki. Image source: PTI.

Thus the main challenge facing the mental health care sector today, besides a lack of funding, is the lack of mental health professionals, especially in government institutions.

There is also a gigantic deficit of public mental care institutes. A report published in the Lancet in May 2016 reveals shocking statistics: six states in India have absolutely no public mental care institutes. These Northern and Eastern states have a population of 56 million. The rest of India has 443 public institutes.

The state of many government-run mental institutions is less than adequate, with some patients sleeping on the floor because there aren’t enough beds.

With over 15 deaths per 100,000 people, India currently has one of the world’s highest suicide rates. Suicide is the top cause of death among the youth of India, which reflects deeply on the country’s mental health condition.

mentally disabled people
2001 Eravadi, Tamil Nadu: Those are not wooden logs in the picture. Zoom in, these are corpses of 25 mentally challenged people, who couldn’t escape a fire and were charred to death because they were chained to their beds (Photo: Wikipedia)

The images above shows the drastic effects of the lack of healthcare services in the country.

A peek into the future:

A new report says the burden of mental illness will increase rapidly in India over the next 10 years. In 2013, 31 million years of healthy life were lost in India. Estimates now suggest that by 2025, 39.6 million years of healthy life will be lost to mental illness in India, which amounts to a 23 percent increase.

India accounts for 15 percent of the global mental, neurological and substance-use burden. Dementia is also a growing problem.

From 2012 to 2025, the number of healthy years lost to dementia will increase by 82 percent in India (from 1.7 million to 3.2 million).

Projected changes in disability adjusted life years or DALYs (reflecting years of healthy life lost due to morbidity and mortality — life lost due to disease and death) for all mental, neurological ,and substance use disorders are expected to increase sharply in India.

In a bid to change this situation, the Rajya Sabha passed the Mental Health Care Bill in the Rajya Sabha earlier this year.

The bill seeks to redefine mental illness, to better understand various conditions that are persistent among the population. It says mental illness is a ‘substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life’. Mental conditions related to alcohol or drug abuse were also included in the definition.

The MHC bill will override the law that suicide and attempted suicide are criminal offences, and the offender is to be charged under section 309 of IPC. It states that the person attempting suicide will be presumed to be ‘under severe stress’ unless otherwise proven, and is not punishable. The move is welcomed by mental health care professionals across the country, as it takes away the burden of implicating a mentally ill person in a crime that he or she had no sane control over.

The new bill has provisions to introduce a Mental Health Review Commission, to set up Central and State authorities, and to increase the number of health care institutions.

To improve mental health status in India we need to establish more rehabilitation centers, to avoid discrimination of the people who suffer from mental diseases, upgrade existing mental hospitals and motivate and educate people on mental health.

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