"Health is pivotal in growth and development of a society. A healthy and productive society is important for economic progress of a nation. WHO defines health as “state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.”
Although, the developing and the developed nations are beset with different types of health issues, mental illness is one of the leading non-communicable diseases ailing the world and has become a major public health problem.
Mental disorders contribute to a significant load of morbidity and disability. As per Global Burden of Disease report 2015, mental disorders account for 13 per cent of total DALY (disability adjusted life years) and loss for years lived with disability (YLD). Among these Depression is the leading cause.
According to WHO, depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. Globally, more than 300 million people of all ages suffer from depression.
More women are affected by depression than men. At least 13.7 per cent of India's general population has been projected to be suffering from a variety of mental illnesses and 10.6 per cent of this requires immediate intervention. In all, nearly 150 million Indians are in a need of active medical intervention, according to the National Mental Health Survey 2015-2016 submitted by NIMHANS to the Union Ministry of Health and Family Welfare.
Dear sisters and brothers,
Another major area of concern is the prevalence of suicide. Time and again, we read news reports of suicide by youngsters, farmers and women. It is a very disturbing trend and collective efforts are needed from all stakeholders— the immediate family members, public health planners, policymakers and NGOs to prevent suicides. I feel that there is a need to launch a national campaign and a national suicide prevention strategy. Timely counseling and family support can prevent people suffering from depression from taking any extreme step. Experts in the field feel that one of the reasons for the suicides is the lack of appropriate healthcare services to identify and manage people at risk.
India is placed in a uniquely advantageous position because 65 per cent of the population is below the age of 35 years. Yet, it is just this group (especially people aged 15-29 years) who are at the highest risk of suicidal death. This is a major public health concern and we need to need to hugely step up our efforts to help youth who are prone to bouts of depression to get rid of the problem.
Stigma and Awareness
One of the major challenges is the social stigma associated with mental illness. It is unfortunate that people suffering from mental illness often face ill-treatment and discrimination, sometimes at the hands of close relatives and family members. This is simply unacceptable even it is due to lack of understanding or misunderstanding. Nobody has any right to ill-treat patients with mental illness and such kind of behavior will further aggravate the severity of illness.
I would like bodies like yours to take up countrywide campaigns in creating awareness among people on this aspect. It is all more necessary in the present times because modern medicines and proper treatment will enable people suffering from psychiatric disorders to lead normal productive lives even if they had faced the problem for a long-term.
I am told that more than 50 per cent with schizophrenia can be free of relapse at the end of one year’s treatment with antipsychotic drugs and family intervention. Similarly, up to 90 per cent of those suffering from depression can recover with a proper combination of antidepressant drugs and psychotherapy. There has to be greater awareness on both social stigma and affordable treatment.
Distribution of mental healthcare service
Another major handicap we are facing in providing effective mental healthcare is the lack of adequate number of psychiatrists, psychologists and trained nurses in the field. This shortage has to be filled on a war footing for providing quality treatment to patients.
Mental Healthcare Act, 2017
While the Mental Healthcare Act, 2017 is a patient-friendly act and aims to protect the rights of people with mental illnesses, it also takes into account the caregivers’ concerns and encourages their involvement.
Economic burden on care givers
Mental health still continues to get less attention from governments in allocating budgets and there is a need for the policy makers to rectify this situation. Most developed nations spend above 4% of their budgets on mental health care and research, according to a 2011 World Health Organization report.
Major psychiatric disorders have a chronic course and require prolonged treatment. While the direct costs relate to consultation fees, medication, therapy costs, travelling costs and the loss of pay from work for both caregivers and patients, the indirect cost is the time involved in the care giving for patients.
In many low and middle income countries (LAMIC), costs for formal mental health services are paid by the patients or their care givers’ out of the pocket, this mode of approach will limit the utilization of mental health services according to the ability to pay and resulting in inequitable access to mental health care. Continued high out-of-pocket expenses for mental health treatment may impede access to the treatment especially for those who need greater treatment.
The best solution for this problem would be to strengthen public health care system, but till then medical insurance which incorporates mental health is beneficial. Medical Insurance to cover all Psychiatric disorders is the need of the hour.
Policy and legislation
Dear sisters and brothers,
India has many advantages compared to other countries. We have cheaper medication and a well distributed public health system across the country. Gaps in the public health system can be potentially addressed through tele-psychiatry (tele-medicine) as done by SCARF foundation in Tamil Nadu. Tele-psychiatry can be tried in other places, especially rural areas with broadband and mobile phones connectivity. Video consultation can be just a ring away! Less human resource usage and availability of quality care can be beneficially utilized.
India has certain advantages for tapping the potential of medical tourism in this area. With the availability of quality treatment, cheaper medication and lesser costs, there is indeed scope for providing proper mental healthcare services to patients from other countries.
Providing employment opportunities for the mentally disabled, who do all the tasks properly after treatment, is another area where policy and planning can make a major impact. With the advent of modern medical treatment of psychiatric conditions, many people have the possibility of becoming financially independent and such people should have provision for employment.
I am sure that all the experts gathered here would deliberate upon the whole gamut of issues relating to mental healthcare and come out with recommendations for improving the services.