Crying for Help: The Ongoing Mental Health Crisis in India

In 2015, the National Institute of Mental Health and Neuro Sciences, under the directive of the
Ministry of Health and Family Welfare, embarked on the ambitious project of conducting an all-
India survey of mental, behavioral and substance use disorders. The objectives of the government
led survey was to develop data on the prevalence, pattern and outcome of mental health
disorders across 12 selected states in India. A group of trained staff collected the data through
hand-held devices from 39,532 individuals across the states. Along with this, secondary data
sources and qualitative methods were also taken into use to set down indicators. At the end of the
survey in 2016, the results were, what many National newspapers described as shocking.

It is shocking perhaps, to the mainstream media that has been preoccupied with sensationalizing
news rather than sensitizing it, that 13.9% of the total population are in dire need of mental
health support. It was estimated that 1 in every 20 Indians suffer from depression and nearly 1%
of the total population was reported to have high suicidal risk, which brings the number of
people in need of immediate medical attention to 150 million. The highest prevalence of
psychoactive substance use was found to be in urban areas and in people who had been widowed
or separated, indicating a direct correlation between alienation and substance use. The test also
looked into the treatment gap in mental disorders and alcohol abuse which ranged from 28% to
83% and 86% respectively.

Therefore, given the data collected, it is safe to say that India is amidst a grave crisis when it
comes to mental health disorders. This has severe implications, not just on the happiness and
health index, which is obvious, but also on the economic productivity of the country. The survey
also revealed that men in the age group of 30-49 years are most affected by mental health and
substance use disorders. This may motivate many corporate employers to provide support, but
whether they will be geared towards the right initiative, is less sure.

In this context, it has to be stated that the understanding of mental health has to be distinct from
that of other long term diseases, both within the medical fraternity and among laymen. Owing to
the high prevalence, many may be tempted to refer to the situation as a mental health epidemic.
However, what this does is pathologize the cause of such disorders as if they are viruses that
needs to be eradicated. The eradication of triggers cannot be the solution of mental health
disorders the way in which insulin shots can help curtail the creation of excessive blood sugar.
Diabetes is an epidemic, depression is not. It is easy to conflate them since there are many points
of comparison between the two in both cases certain people are genetically susceptible to it,
they both hamper the bodys natural abilities and they both require long term treatment in
mainstream allopathic medicine. However, unlike diabetes, it is normal for every person to be
depressed at some point in their lives for a period of few months as per Stephen Paul Wests
book Depression Symptoms Decoded. The occurrence of depression is not a malfunction; in fact,
it is an indication of the bodys natural reactions to certain stimuli which are distressing to the
person. Therefore, divorcing the mental and physical aspects of depression, such that the
approach for treatment is symptom eradication and not assimilation, is an ineffective and
insensitive form of treating it.

In this context, it is important to address the question of high treatment gap in India. According
to Sarbojeet Basu, a researcher of Applied Psychology at Galgotia University, Greater Noida,
there is a huge shortage of trained psychologists in the country. However, even the few that are
there are hard-pressed for a living (unless affiliated to major institutions), as the stigma against
mental health keeps majority of the patients away from whatever little support system there is.
This was ratified by an independent practicing psychologist in New Delhi, who wished to remain
anonymous. Owing to the lack of assured income, psychologists choose to affiliate themselves
to prominent private hospitals and other institutions resulting in the hike of treatment costs,
which acts as a further deterrent to patients.

While there are public sector initiatives that try to make mental health support affordable to the
general population, the attitude towards mental health itself is such that it pervades the stigma
against seeking help, rather than combating it. A patient who approached the psychiatric
department of AIMS, Delhi stated in confidence that the attitude of the receptionist as well as the
treating doctor was such that she felt ashamed to go back there and therefore discontinued her
treatment. Therefore, the situation is such that there are not enough trained professionals to
provide the much-needed support to mental health patients and those that exist are either too
expensive, or too incompetent.

There have also been some philanthropic initiatives like Deepika Padukones Live, Love, Laugh
Foundation. After having battled with depression at a time when her career was at its peak, this
Bollywood actress started a foundation that works on generating awareness of the debilitating
condition that is depression and helping people find affordable counseling near them. While the
focus of this foundation is solely on depression, it has still contributed significantly to tackling
the issue of stigma against mental health. However, there remains many gaps in treatment yet
that needs to be filled in by different stakeholders, in both the public sector and private.

The two biggest hindrances to leading a mentally healthy life in India are stigma against
disorders and lack of access. While private sector initiatives led by celebrities and opinion
leaders can go a long way in tackling stigma, private sector could help increase access for people
of disparate backgrounds. The National Mental Health Survey team in their summary state that
efforts towards bridging the mental health gaps in the country should be based on equity,
promote a rights approach and enhance access. It also makes an open request to the country at
large to come together in finding solutions together. This is key when it comes to tackling
mental health, since all-round support, including that of kith and kin, is essential towards
overcoming this national crisis.