Current Indian Mental Health Scenario

Health is pivotal in growth and development of a society. According to World Health Organization,
Definition of Health includes physical, social, spiritual and mental aspects of health and is not just the
mere absence of infirmity. Mental health is an essential and integral part of health. Mental health 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% of total DALY (disability adjusted life
years) and loss for years lived with disability (YLD), among these Depression is the leading cause. It's
estimated that over 1.1 billion people worldwide had a mental or substance use disorder in
2016. The largest number of people had depression, estimated at around 4 percent of the population.

At least 13.7% of India's general population has been projected to be suffering from a variety of mental
illnesses; and 10.6% of this requires immediate intervention. Among these, 10% of the population has
common mental disorders and 1.9% of the population suffers from severe mental disorders. 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.
Prevalence of various mental health conditions in India according to this report are as follows –

Suicide

Another major area of concern is the prevalence of suicide. India has the highest rate of suicide among
world countries. It is ranked as one of the top countries in Southeast asia, accoriding to the WHO report
on suicides (2000-2012). Experts in the field feel that this is due to lack of appropriate healthcare
services which identify and manage people who are at risk.

India is considered a unique country with highest proportion of young people with all the possible
potential and skill. Yet it is the just this group (especially people aged 15-29 years) who are at the
highest risk of suicidal death. This is a huge public health concern and we need innovative solutions to
this vexing problem.
Stigma and Awareness

Provision of mental healthcare faces many hurdles, one of which is the social stigma associated with
being mentally ill. Social stigma is due to misunderstandings about the causes of mental illness, wherein
the most common causative factor is wrongly thought of as ‘weakness of mind’ or ‘weak character’.
Such misconceptions lead to denial of illness where present and avoidance or mistreatment of people
with mental illness. In either situation, timely treatment is not provided which furthers the severity of
illness and resultant disability.

Despite the chronic and long-term nature of some mental disorders, with the proper treatment, people
suffering from mental disorders can live productive lives and be a vital part of their communities. Over
80% of people with schizophrenia can be free of relapses at the end of one year of treatment with
antipsychotic drugs combined with family intervention; and up to 90% of people with depression can
recover with a proper combination of antidepressant drugs and psychotherapy. Social stigma has to be
fought against by raising public awareness about mental illnesses and availability of affordable
treatment.

Distribution of mental healthcare service

Mental healthcare suffers from inequality in distribution in health services. One of the parameter in
measuring this is the difference between the number of healthcare providers needed and the actual
number of healthcare providers. There is a lack of psychiatrists, psychologists, psychiatric social workers
and psychiatric nurses compared to the ideal requirement to meet the health needs of people.

Mental Healthcare Act, 2017

Mental healthcare Act, 2017 is a progressive act with its clear aims of protecting and enhancing rights of
people with mental illnesses. Patient rights and their subsequent integration into the community are
major aspects of this act. Responsibilities of various government departments like police and judiciary
are delineated so as to facilitate early identification, treatment and community integration. Caregivers’
concerns are also taken into account and their involvement is encouraged.

However, sometimes due to excessive focus on patient rights might force the service provider into a
defensive healthcare practice. This is due to the unique nature of few mental health conditions in which
the suffering person loses his ability to recognize his illness, i.e. they are not aware of their mental
derangement. Historically, all over the world other than the police and judiciary, no other public or
private professional, except a psychiatrist, is given an authority to give involuntary treatment. This is
because of the above mentioned unique nature of some kinds of mental illnesses. I think, under this
new act, this provision should be preserved although with checks and balances which protect against
abuse and exploitation.

Economic burden on care givers

Mental health still continues to be the last priority in terms of policy making or financial resourcing
globally. India spends 0.06% of its health budget on mental healthcare which is less than Bangladesh
(0.44%). 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 continuous treatment, most of the cases require prolonged treatment. The direct costs
incurred would be consultation fees, medication and therapy costs, travelling costs and the loss of pay
from work for both caregivers and patients; while the indirect cost is the time involved in the care giving
for patients.

Key drivers of direct costs were medications (50%) and travel expenses (27%), amounting to 31% of their
monthly incomes. In many low and middle income countries, 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 intensity. Best solution for this
problem is strengthening public health care system, but till then medical insurance (like the proposed
‘Modicare’) which incorporates mental health is beneficial. However, medical insurance providers
shouldn’t be allowed to work only for profit-making but should be regulated by governmental agencies.

Policy and legislation

India has many advantages compared to the global scene. We have cheaper medication and public
health system layout across the country. Gaps in the public health system can be potentially addressed
through tele-psychiatry (tele-medicine) as done by SCARF foundation in Tamilnadu. These are user
friendly and provide care in the communities through computerized mechanism. Less human resource
usage and availability of quality care can be beneficial used.

Medical tourism can also be applied to psychiatric treatment because of fair quality of treatment,
cheaper medication and overall costs in India. This can be used as an advantage for psychiatric
conditions as is being done in other specialties in medicine. Promise of medical tourism as a business is
huge and many prospective patients come from African, South-Asian countries and even USA.

Clamping down on the illicit drug distributors and drug-mafias is another area which can reduce many
consequent mental health conditions. Police and governmental agencies along with NGOs can be pro-
active in this area and collaborate with psychiatric professionals.

Employment opportunities for the mentally disabled people who are doing adequately well with
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, so they should have provision for employment.