MENTAL HEALTH:

MISAPPREHENSIONS, BELIEFS,
ATTITUDES AND RESULTING
PROBLEMS

Jayendra Kasar
M2014HE09
Rahul Hirekhan
M2014HE22
Robert Sandeep Madduri M2014HE24
Swati Bakshi
M2014HE33
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DEFINITION
Mental health is not just the absence of mental

illness. It is defined as a state of well-being in which

every individual realizes his or her own potential, can
cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a
contribution to his or her community. (WHO, 2007)
Mental Health is about :
How we feel about ourselves
How we feel about others
How we are able to meet the demands of life
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Socially, mental illness is a

stigma and the society is
frightened and embarrassed
by the Mentally ill persons and
henceforth these people are
marginalized from the society
by not providing them with
enough sunlight, condor and
unashamed conversation
which are of utmost
importance for a mentally ill
person.
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Background & Introduction

Till about 17 century all abnormal behaviour was seen as

an act of the devil that is against god.

Hallucinations were seen as communications with Satan.
Consequently, the ill were seen as evil and Christianity

approved specific sanction to kill them or punish them.

The description of witches were of mentally ill person.

Background & Introduction(contd.)

All abnormal behaviours were considered as criminal that

is, anyone whose behaviour was socially unacceptable was

classified as bad and they were put in jails along with other
criminals.
With the advent of modern science, focus was shifted from

evil to ill and the people who were considered bad started
being labelled as mad or insane.

Causes of Mental illness

Types of Mental Illnesses

Common mental illnesses
include:
Depression
Anxiety/ Phobias
Eating Disorder
Stress
Severe mental illnesses include:
Schizophrenia
Bipolar disorder (Manic depression)
Clinical depression
Suicidal tendency
Personality disorder
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Burden of the Disease

Globally, mental illness has affected over 450 million

people.
80% of them live in the middle and low income countries.
According to a community based study under the WHO

Mental Health GAP Action Program, in India, the life time

prevalence of mental disorders ranges from 12.2% to 48.6%.
The burden of these disorders is likely to increase to 20% by

2020 in India.

Burden of the disease (Contd.)

Mental Illnesses like Schizophrenia and Bi-polar disorder are

prevalent in about 200 cases per 10000 people

In India there are at least 100 million people suffering from

mental illness and about 10 million of them need

hospitalization.
The Ministry of Health and Family Welfare suggests that 6-7%

of Indias population suffers from mental disorders with about

1% suffering from severe mental disorders.

Burden of the disease (Contd.)

It was proved by a study in Delhi that 23.4 percent of migrants

from UP, Bihar, Haryana and Rajasthan were at moderate risk of
mental illness and 3.4 percent were at high risk.
In India in total there are approximately 4000 psychiatrists,
30000 psychiatric beds and only 43 government mental
health institutions. The vast treatment gap is not about the
numbers only; the conditions of existing infrastructure are
extremely poor.

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MYTHS IN THE COMMUNITY

REGARDING MENTAL ILLNESSESMental Illness has been a matter of enigma and

misconception since the prehistoric era.

Across the cultures Mental illnesses have been translated

as the consequences of some factors like:

The mentally ill was thought to be possessed by evil

spirits.
They were thought to be chosen by higher powers for
punishment.
They were believed to be the victims of bad fate, religious
and moral transgression or even witchcraft.
As a result, they were typically reticulated, tormented and
alienated from the society.
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 Its believed that people with mental illness can never be

productive or do normal work like normal people.
REALITY
At present 90% of the patients with any kind of mental
illness respond to pharmacotherapy and psychotherapy. They
can very well lead a productive and qualitative life any normal
person. Many high level jobs are performed by people who
have experienced mental illness. Person who have had mental
illness have excelled in many areas.

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 Mentally ill people are considered to be dangerous and

hence should be chained.

REALITY
Research from National Institute of Mental
Health(NIMH,USA) indicates that only 1% of mentally ill
person are potentially dangerous. The agitated patients can
also be successfully treated with pharmacotherapy and
other biological treatments like ECT.
2
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Its believed that psychiatric treatment causes irreparable

brain damage.
REALITY

Psychiatric treatment, with proper care, counselling and

medications can treat millions with mental illnesses like
depression, schizophrenia, suicidal tendency, epilepsy,
etc. without causing any brain damage.

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People believe that mentally challenged people are possessed by

evil spirits and are taken to witch doctors and black magicians to
chase away those evil spirits.
The black magicians believe that these evil spirits could be

chased away by:

1.Whipping or canning
2.Making the person inhale burnt chillies
3.Smearing chillies into the eyes
4.Branding with red hot coins

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In the villages of Rajasthan, people believe that a person

becomes mentally sick and go under the spell of spirits if they
had killed a cow during a past life. So people chain them up,
chant spells, poke them with pins and beat them "to force the
spirits out.
A common belief is that the spirit cant get out as there is no

exit , so they puncture the ear drums on both the sides with
sticks or pins. (Rajouri, J&K)
REALITY
Mental illness is a medical problem and can be cured by
medical and psychological treatment not by faith healing.
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Barriers for Mental health care in

India
GOVERNMENT FUNDING - Health is not a priority so, the
expenditure on health is restricted to not more than 2% of GDP
and out of it only 1-2% is allocated to mental health.
MENTAL CARE INSTITUTIONS - There are only 43 mental care
institutions all over India and among them only 6 are in livable
condition.
TREATMENT - Inhumane treatment regimen where patients are
chained and severely ill patients are locked up in 4*5 feet cells. To
kill the body lice, patients are stripped and sprayed with
insecticides which are used to kill cockroaches.
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Chained inmates of an asylum burnt to

death
26 mentally challenged people

were burnt to death in Yerwadi,

Tamil Nadu.
They couldnt escape as they were

chained.
This shows how inhumanely and

miserably the mentally challenged

people are treated.
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LOGISTICS- Most of the hospitals don't have clean water

supply and the materials which were supplied to the
hospitals were used by the hospital staff in their homes.
HUMAN RESOURCES- Limited number of psychiatrists
out of which 70% live in urban areas that is why
physicians and gynecologists are in charge of most of the
hospitals. Ex - one psychiatrist for 331 bedded hospital in
Varanasi.
LAW - Improper implementation of laws which resulted in
increase in number of faith healers who torture patients
and exploit people in the name of evil spirits.
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Barriers for mental health care in

India (contd.)
COMMUNITY-

Stigma
Lack of awareness
Ignorance and superstitious beliefs
Social exclusion
Lack of care and familial bonding
Dumping of mentally ill in asylums and forests

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Legal provisions in India

Relationship between psychiatry and law most often comes
into play at the time of treatment of Mental illness.
Treatment of Person with mental illness mostly involves
curtailment of his/her personal liberty.
Most of the countries in the world have their own laws
regulating the treatment of psychiatric patients, though
India has few but they are the innovation of the British.
After taking over the administration from the East India
company, the British crown has enacted successive laws for
controlling the care and treatment of mentally ill persons in
British India.
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Acts from pre to post Independence

These laws were:
1)The Lunacy (District Courts) Act, 1858
2)The Indian Lunatic Asylum Act, 1858 (with amendments passed
in 1886 and 1889)
3)The Military Lunatic Acts, 1877.
The above mentioned acts gave the framework for mental asylums
and established a procedure for the admission of mental patients. As
the awareness on the pitiable condition of mental
hospitals were
th
increasing during the early decade of the 20 century, The British
India enacted Indian Lunacy Act on 1912 which guided the destiny
of psychiatry.
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1)Mental health Act submitted in 1950 and enacted in 1987

2)Persons with disability act- 1995
3)National trust act-1999
The above two acts are under revision in light of UNCRPD2006 due to improper addressal of human rights and
mental health issues
1)UNCRDP was adopted in December 2006 and was
ratified by the Parliament in May 2008
2)Finally in Oct 2014, National mental health policy was
launched to provide universal psychiatric care to the
population, 20 percent of which are likely to be suffering
from mental illness by 2020

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Case study-1 (provision of proper

care)
Neha was an engineer who had a good childhood and
married life until she delivered a son. After that she broke
down mentally and her partner whom she thought would be
there for her, left her alone with the onset of mental illness
and moved out of house treating her as an untouchable. Her
parents who were both scientists were devastated by the
news of their daughter and died due to the shock leaving her
all alone.

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Case study-1 (provision of proper care)

Contd.
Looking at her plight, some neighbours handed her over to
an NGO that looked after destitute women. There, Neha
was becoming increasingly withdrawn, dull and neglected
her personal hygiene. She used to get poor sleep and hardly
ate anything which necessitated psychiatric referral. She
was diagnosed with Schizophrenia for which she underwent
treatment for 6 months after which she became better.

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Case study-1 (contd.)

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Problems the mentally disabled people face-

the stigma attached

the discrimination
lack of social support ,

all are depicted in this case study.

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Case study-2 (Improper care)

Mansi hailed from the Maddur Taluk of district Mandya in
Karnataka. Her father was a poor farmer, who worked hard
but was unable to make both ends meet. He had three
children two girls and one boy. Mansi, who was a shy and
reserved girl, suddenly started to sing and dance with out
any provocation. The family thought some evil spirit had
possessed her and so they consulted a local priest who
ordered some rituals to drive away MOHINI which had
apparently possessed Mansi but it yielded no result and
suddenly one day Mansi disappeared from the house.
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Case study-2 contd...

The family, villagers and local police joined the search but
was not fruitful. Finally the family came to know that Mansi
got rescued by an NGO from the streets of Mysore and was
taking treatment for her mental illness which was
diagnosed as MOOD DISORDER. After recovery she was
sent back to her parents where she discontinued her
schooling due to the stigma and discrimination she faced by
the society and stopped her medication as her family
couldnt afford it. This resulted in the relapse of the illness.

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Case study 2 contd...

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So, we see from the case study that

Poor access to mental health care

Poverty
Stigma and discrimination
Poor awareness about the illness
Discontinuation of medication

All are hindrances to the proper care of the mentally

disabled.

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Recommendations
Training more professionals. It is desirable to have at least one

psychiatrist per 100 000 people in the general population, India

has less than one psychiatrist for every 300 000 people, most of
whom practice in urban areas where treatment costs are
prohibitively high.
Implementation of Community mental health programmes

across the country.

Advocacy activities to bring awareness.
Increasing the budget of mental health.
Checking malpractices and corruption in public mental health

institutions.

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Providing treatment to patients in compliance with human rights.

Making laws more stringent to curtail faith healers and operating

illegal asylums.
Govt. should recognise mental health as a rising public health

problem and should make psychiatrists available atleast at the CHC

level.
The govt should maintain adequate supply of mental health drugs in

all the 3 tiers of public health system to reduce the OOP expenses.
Formulating policies keeping in view both the biomedical and socio

psychological roles in mental health rather than biomedical alone.

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THANK YOU

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