Every fourth person in the world suffers from some mental or neurological illness, which leads to a poor quality of life. In India, social stigma and inadequate manpower, combined with lack of infrastructure for mental healthcare, worsen the situation

Mental health is a state of emotional, psychological and social well-being in which the individual realises his/her own abilities, copes with the stresses of life, works productively and possesses the ability to contribute to society. It is an integral part of health and not just the absence of mental illness. Mental well-being can be affected by a number of factors and every person is vulnerable to problems, irrespective of age, gender, socio-economic status and ethnic background.

Every fourth person in the world suffers from some mental or neurological disorder, which leads to a poor quality of life, decreased productivity and lower earning potential.

Around 450 million people across the globe currently suffer from some kind of disorder, making it one of the leading causes of ill-health and disability worldwide.

According to the World Health Organisation (WHO), 6.5 per cent of Indians suffer from some form of serious illness like schizophrenia, with an equal distribution among rural and urban populations. The National Mental Health Survey (NMHS) concludes that 10.6 per cent people in India suffer from common disorders like depression, anxiety and substance abuse.

About 56 million people in the country suffer from depression and its severe form may lead to suicide, a major cause of death in the age group of 15-39 years. Suicide deaths in India have drastically increased since 1990 and around 230,314 were recorded in 2016. Incidents of student taking their lives are also on the rise and close to 26,000 students died between 2014 and 2016.

Given the continued trend, India won’t be able to achieve the Sustainable Development Goal (SDGs) of the United Nations to reduce the global suicide rate by one-third by the year 2030.

According to the NMHS, approximately 150 million Indians need professional care but only a small proportion of them is able to access mental health services. Nearly two-thirds of people with known disorders never seek professional help, resulting in a huge treatment gap.

This could be because of several reasons such as stigma associated with mental illnesses, lack of awareness, lack of resources, poor infrastructure and apathy on the part of policy makers to counter these problems.

In fact, stigma is a significant hindering factor in Indian society and prevents patients from reaching health facilities, resulting in neglect in the care of the mentally ill. It has been found that the attitude of doctors, other than psychiatrists and other healthcare professionals, contributes to the stigma due to their limited knowledge and awareness about psychiatry and mental health problems. In many cases people are not even ready to acknowledge these problems.

Because of stigma, mental illness is often discounted and the affected person is discouraged from seeking treatment. S/he is often advised to be strong and snap out of the condition. People in need of help should be encouraged to seek expert advice and those undergoing treatment should be urged to regularly visit their psychiatrist and comply with the instructions.

The mental health workforce in India is extremely low considering the prevalence of disorders — there are 0.3 psychiatrists, 0.12 nurses, 0.07 psychologists and 0.07 social workers for 100,000 people. The available professional manpower is much less than the laid down WHO standards.

Stigma and inadequate manpower, combined with lack of adequate infrastructure for mental healthcare, worsen the situation.

The solution lies in training other healthcare professionals in mental health and utilising their services to treat common disorders which could be easily treatable by general healthcare providers.

Integration of mental health with the general health services is the objective of the National Mental Health Programme (NMHP) launched in 1982.

The District Mental Health Programme, started in 1996 under the NMHP, had aimed at the integration of psychiatry services with general health services as one of its key goals.

However, it has largely remained a psychiatrist-oriented programme and the desirable transfer and integration of care from psychiatrists to general medical practitioners has not been achieved. Treatment and cure are of utmost importance and ignoring or neglecting disorders can escalate the issue pretty exponentially.

There is much to be achieved and progress needs to be made in almost all aspects of the mental health framework. Adaptation of therapeutic techniques to Indian sub-cultures, temperament and cognitive biases needs to be addressed to stay ahead of the challenges professionals are currently facing. Policy makers should promote availability of and access to cost-effective treatment of common disorders at the primary health care level.

An environment needs to be created which promotes healthy living and encourages people to adopt an active lifestyle. Mental health promotion will now receive more focus, with its inclusion in the SDGs that need to be addressed through comprehensive strategies for promotion, prevention, treatment and recovery in a whole-of-Government approach.

Introduction of the Mental Healthcare Act, 2017 protects the rights of and enables citizens to decide the ways they wish to be treated if they fall prey to a mental illness. The Act promises to provide mental healthcare and services and to protect, promote, and fulfil the rights of such persons during delivery of mental healthcare and services. However, the Act remains silent on the services provided in the community.

Suicide prevention, which was the theme of this World Mental Health Day, is highly relevant in view of the fact that close to 800,000 people kill themselves every year across the globe and 17 per cent of these deaths are in India. One person commits suicide every 40 seconds and behind every death there are 20 suicide attempts.

Suicides are preventable and much can be done to prevent them at the individual, community and national level. It is time for us to spread awareness about mental disorders, their management and prevention. It is time also to reflect upon some of the challenges we face as a society in India.

(The writer is professor at the Hamdard Institute of Medical Sciences and Research)