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INDIA: 10 Million Depressed – on the Optimistic Side

THIRUVANANTHAPURAM, Sep 10 2011 (IPS) - While Indian psychiatrists have rejected a World Health Organisation (WHO) study portraying India as the depression capital of the world, they say it has indirectly drawn attention to an acute shortage of trained personnel and facilities to deal with mental illness.

“Declaring India as having the highest rate of major depression in the world is an aberration in interpretation,” Dr. Roy Abraham Kallivayalil, secretary-general of the World Association of Social Psychiatry, told IPS.

The WHO study, based on interviews with nearly 90,000 subjects across 18 countries with different income levels, said that the average lifetime rates of depression were found to be 14.6 percent in 10 high-income countries, and 11.1 percent in eight low and middle-income countries.

The study, released late July, said while around nine percent of people in India reported having an extended period of depression within their lifetime, incidents of major depressive episodes (MDE) were highest among Indians at 35.9 percent. China, a comparable large country, recorded the lowest with 12 percent.

Kallivayalil and other experts in the Indian mental health sector pointed out that the figures for India were not representative in that while 11 centres across the country participated in WHO’s mental health survey initiative, figures were largely extrapolated from just one centre, Puducherry.

“The Indian Psychiatry Society has formally rejected the WHO study,” Kallivayalil, who is vice-president of the society, told IPS.

While the WHO figures for major depression in India may be exaggerated, specialists say there is a growing incidence of depression in this country and warn that the average age of the depressed Indian is dropping fast and will hit 30 years in the near future unless timely measures are taken.

Dr. Devapalan, a clinical psychologist in Hyderabad, said that mental illness is already high in the age group 30–40 and that minor depression if not properly addressed could easily deteriorate into major depression.

A study conducted in 2009 by the Bangalore-based National Institute of Mental Health and Neuro- Sciences placed the average age of the depressed Indian at 31 years.

The National Crimes Records Bureau states that of the 127,151 recorded suicides in 2009, 8,469 were linked to serious mental illness. “Insanity or mental illness accounted for 39.2 percent suicides in Ludhiana, 34.2 percent in Kochi and 31.3 percent in Amritsar,” the bureau observed.

The government launched the National Mental Health Programme in 1982, keeping in view the increasing burden of mental illness and the inadequacy of the mental healthcare infrastructure, but the programme achieved little because of a shortage of psychiatrists.

Health activists say that for real change to happen parliament must pass the new Mental Healthcare Bill which will replace the deficient 1987 Act and restructure mental health institutions in India.

Mathew Vellore, director of the Psychotherapy Centre in Thiruvananthapuram, told IPS that essentially the mental health sector needs larger fund allocation in the annual budgets. “A lot has to be done in respect of training, research, and provision of clinical services to promote mental health among all sections of society.”

According to WHO, countries like India allocate less than one percent of their health budget to mental health activities compared to some western countries which give 10 to 18 percent.

India has 3.5 psychiatrists per million people. But, given that doctors are located predominantly in the cities and that mental health treatment facilities in primary healthcare centres are poor, the number of unattended mentally ill in the villages is likely to be very high.

A 2010 report by the Stanley Medical College (SMC) in Chennai titled ‘Training and National Deficit of Psychiatrists in India’ said: “With 6.5 percent prevalence of serious mental disorder, the average national deficit of psychiatrists in India is estimated to be 77 percent.”

That report estimated that with 6.5 percent prevalence of serious mental disorder, the average national deficit of psychiatrists in India would be 77 percent and that more than one-third of the population had a 90 percent deficit of psychiatrists.

Such statistics give credence to estimates that put the number of Indians who suffer from depression around 10 million.

“The only solution to the problem is to train undergraduate medical students to provide a strong fundamental basis in psychiatry,” the SMC report suggested.

Dr. D. Raju, secretary of the Kerala State Mental Health Authority, run by the state government, told IPS that the steady migration of psychiatrists to Western countries like the United States and Australia and inadequacies in manpower development are the main reasons behind the shortage.