About 10 percent of the Indian population of 1.2 billion people experiences a form of mental illness - that is about 200 million people. Credit: IPS

By Minto Felix
NEW DELHI, Mar 4 2015 (IPS)

India is not only poised for greatness, some say it is already on its way. The events that have shaped the nation’s dialogue over the past month showcase an India with a bold vision – to transform industry, to close the gap on inequality and ultimately, to redefine its place as a leader among the world.

Yet, it is a baffling reality that political leaders from across the spectrum have failed to adequately respond to one of the most pressing human challenges facing India today. A challenge that not only comes attached with significant consequences to the most important asset of the country – it’s people – but also, if not taken seriously, is likely to impede upon the continued progress achieved by the nation.

India has only one psychiatrist for every 343,000 people, and one of the highest suicide rates in the world.
The challenge of mental illness is an urgent priority for the country, one that requires collective action and constructive reforms.

Imagine this: by the year 2020, depression and anxiety is set to be the biggest illness facing humanity, costing the world about 13 trillion dollars to treat.

In India, conservative measures from the Bangalore-based National Institute of Mental Health and Neurosciences (NIMHANS) estimate that about 10 percent of the population experiences a form of mental illness – that is about 200 million people.

Whether they’re Bollywood celebrities like Deepika Padukone, who recently and poignantly blogged about her struggle with anxiety, or the painful stories of suicide that have emerged in recent years from farmers grappling with the pressures of prolonged drought, mental illness impacts individuals from every walk of life and throughout the lifespan.

It is also well established that mental illness particularly impacts those most vulnerable in our communities, especially those that experience poverty and discrimination.

With the exception of India’s first Mental Health Policy, which was launched to positive public reception in October last year, we have seen little to no action follow suit in driving through core reforms identified.

Further, with mental health expenditure occupying only 0.83 percent of the total health budget, which, in turn, also continues to be a tiny fraction of overall government expenditure, the plausibility of important change occurring in this arena remains grim. So what’s needed to shift the status quo?

1. Start an informed conversation

The essential first step in driving positive change on mental ill-health is to learn about it. Whilst there certainly have been improvements over the past decade, the mental health literacy amongst Indians remains low.

This is problematic for several reasons, as it allows for misinformation to propagate at the community level, and as a natural consequence, stigmatising attitudes that prevent individuals from seeking the appropriate help they require.

Improved understanding of mental illness not only removes stigma, it also builds compassion – of how to adequately care for oneself, as well as for others, when experiencing mental health difficulties.

A population that is mental health literate is also armed with the tool kit to be powerful agents of change, and can confidently hold medical professionals, governments and policy makers to account in improving the status of mental health in India. To have individuals experiencing mental illness labeled as inadequate and deprived of their humanity is simply not acceptable in 2015.

2. Build world-class infrastructure

It is altogether unacceptable that India has only one psychiatrist for every 343,000 people, and it is worrying that India has among the highest suicide rates in the world, particularly within its youth population.

This reflects poorly resourced infrastructure, and also inadequate services to match the deep needs experienced by the population.

In some senses, the answer is simple – increase the amount of funds directed towards tackling mental illness, and in other senses, the solutions are more complex – of determining quality care coordination across states, of making investments in priority areas such as youth mental health, and working to increasing the number of trained mental health professionals.

As is the case with technology and infrastructure, India should aspire to have a word-class mental health system that is efficient, effective, and accessible by its entire population.

3. Age of innovation

One of the genuine achievements of the past year with regards to mental health is the decriminalisation of attempted suicide. The repeal of this legislation is an important step in working towards reducing the number of suicides, but also reflects the broader societal factors that need to be addressed in strengthening the mental health of Indians.

Economic, social and political factors all play a vital role in strengthening or damaging a person’s level of health, and this is no different with mental illness.

Countless NGOs and government agencies around the country are implementing exciting projects that seek to alleviate mental illness, as well as surrounding factors of gender based violence, homelessness, and drug abuse. However, in order for these projects to make a lasting difference, they need be implemented on a larger scale.

The Banyan, a Chennai based mental health NGO, is leading the way in this space, with both its innovative service delivery in working with vulnerable women experiencing mental illness but equally, in its commitment to scale through establishing partnerships with universities in other parts of India and government agencies to increase the organisation’s reach.

By the very same token, it is indeed the role of the government to evaluate, to encourage, and extend the full potential of these initiatives. There is a pressing need to build a bank of evidence-based solutions for tackling this health issue.

There is no health without mental health, and the call for reform is crystal clear. If we are able to promote the full mental health of each and every person living in this country, India can only be stronger, richer, and indeed a more fulfilled nation.

Edited by Kanya D’Almeida

Excerpt:

Women in India’s mental health institutions often face systematic abuse that includes detention, neglect and violence. Credit: Shazia Yousuf/IPS

By Shai Venkatraman
MUMBAI, Jan 30 2015 (IPS)

Following the birth of her third child, Delhi-based entrepreneur Smita* found herself feeling “disconnected and depressed”, often for days at a stretch. “Much later I was told it was severe post-partum depression but at the time it wasn’t properly diagnosed,” she told IPS.

“My marriage was in trouble and after my symptoms showed no signs of going away, my husband was keen on a divorce, which I was resisting.”

“The nurses were unkind and cruel. I remember one time when my entire body was hurting the nurse jabbed me with an injection without even checking what the problem was.” -- Smita, a former resident of an Indian mental health institution
After a therapy session, Smita was diagnosed as bi-polar, a mental disorder characterised by periods of elevated highs and lows. “No one suggested seeking a second opinion and my parents and husband stuck to that label.”

One day after she suffered a particularly severe panic attack, Smita found 10 policemen outside her door. “I was taken to a prominent mental hospital in Delhi where doctors sedated me without examination. When I surfaced after a week I found that my wallet and phone had been taken away.”

All pleas to speak to her husband and parents went unheeded.

It was the beginning of a nightmare that lasted nearly two months, much of it spent in solitary confinement. “The nurses were unkind and cruel. I remember one time when my entire body was hurting the nurse jabbed me with an injection without even checking what the problem was.”

On one occasion, when she stopped eating in protest after she was refused a phone call, she was dragged around the ward. “There were women there who told me they had been abused and molested by the staff.”

Not all the women languishing in these institutions even qualified as having mental health problems; some had simply been put there because they were having affairs, or were embroiled in property disputes with their families.

Days after she was discharged her husband filed for a divorce on the grounds that Smita was mentally unstable.

“I realised then that my husband was building up his case so he would get custody of the kids.”

Isolated and afraid, Smita did not find the strength or support to fight back. Her husband won full custody and left India with the children soon after. “My doctor says I am fine and I am not on any medication but I still carry the stigma. I have no access to my kids and I no longer trust my parents,” she told IPS.

Smita’s story points to the extent of violence women face inside mental health institutions in India. The scale was highlighted in a recent Human Rights Watch (HRW) report, ‘Treated Worse than Animals’, which said women often face systematic abuse that includes detention, neglect and violence.

Ratnaboli Ray, who has been active in the field of mental health rights in the state of West Bengal for nearly 20 years, says on average one in three women are admitted into such institutions for no reason at all. Ray is the founder of Anjali, a group that is active in three mental institutions in the state.

“Under the law all you need is a psychiatrist who is willing to certify someone as mentally ill for the person to be institutionalised,” Ray told IPS. “Many families use this as a ploy to deprive women of money, property or family life. Once they are inside those walls they become citizen-less, they lose their rights.“

Ray points to the story of Neeti who was in her early 20s when she was admitted because she said she heard voices. “When we met her she was close to 40 and fully recovered, but her family did not want her back because there were property interests involved.”

With the help of the NGO Anjali, Neeti fought for and won access to her share of family property and was able to leave the institution.

Those on the inside endure conditions that are inhumane.

“There is hardly any air or light. Unlike the male patients who are allowed some mobility within the premises, women are herded together like cattle,” says Ray. In many hospitals women are not given underclothes or sanitary pads.

Sexual abuse is rampant. “Because it is away from public space and there is an assumed lack of legitimacy in what they say, such complaints are nullified as they are ‘mad’,” adds Ray.

Unwanted pregnancies and forced abortions impact their mental or physical health. They languish for years, uncared for and unattended.

“One can’t help but notice the stark contrast between the male and female wards,” points out Vaishnavi Jaikumar, founder of The Banyan, an NGO that offers support services to the mentally ill in Chennai, capital of the south Indian state of Tamil Nadu.

“You will find wives and mothers coming to visit male patients with food and fresh sets of clothes, while the women’s wards are empty.” Experts also say discharge rates are much lower when it comes to women.

The indifference towards patients is evident not just in institutions, but also at the policy level, with mental health occupying a low rung on the ladder of India’s public health system.

According to a WHO report the government spends just 0.06 percent of its health budget on mental health. Health ministry figures claim that six to seven percent of Indians suffer from psychosocial disabilities, but there is just one psychiatrist for every 343,000 people.

That ratio falls even further for psychologists, with just one trained professional for every million people in India.

Furthermore, the country has just 43 state-run mental hospitals, representing a massive deficit for a population of 1.2 billion people. With the District Mental Health Programme (DMHP) present in just 123 of India’s 650 districts, according to HRW, the forecast for those living with mental conditions is bleak.

“Behind that lack of priority is the story of how policymakers themselves stigmatise,” contends Ray. “The government itself thinks [the cause] is not worthy enough to invest money in. Unless mental health is mainstreamed with the public health system it will remain in a ghetto.”

Depression is twice as common in woman as compared to men and experts say that factors like poverty, gender discrimination and sexual violence make women far more vulnerable to mental health issues and subsequent ill-treatment in poorly run institutions.

Gopikumar of The Banyan advocates for creative solutions that are scientific and humane like Housing First in Canada, which reaches out to both the homeless and mentally ill. The Banyan is presently experimenting with community-based care models funded by the Bill and Melinda Gates Foundation and the Canadian government.

“Our model looks at housing and inclusivity as a tool for community integration,” says Gopikumar. “The poorest in the world are people with disabilities and most of them are women. They are victims of poverty on account of both caste and gender discrimination and its time we open our eyes to the problem.”

*Name changed upon request

Edited by Kanya D’Almeida