Mental Health

WHY IN NEWS?

• Since the onset of the Covid-19 pandemic, several reports have indicated a worsening of mental health issues among individuals across age groups. WHO estimates that about 7.5 per cent Indians suffer from some mental disorder.

BACKGROUND:

• Mental health is an integral part of health; it is more than the absence of mental illnesses.
• It is the foundation for well-being and effective functioning of individuals. It includes mental well-being, prevention of mental disorders, treatment and rehabilitation.
• Common mental disorders (CMDs) includes:
  • Depression
  • Anxiety disorders
  • Substance use disorders (SUDs)
• Determinants of mental health include individual attributes such as the ability to manage one's thoughts, emotions, behaviours and interactions with others

STATISTICS:

• As per WHO estimates:
  • Burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 100 00 population
  • Age-adjusted suicide rate per 100 000 population is 21.1
  • The economic loss due to mental health conditions, between 2012-2030, is estimated at USD 1.03 trillion (22 percent of the economic output).
• Suicide rate in India:
  • India’s contribution to global suicide deaths increased from 25% in 1990 to 36% in 2016
  • Suicide has surpassed maternal mortality as the leading cause of death among women
• As per the National Mental Health Survey 2015-16:
  • 9.8 million teenagers in the age group 13-17 years suffer depression
  • Substance use disorders (SUDs), including alcohol use disorder, moderate to severe use of tobacco and use of other drugs (illicit and prescription drugs) was prevalent in 22.4 % of the population above 18 years.
• Prevalence of mental morbidity is high in Indian urban metros. Possible reasons include fast paced lifestyle, stress, complexities of living, breakdown of support systems, challenges of economic instability.
• Neurosis and stress related disorders affect women disproportionately (nearly twice as much as males).

CHALLENGES TO MENTAL HEALTH IN INDIA:

• Poor awareness:
  • This results in delayed treatment seeking behaviour, social isolation of people suffering from mental disorder etc.
• Low budgetary support:
  • Mental health care accounts for 0.06% of the total Union Health Budget, which is less than that of Bangladesh, which spends 0.44 %.
• Lack of insurance coverage:
  • Insurance companies do not provide medical insurance to people who are admitted in hospitals with mental illnesses.
• Stigma, shame and social ostracism associated with the disorder:
  • A survey conducted by AIIMS in collaboration with WHO found that 95 percent of those with mental-health problems remain deprived of treatment due this.
• Lack of essential infrastructure, treatment facilities and their sickening ambience:
  • There are only about 43 mental hospitals with less than 26,000 hospital beds are dedicated to mental healthcare in the country, and most of them are in disarray.
• High cost involved in private mental care:
  • Visiting private clinics and sustaining the treatment, which is usually a long, drawn-out affair, is an expensive proposition for most families
• Lack of enough mental health professionals:
  • WHO reports that there are only 3 psychiatrists per million people in India, while in other Commonwealth countries, the ratio is 5.6 psychiatrists for the same.
  • By this estimate, India is short of 66,200 psychiatrists.

INITIATIVES:

• Mental Healthcare Act, 2016:
  • It provides the legal framework for providing services to protect, promote and fulfil the rights of people with mental illnesses.
  • Definition:
    • It defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life.
  • Rights of persons with mental illness:
    • It gives every person the right to access mental healthcare from services operated or funded by the government.
    • It also includes good quality, easy and affordable access to services.
  • Advance Directive:
    • A person with mental illness shall have the right to make an advance directive i.e. how he wants to be treated for the illness and who his nominated representative shall be.
  • Mental Health Authority:
    • The Act empowers the government to set-up Mental Health Authority at national and state levels where mental health institutes and practitioners have to be registered.
  • Decriminalising suicide:
    • It effectively decriminalises suicide attempt under the section 309 (attempt to commit suicide) of Indian Penal Code (IPC).
  • Prohibits electro-convulsive therapy:
    • It will be not used for minors. It will be allowed for adults only with the use of anaesthesia.
• National Mental Health Policy, 2014:
  • It upholds a participatory and rights-based approach for quality service provisions.
  • Objectives:
    • Universal access to mental health care.
    • Reduce prevalence and impact of risk factors associated with mental health problems.
    • Reduce risk and incidence of suicide and attempted suicide.
    • Ensure respect for rights and protection from harm of persons with mental health problems.
    • Reduce stigma associated with mental health problems.
    • To enhance availability and equitable distribution of skilled human resources for mental health.
    • Enhance financial allocation and improve utilisation for mental health promotion and care.
    • Identify and address the social, biological and psychological determinants of mental health problems and to provide appropriate interventions.
• Judicial interventions:
  • The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution.
  • Supreme Court in Rakesh Chandra Narayan case (1988) held that the Government has an obligation to ensure that medical attention is provided to every citizen in the country.
• International collaboration:
  • Mental Health Atlas was launched by WHO in 2017.
  • WHO’s Comprehensive Mental Action Plan 2013-2020 was adopted by the 66th World Health Assembly.
  • Convention on the Rights of Persons with Disabilities:
    • It covers persons with physical, mental, intellectual disabilities
• National Mental Health Programme (NMHP)
  • It aims to improve the status of mental health in India. It has 3 components:
    • Treatment of mentally ill
    • Rehabilitation
    • Prevention and promotion of positive mental health
• District Mental Health Program (DMHP)
  • It was launched under NMHP
  • The DMHP was based on ‘Bellary Model’ with the following components:
    • Early detection and treatment.
    • Training: imparting short term training to general physicians for diagnosis and treatment of common mental illnesses with limited number of drugs under guidance of specialist. The Health workers are being trained in identifying mentally ill persons.
    • Public awareness generation.
    • Monitoring: the purpose is for simple Record Keeping.
• Deaddiction centres and rehabilitation services

BEST PRACTICES:

• ESSENCE:
  • It is a five-year research project in Madhya Pradesh
  • It aims to evaluate the use of technology interventions to train and support ASHA workers to deliver therapy for depression
• Aswasakiranam (Kerala):
  • This scheme provides financial support to bedridden and mentally challenged patients, their families and primary caregivers
• Mental health policy of Chile:
  • Over the last 20 years, Chile has increased the mental health share of its public health budget and implemented policies that radically transformed psychiatric services in the country

WAY FORWARD:

• A nationwide campaign to tackle social stigma:
  • Involving various stakeholders including communities, NGOs, technology/data firms and private mental-healthcare players with evidence-based tracking and pivoting.
• Better coordination:
  • Healthcare is a state subject. There is need for better coordination between Center-States for proper implementation.
• Innovative measures to tackle the resource shortage:
  • Tele-Mental health solutions, promoting NGOs working in mental health care space, community level efforts and small private players to be embraced.
• Multisectoral engagement and a life-course approach
  • Mental health promotion involves creating an environment, which promotes healthy living and encourages people to adopt healthy lifestyle.
  • Enabling environment through national mental health policies and legal frameworks are imperative for effective management of mental health disorders and providing overarching directions for ensuring mental health promotion.
• Improving mental health care ecosystem:
  • Defining relevant quality metrics, followed by auditing and benchmarking of government and private mental health care units.
• Celebrating and rewarding role models:
  • Psychiatrists, psychologists, social workers, companies who have worked relentlessly in the field of mental health care must be recognised and awarded.
  • This will push innovation and action from other mental-health field players
• Affordability and accessibility:
  • Treatment at the primary health care level
    • Policy makers should be encouraged to promote availability of and access to cost-effective treatment of common mental disorders at the primary health care level.
  • Insurance coverage:
    • Mental-health problems requiring long term medication, therapy regime and hospitalisation to be brought under the insurance umbrella.
  • Incentivising low-cost interventions
  • Promoting innovative business models in mental health sector
• Alternative medicines:
  • India’s rich traditional healing systems such as Yoga and Ayurveda should be explored in the context of treating mental health disorders.

PRACTICE QUESTION:

Q. ‘There is a need for a focused attention for addressing the increasing incidence of mental health issues in India’. Discuss