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Lifting the Curtain on Mental Health

by Deepa Bhalerao January 29 2015, 5:55 pm Estimated Reading Time: 10 mins, 30 secs

“Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living, and enjoy life,”

–World Health Organization

October 2013

The cell-phone rang at 3.30 a.m.

“I need to ask you to tell my mother that I really tried. Tell her also that I love her very much and to please not cry when I am gone.” The voice said.

The noise of cars whirring past was interrupting the words and making them sound breezy. There was quiet resignation in her voice. It was a young woman who was coming to me for emotional support for a couple of weeks now. She was overcome by intense grief at finding out that her husband wanted to end their marriage after just one year. Her paternal family was asking her to “adjust”, “find a way”, “endure”, etc.

It took two hours of negotiating and some coordination calls for help before she was shifted to a safe place.

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April 2013

As I was leaving my then workplace in a high school and college complex around 5 p.m. in the evening, the security guard came running and almost dragged me to the first floor towards the boys’ bathroom. The glass front of the door lay broken and a young student stood with his wrist injured and bleeding profusely amid the shattered glass. He appeared dazed and had to be taken to emergency care.

In the hospital, he was silent throughout the time they administered first –aid and interventions. When informed that his mother was on her way, he finally spoke out and asked me to tell her that it was an accident. He also requested to not be left alone even after she reached the hospital, as he was afraid of her reaction.

The incident was provoked by a prank by one of his classmates, who had locked this boy in the bathroom and bolted the door from outside. This had made him so angry, that he had punched through the thick glass that was on the top half of the door and hurt himself gravely in the process.

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February 2013

A popular college teacher who was known for her joie de vivre and much loved by the students suddenly started to lose her temper and get very emotional in class. She struggled to keep focus and would often go blank midway through the lecture.

Subsequently, she began to withdraw herself from her colleagues and remained distant despite their attempts to communicate with her. Any dialogue about her altered behaviour would make her break down and start blaming herself. She was terrified when the management suggested that she take a break and begged to be allowed to come to college every day.

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January 2013

A bright young girl student in Std 7 started getting restless in class. She spoke of a vague sense of discomfort and always looked at the corners of ceilings with anxiety. She would suddenly speak out loud appearing to have a conversation, which seemed bizarre to the others present. She continued this despite being asked to keep silent. Even the teacher’s reprimanding her did not work.

She slowly began to avoid coming to school and would scream, as though petrified, if her parents insisted. They gave in thinking it was perhaps some discipline issue in school, but got concerned when the behaviour did not alter after a week. All attempts to speak to her were futile and her nature turned fearful and anxious.

After a while, her behaviour at home became similar to that at school and she stopped eating meals and would cower if her parents tried to speak with her.

She was showing signs of a mental health disorder, but counselling the parents turned out to be a difficult task. They were reluctant to approach a psychiatrist as the stigma was a big concern for them.

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(Each of the above are abridged from actual case histories)

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Stress, anger, depression, and schizophrenia are just a few among the wide range of mental health issues that affect the various strata of the population. They occur in a range of severity and length, and, if left untended, can escalate to a level where they could bea threat to the wellbeing and even the life of those affected.

Mental Health is a broad term which encompasses preventive, promotive and curative aspects of all psychological issues. Health and wellbeing are not restricted to physical health only. In fact, physical and mental health are equally important components of what we understand as health, along-with social (and, according to many, also spiritual) health.

However, mental health has not received as much attention as is due. Public health policy and programs did not include the mental health component till very recently and it is only in October 2014 that India unveiled its first ever Mental Health Policy.

A. Mental Health Prevalence and Services in India- An Overview

For more than 70 million people with psychosocial disabilities — mental health conditions such as schizophrenia or depression — who live in India, access to mental health services is poor, with only 43 state-run mental hospitals across the country, three psychiatrists and 0.47 psychologists per million people. The few voluntary community-based services that do exist are short-staffed and lack resources.
Similarly, for people with intellectual disabilities — cognitive impairments such as Down’s Syndrome — not only are support services limited but the few existing services are under-utilised.
A 2012 survey by Parivaar, a national confederation of over 230 parents’ associations and NGOs working to empower persons with intellectual disabilities and their families, found that 40% of people interviewed in 58 districts across 10 states did not benefit from any services at all.
More recently, the Global Burden of Disease Report 2013 has listed Suicide as the seventh among the top ten causes of death in India. This is a wake-up call. There are intermittent news items in mainstream news channels on farmer suicides, stress induced depression and suicidal behaviours, but mental health issues do not get much independent coverage.

B. Children and Mental Health-

“At least 20 per cent of Indian children suffer from some form of mental disorder, of which about 2-5 per cent are serious disorders,” says Manju Mehta, Professor Department of Psychiatry, at Delhi’s All India Institute of Medical Sciences. “Irritability, sleeping and eating disorders and obsessive compulsive disorders, if ignored, could later manifest as more serious concerns,” she adds.

“I’m not sure about the figures for India but children are just as susceptible to mental disorders as adults though their treatment modules have to be very different,” says ShekharSeshadri, Professor, Child and Adolescent Services, Department of Psychiatry, NIMHANS

C. Mental Health as a Public Health Issue

The Public Health system in India plans and implements large scale interventions on communicable and non-communicable diseases, and there is the much needed focus on the urgent healthcare needs of the most vulnerable components of the society in addressing Reproductive and Maternal Health and Child Health and Nutrition, but there are no parallel interventions on mental health across all levels of health care services.In fact, mental health is conspicuous by its near absence in the national health discourse.

“Coping with the growing number of mentally ill is an uphill task. The biggest hurdle is that we have not managed to integrate mental health into the Government-run Primary Health Centres (PHC) in India. The more we isolate mental health, the more we create barriers,” says Gopikumar, who founded The Banyan with VaishnaviJaikumar to rehabilitate mentally ill and destitute women in Chennai. The organisation has helped more than 1,500 destitute women find homes and rehabilitated 1,000 mentally ill people in the last 15 years.

D.What is the way forward ?

Given the scenario, it is time that mental health and wellbeing are brought into the realm of public health discourse and integrated into the existing systems of health services.

A look at the recent reports and write-ups offer some suggestions-

(i) The WHO factsheet on Mental Health states that

Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. (For example, persistent socio-economic pressures are recognized risks to mental health for individuals and communities. The clearest evidence is associated with indicators of poverty, including low levels of education).
Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyles, risks of violence, physical ill-health and human rights violations.
There are also specific psychological and personality factors that make people vulnerable to mental disorders.
Lastly, there are some biological causes of mental disorders including genetic factors which contribute to imbalances in chemicals in the brain.

(ii) Given the complex and overarching landscape of the issue, the first step forward as suggested by the WHO involves the three Ps – prevention, promotion and management.

Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include a range of actions to increase the chances of more people experiencing better mental health.

A climate that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health.

National mental health policies should not be solely concerned with mental disorders, but should also recognize and address the broader issues which promote mental health. These include mainstreaming mental health promotion into policies and programmes in governmental and nongovernmental sectors.

In addition to the health sector, it is essential to involve the education, labour, justice, transport, environment, housing, and welfare sectors as well.

The Role of Media is extensive in the context of the preventive, promotive and also curative aspects of mental health. Media is the window to the common as well as the discerning viewer’s choice of preferred entertainment.

Mental health issues can embellish storylines, give the necessary edge to the gender discourse, acknowledge the existing lacunae in the universe of what we call ‘wellbeing’ and open a world of empathy and compassion for content creators to explore and contribute in a powerful way.

When relevant and specific content is created keeping in mind the different facets that encompass mental health and addressed directly and indirectly, it will prove to be among the most meaningful of interventions for contemporary society, and nothing short of a landmark for community level intervention, even without the nomenclature.

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