Nearly 150 million citizens suffer from common mental disorders, need active interventions and support

Suitably, to centre public discourse on mental health, the WHO identified “depression” as the theme for World Health Day (April 7) this year; similarly, World Mental Health Day (October 10) specifically focussed on “mental health at the workplace” to reinforce how this issue is creeping into our daily life. In India, as in many countries across the world, issues around mental health have been both denied and stigmatised. A steep change is needed — starting with the acceptance that the problem exists.

Several factors contribute to mental health morbidity (people suffering from a disease, at a given point in time) — stress, breakdown of support systems, gap between expectations and reality, economic instability and the complexities of modern living. As per the National Mental Health Survey 2016 (NMHS), 11 per cent of the population suffers from common mental disorders like depression, anxiety, bipolar disorders etc. This broadly translates to nearly 150 million Indians who need active interventions and support, through creating awareness, medicines or psychotherapy. The NMHS survey indicated that individuals aged between 40-49 were predominantly affected with psychotic, neurotic and stress-related disorders. Substance-use disorders were highest in the 50-59 age group at 29 per cent. While more males were affected with alcohol use disorders (9 per cent vs 0.5 per cent), more females were suffering from depressive disorders. Notably, the prevalence of mental disorders was higher in urban areas and in persons from lower income groups. While the District Mental Health Programme (DMHP) is being implemented in rural areas through the primary healthcare centres, these findings highlight the need for an urban specific mental health programme.

From Research to Policy

The importance of mental health was recognised as early as the 1950s, when task force groups were set up by ICMR under eminent psychiatrists. A study conducted in the 1960s reported that 1 per cent of the population in rural areas was affected by severe mental health problems. Subsequent studies have shed light on the burden of mental health problems, assessed the impact of interventions and contributed to the strengthening of the National Mental Health Programme. 

In a historic step, patients have been empowered through the National Mental Healthcare Act 2017, which underlines the role of government in providing mental healthcare services. Similarly, the Rights of Persons with Disabilities Act 2016 charts out the roadmap for care and social rehabilitation.

Recent community-based work on suicide ‘ideators’ and ‘attemptors’ has identified risk factors like gender, unemployment, economic stress, poor educational level, along with high levels of psychosocial stress, hopelessness, relationship difficulties as risk factors for suicidal ideation. Mental health consequences of disasters have also been studied at various settings including the Bhopal Gas disaster; cyclones in Orissa; earthquake disasters in Maharashtra and Gujarat; and the aftermath of the tsunami in Tamil Nadu. These studies have highlighted that coping in Indian populations was strong due to better cohesion among community members and active participation of groups working within these communities. Technology is also stepping in to offer support to parents of children with autism and patients suffering from depression — these include various app-based self-help tools to bridge the gap in low resource settings like India.

Using ‘Reel’ to Mirror ‘Real’ 

Films are a good way to raise awareness about societal issues and in bringing about a change in attitudes that perpetuate stigma and discrimination and further isolate individuals. ICMR’s SERVE (Strengthening Education and Research via Entertainment) is a stakeholder engagement initiative, under which national award-winning films like Kaasav are being screened and discussed at different public venues. Sustaining such initiatives can help facilitate nuanced discussions with greater sense and sensibility. Fortunately, a whole new generation of youth icons like Yuvraj Singh and film stars like Deepika Padukone, Lisa Ray, Anushka Sharma are sharing their experiences to reinforce that mental health issues can affect anyone and must be dealt with head-on.

Way forward

Mental health is poorly resourced. With fewer than 6,000 psychiatrists in the whole country, it is important to plan the provision of mental healthcare services using the available workforce as well as train more “community-level mental health workers”. It is also critical to evaluate various strategies and assess their effectiveness in local socio-cultural contexts through “implementation research”. Last but not the least, the focus of research now needs to shift from estimation of disease burden and development of tools to deal with mental health issues. 

The current situation demands direct research-based inputs to shape and strengthen mental healthcare programmes and policy. This is best done with an open-minded and inclusive approach where government programmes partner with academics, NGOs and affected communities to design and test interventions. The experiences of organisations like NIMHANS, Tata Institute of Social Sciences, Indian Law Society’s Centre for Mental Health Law and Policy as well as NGOs like The Banyan, Sangath and Schizophrenia Research Foundation (SCARF) would be invaluable. The Sustainable Development Goals include specific targets within the health goal: “By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” Undoubtedly, adopting an integrated approach to both mental and physical wellbeing will be equally important for a healthy and productive life.

The author is Secretary, Department of Health Research, Ministry of Health & Family Welfare and DG, Indian Council of Medical Research