Mental health: India needs to talk frankly about depression

Last week, there was an outpouring of grief and compassion on social media after the suicide of American chef and television personality Anthony Bourdain. The chef had a long-standing history of depression. As people shared stories of depression with their “it can happen to anyone” anecdotes, one could hardly feel unaffected while living in a country where at least 60 million people suffer from mental disorders.

In India, more than five per cent of the population suffers from common mental disorders like anxiety and depression. The figure seems intimidating, but in a country like ours where capturing mental health related data is in itself a challenge, one fears that the numbers are well above that.

Depression is the great plague of our era. According to a World Health Organization report, over 350 million people suffer from depression. In India, the social stigma around depression and other mental illnesses results in many such cases being undiagnosed and untreated.

Despite the scale of the epidemic, India spends only 0.06 per cent of its healthcare budget on mental healthcare. The lack of psychiatrists and clinical psychologists only add to the problem. For many living in rural India, getting access to mental healthcare is almost impossible. 

There could be many reasons behind the widespread prevalence of depression or anxiety disorder in India. Agrarian distress, violence against women and adolescents, lack of proper reproductive health facilities, absence of menstrual counselling, urban lifestyle, work pressure, exam pressure, lack of job opportunities; the reasons can be varied and sometimes difficult to pinpoint. 

One of the main problems with mental illness diagnosis in India is the apathy towards such diseases. Even ‘educated’, middle and upper class families tend to deal with depression as some artificially constructed notion and not as something that is clinically defined. ‘Just clear your head’, ‘don’t think too much’ and ‘just eat well and be healthy’ are frequent suggestions that anyone suffering from depression or anxiety often receive.

In small towns and cities, many parents hesitate to take their children to a psychiatrist or a psychologist. Firstly, there is a stigma attached to the idea that their child has some ‘mental problem’, as it is generally referred to.

Secondly, people start imagining the side effects and prospective addiction to such medication even before the treatment. If you go to a general physician and he gives you an antibiotic, there is a chance that it has some side effects, but you still follow his advice because you know it’s probably going to cure the disease. The attitude towards mental health medication is completely different, partly due to perception and partly due to lack of awareness about mental illnesses.

There are very few institutions dedicated to mental health patients in India and accessibility becomes a barrier in evidence-based treatment of those suffering from mental illness. Those who suffer from severe mental disorders such as schizophrenia and bipolar disorder are treated inhumanely. Most of those suffering from psychosocial disabilities are often forced into mental hospitals and institutions, which have low level of hygiene, lack infrastructure and manpower required for treatment and care. Moreover, women and girls in these institutions are often vulnerable to physical and sexual violence.

What is hurting the mental health system in India the most is the lack of doctors and counsellors. Although the government has proposed many new initiatives to expand the infrastructure as well as number of doctors, which might improve the situation in the future, there needs to be a massive effort to try and tackle the problem right now. Even mental health helplines run by the government and other non-government organisations are not sufficient and often limited to big cities.

Our overall health system continues to disappoint millions of people across this country on a daily basis. Non-functional Primary Healthcare Centres, absentee medical officers, insufficient beds in government hospitals, very expensive private hospitals; all these continue to haunt the people of India. Women, rural poor and children — the most vulnerable sections of our population become the victims of this failing system with disastrous consequences to their health and finances. The mental health system is just a reflection of this system. But what makes the matter worse is complete indifference to mental illness and the stigmatisation of mental diseases and people who suffer from it.

The government has to play a major role if India has to tackle growing cases of mental diseases. The emphasis has to be on prevention as well as cure. Children, adolescents and adults must have access to mental health counselling, both in rural and urban areas. This can be integrated and made part of the existing curriculum for front line health workers as well as doctors working at different levels. The role of non-government organisations is also very important in tackling mental health issues on the ground. It has to be a collaborative process, which spreads awareness and encourages people to treat it as any other clinical illness, which can be cured. Reaching out can save lives, so reach out.

The author is a poet and activist based in Delhi. Views are personal.