Quest for mental wellness

Every year in December, Altmetric (a data science company, which tracks published research online and provides insights related to institutions, publishers, researchers and funders), comes out with a list of the top 100 scientific papers. This year 3 out of the 100 are on mental health and depression, with one being in the top 10 examining the relationship between exercising and mental health in US. The other two are on the side effects of consumption of anti-depressants and on prevalence of mental health issues in graduate education. 

This is more than mildly alarming. As 2018 comes to an end,  events like Elon Musk’s breakdown on Twitter, the suicide of Stanford University physicist and entrepreneur Zhang Shoucheng (who was apparently in line for the Nobel Prize), and closer home, depression hitting IIT aspirants in Kota, or suicides of farmers make one point clear: The ogre of mental illness is staring at societies rich and poor, in many ugly ways.

The World Health Organization in March 2018 noted that globally some 300 million suffer from depression and in October 2018, perhaps in recognition, the United Kingdom appointed formally a minister for suicide prevention. Around the world, depression is now affecting the young, the married, the working professionals and entrepreneurs, farmers in rural landscapes and also the aged. Unfortunately, social stigma, delayed detection and an understaffed supply side with psychiatrists, counsellors, and therapists make the matter worse not just in India but in many developing countries. To complicate the story, given the big medical challenge of the blood-brain barrier, innovation, and efficacy in the performance of anti-depressant medicines have been underwhelming. A recent study in the UK reported that even toddlers may not be exempt, the defiant ones potentially showing symptoms tomorrow. Additionally, other findings here point to the gender element. 

Even more concerning is that in India alone, statistics from the National Mental Health Survey of India, 2015-16 indicate that 150 million need support for mental disorders and this has been now repeatedly featured even in recent speeches of the country’s political leaders, including the Prime Minister’s and the President’s. Some other studies have noted that some 20 per cent of the Indian population will be suffering from at least one mental health problem by 2020 and the lay of the land is complicated by the fact that therapy is not commonly embraced in India. In addition, as answered in Lok Sabha by the minister of state of health and family welfare, there are just 3,827 psychiatrists and 898 clinical psychologists in the country. Further the distribution of this limited mental health workforce is also geographically heterogeneous. While frank discussions here, especially by prominent members of the society like Deepika Padukone help, given that there are currently evolving deep changes in the social structure, mere recognition and awareness may not be able to bridge the gap between supply and demand, leave alone handle issues around financing costs for therapy and treating mental health in a market dominantly out of pocket in the broader healthcare context. 

One way to potentially solve this problem may be to take advantage of entrepreneurship and technology leapfrogging the supply barrier. A technology-enabled multi-sided platform that guarantees confidentiality, gauge moods using natural language processing and artificial intelligence and matches therapists to unwell citizens could be a way forward, especially keeping in mind affordability and access. While international start-ups like Talkspace, 7 Cups and Better Help are already operating in this space, even here in India, platforms like TickTalkTo and YourDost are gaining prominence. Several organisations, in fact, are also using such platforms along with chat bots to promote employee wellness and thereby trying to improve productivity and reduce attrition. 

In addition, policy interventions are also needed. For example, treatment of mental health should be added to India’s national and statewide universal healthcare coverage programmes on a priority basis (encouraging here is to see that the Insurance and Regulatory Development Authority recently asked private insurers to include mental health in their packages) and brick and mortar investments need to happen to bridge the supply gap in professional psychiatrists, not just in urban but also in rural areas. In addition, the government could do well to turn to traditional medicines and wellness initiatives that promote healthy living. Finally, there is also an urgent need to attend to air pollution across India since recent research has found with postmortem brain samples from people exposed to high levels of air pollution (living in Mexico City and UK), the higher likelihood of brain disorders like Alzheimer’s.

Also, in recent times, the Mental Health Policy, the new Mental Health Act, recommendations from National Human Rights Commission, directives from the Supreme Court of India, advocacy actions and the introduction of ‘Happiness Curriculum’ in Delhi government schools are all undoubtedly steps in the right direction.

This is precisely the mission driven multifarious approach required in a country where issues like farm productivity, joblessness, a pressure to perform and compete, societal transformations in the urban and rural landscapes are denting the overall quotient for happiness. One can also draw inspiration and learning from the much successful polio mission here, facilitate healthcare entrepreneurship in this area, spur public and private investment in structural transformation of the supply side and further augment financing of mental health treatment. As the Dalai Lama said, happiness is not something readymade, it comes from your own actions, it is time for the country to recognise that and bolster its quest for mental wellness going forward.

Author is with IIM, Ahmedabad