The Lockdown of Stigma related to Mental Health

Introduction

The World Health Organization (WHO) released a report for the 2008-13 period about non communicable diseases (diabetes, cancers, etc.). In a footnote, they stated that “Mental health disorders are not included here despite the heavy burden of disease that they impose, as they do not share the same risk factors … ”

This is often misunderstood to not consider mental health. That is where the problem begins. So long as mental health is not considered as an issue valid enough to be dealt with, a nation’s mental health crisis is bound to aggravate unless saved by a messiah or two.

In this piece, S Sanjana from Hues of the Mind and I will walk you through why mental health needs more work at a policy and individual level in India.

Huesofthemind is a non-profit organization run by progressive youth whose mission is to have more conversations about mental health to reduce the stigma around it. Their team also creates self-help resources and has created a safe space for over 4000 people.

Table of Contents

(1) The Importance of Considering Mental Health as a Valid Illness
- (a) Overview
- (b) The Economics of Indian Mental Health Challenges
(2) Existing Policies
(3) India’s First Comprehensive Mental Health Policy (1982)
(4) The Mental Healthcare Act 2017
(5) Mental Health Policy Needs More Work
- (a) Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) 2018
(6) The Society’s Role in Mental Health
(7) What’s Next? (Proposed Solutions)

The Importance of Considering Mental Health As A Valid Illness

Overview

Not only is mental health a valid medical area to consider, but it is also linked with other forms of health. For example, one study shows that about half of the patients victim to cancer are also victims of depression. Conversely, patients suffering with mental health challenges are more likely to develop noncommunicable diseases like cardiovascular diseases and others.

The state of mental health infrastructure in India is still underdeveloped. A parliamentary questionnaire in 2019 revealed that India has only 43 government mental hospitals spread across just 21 states. A WHO mental health atlas in 2017 showed that for every 100,000 individuals, India has only 0.29 psychiatrists. When the number of child psychologists is brought to the table, just 49 existed. For a nation that is estimated to have one in four families with at least one member facing mental health challenges, these numbers pose a major crisis.

Data amidst the lockdown and the “mental health epidemic” has further shown that for society to be resilient, their mental health needs to be taken care of appropriately.

The Economics of Indian Mental Health Challenges

It can also be proven that mental health has an economic implication as well. A research claims that corporate mental health challenges in India costs the industry about 1 trillion U.S. dollars.

Existing Policies

Although the crisis is significant and changes are needed, the groundwork for mental health is not nonexistent. The same WHO atlas also acknowledged that the government provided school-based and anti-stigma awareness resources. Additionally, in 2020, the New Education Policy also discussed mental health in two places:

Clause 2.7 – “Children are unable to learn optimally when they are undernourished or unwell. Hence, the nutrition and health (including mental health) of children will be addressed…”
Clause 4.27 – “Basic training in health, including preventive health, mental health … will also be included in the curriculum, as will be scientific explanations of the detrimental and damaging effects of alcohol, tobacco, and other drugs.”

mental health new education policy india 2020

While these are also stepping stones to making good progress, there is more work and realism needed. For example, I believe that the inclusion of scientific explanations of the harms of substances in the mental health landscape is inadequate. Addicted youth are already aware of the long term detriment these substances have. However, they do not feel them in the short run and hence use it as a temporary escape. These substances are also often used as a method of self harm. Therefore, providing psychological explanations of why students end up resorting to addictive practices as an escape and what other alternatives exist to cope with mental health challenges needs to be accompanied with the other policy.

India’s First Comprehensive Mental Health Policy (1982)

Decades ago, India responded to these issues via the National Mental Health Program (NMHP, 1982). The objectives of this program were as follows:

To ensure the availability and accessibility of minimum mental healthcare for all… ;
To encourage the application of mental health knowledge in general healthcare and in social development; and
To promote community participation in the mental health service development and … self-help…

The Mental Healthcare Act (2017)

In 2017, India revised their mental health care plan for the first time since their previous NMHP. Their plan acknowledged that many fail to receive treatment as their families associate the illness with shame. They also cited that “According to a study conducted by the National Institute of Mental Health and Neurosciences, 1 in 40 and 1 in 20 people are suffering from the past and current episodes of depression in India.” With over 90% families failing to receive treatment, such measures were imperative.

The 2017 Act made major progressive steps such as:

Right to accessing good quality affordable mental healthcare services,
Decriminalization of suicide,
In case of a failed suicide attempt, a government duty to provide rehabilitation, and
Prohibition of electroconvulsive therapy for minors.

Mental Health Policy Needs More Work

According to a Professor at the Institute of Mental Health in Hyderabad, while the act is good progress, it still contains a few restrictions that need to be resolved such as:

The definition of mental illness (“a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs”) is restrictive and does not include:
- Conversion disorders,
- Phobias,
- Panic disorders,
- Personality disorders.
The act does not have a strong provision to prevent the development of mental illnesses. It talks about rehabilitation post the development of it but not to prevent it.

We acknowledge that existing policy initiatives and programs, such as the District Mental Health Programme (DMHP) and Ayushman Bharat, are continuing to work to provide mental health services integrated with primary health services. However, the implementation of the DMHP is not uniform and various provisions have not been fully implemented yet.

Availing government-sponsored mental health care requires regular visits to government healthcare facilities as the medications are frequently unavailable or only dispensed in small doses. There are time and transportation costs to obtain medication refills for patients with chronic mental illness. These multiple costs add to the psychological and financial burden already borne by individuals and their families. Few who can afford it, turn to more expensive private healthcare as an alternative option. Thus, access to care and treatment is still largely impeded by procedural and financial hurdles.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) 2018

PMJAY has a package covering a list of mental illnesses including schizophrenia and mental retardation, according to officials. From an article on November 19, 2019, The Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) is all set to cover mental illnesses.

Additionally, Ayushman Bharat’s key components state “Screening and Basic management of Mental health ailment” but has currently indulged no updates regarding the improvement of this key component.

In a few other interviews, officials have acknowledged certain gaps in implementing policies and involving more advanced procedures. Yet, many would believe that the acknowledgement is not followed up with rectifying policies.

The Society’s Role in Mental Health

In India, many families value “conformity to norms, emotional self-control, and family recognition through achievement”, mental health challenges are associated with shame. This in addition to other stigma and norms has hindered help-seeking behaviour.

As mental health education is increasing, more and more families are accepting of the existence of mental health challenges. Yet, even then, certain stigmas persist.

Families link religious morality with mental health – families will associate mental health challenges with one’s inability to connect with their faith. “If you are religious, you should be mentally peaceful too.”
It is believed that material success guarantees good mental health – people who either have one or a combination of being well-off, well-known, or have a good career are expected to have good mental health. COVID-19 has set the strongest precedent to disprove this statement.
“Life is not meant to be easy” – Many people’s mental health struggles are delegitimized with this statement. Along with the aforementioned, victims of mental health challenges avoid being open about their feelings as they know they can not expect more than insensitivity from their environment.

What Next?

We have seen the research and we understand that while there are positive steps being taken in the country, we are yet to park our car in this journey. We call for further policy changes coupled with societal belief shifts.

We propose the following specific changes (at policy, organizational, and individual levels) additional to other recommendations embedded throughout the article:

Mental health should be integrated with the National Urban Health Mission and other programs to deal with the high prevalence of mental health issues in urban areas.
The shortage of medical professionals in the field of psychiatry and psychology needs to be filled with incentives.
Families’ beliefs that psychiatry and psychology is inferior to other subjects needs to be changed; the lack of supply of professionals won’t be filled unless this belief is fought.
Given the seriousness of the issue at hand, mental health should have its separate budget rather than relying on the remaining budget of the Primary Health Care budget. Additionally, Mental Health Schemes and Policies should be an equal part of the Primary Health Care system.
As mental health care is expensive (due to private sector presence in the field), it becomes harder for people to afford it. Increased government presence and/or subsidies may be considered to work for this.
The rural population needs to be aware of mental health issues, therefore, such information should be given at an early age embedded in their education.
Mental Health should be given just as much importance as Physical Health; mental health affects our physical health and other parts of life (academics, career, relationships, etc.) if left untreated.
Workshops regarding mental health issues and their awareness should be conducted both in academic institutions and in the workplace.

Policy is not everything. Therefore, it is also important that we fight the stigma around mental health issues at a personal, family, and community level as it will encourage more people to seek medical treatment and knowledge regarding mental health issues.

DISCLAIMER

This piece is not the work of licensed professionals. However, the content is research-based and factual to the best of the writers’ knowledge.

What do you think about our proposals and ideas? Do you have any additional solutions we overlooked? Do you have any points of disagreement with us? We’d love to hear from you and engage in conversations for a better tomorrow!

References

The Vigilant Mind

When truth and falsehood come together, falsehood is bound to perish.

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