On World Health Day, the theme this time is depression. Our Prime Minister did address the topic in his weekly radio program Mann Ki Baat, but he sadly did not take the right vein. He spoke loosely of “sharing with someone”, especially suggesting sharing your problems with family.
If families were understanding, a teenage boy would not jump of the 18th floor of Taj Lands End, telling us steps to suicide, and promising to meet us on the other side.
The truth is that there are three very big problems that lead to our mental health crisis.
The first is our attitude to mental health care:
Only recently have we passed a progressive mental health bill in the Rajya Sabha. However, even though it is called the mental healthcare bill, it in essence speaks largely regarding mental illness or rather, more severe mental illness. We still have an approach that solves the problem after it occurs rather than tackling why and where it begins. Because we are not willing to give up in the way we think of mental health, we tend to cling on to notions like “your family cannot harm you”, when facts show otherwise. At least 20% of young women have faced sexual and physical violence at home. Our domestic violence figures are skyrocketing. We are scared to even put out a law against marital rape because we believe that it will threaten the institution of family. Family problems are also the number one cause of suicide.
Clearly, we need to start thinking from an individual’s perspective and we need to think from a preventive perspective.
Following a medical model:
Research has time and again shown that there are quite a few non-medical treatment models which work as good or better than medications when it comes to mental health problems. Yet, India continues to be caught in the clutches of a medical model. Not only does it place psychiatrists on a pedestal, it also causes likelihood of abuse to the patients. There are some gruelling statistics available of what goes on in most mental institutions in india. There are documented cases where healthy persons have been forced into taking psychotropic drugs due to their family’s disgruntlement with them.
Our obsession with a medical model is to such an extent that the new bill does not even recognize counselors, psychotherapists, psycholoanalysts or any sort of behavioural scientists as mental health professionals! An amendment was suggested to include these professionals and even Dr. Shashi Tharoor spoke of the pitfalls of excessive reliance on a medical model. He said that all professionals contribute equally and there is no need to put one over the other. In fact, his words “We are already having a very hierarchical society. Let us not reduce mental health again being stuck in hierarchy of professional treatment”. The sad reality is that most psychologists and counselors are paid about the same as a receptionist and expected to do an outstanding job of dealing with peoples’ emotional burdens.
Mental health issues are too complex and we cannot draw parallels with biological or physical illnesses and give medicines the prime importance. Social support, coping skills, psychological help go a long way in treatment, prevention and relapse as shown by the work of NGOs like the BAPU Trust. This NGO works with slum communities to strengthen their social capital and coping skills and has internationally won acclaims for their work.
Ignoring societal and environmental factors:
We have a strange culture of lip service and band aid cures in India. For example, we know that exam stress is a killer, yet, instead of radicalizing our education system, we are making it all the more competitive. And if a student or two, kill themselves, we open helplines for some time, so that the students can gain catharsis. Similarly, we know the situation is dire when it comes to family stress for women and workplace stress for all working people. We still follow six day weeks and ten hour working days in India!
India has one of the worst human development indicators and gender ratios. We are not covering peoples’ healthcare costs. Not to mention, people in India struggle with casteism, poverty and many other pressing social and economic factors. How can we expect people to have good mental health when they are being torn apart from all directions?
The violence, substance abuse and crime we see in our people is but an indicator of how badly we feel inside.
India spends only 1.21% of its budget on health, and of that 1.21%, 0.06% is spent on mental health. Is it surprising then, how much the country ails? We need to revolutionize how we look at mental health problems, by respecting each individual’s experience, by shunning a pure medical model, and my addressing social and environmental factors and not just by giving lip service and band-aid cures.
But to do that, we need to acknowledge that our peoples’ health and well-being is more important than fancy bullet trains and statues worth thousands of crores.