Shakti is a 42-year-old woman. She has two kids and speaks English fluently. While narrating her story however, she seems apprehensive. She nervously bites the end of her dupatta as she tells me about the domestic abuse she has faced and how she was thrown out of her house and forced to live on the streets.
Her schizophrenic mother was left by her father. She also describes a few episodes of childhood abuse and poverty.
Three years later she was picked up by the police and sent to a mental health hospital. After her rehabilitation, she joined Tarasha. Tarasha is a unique initiative started by TISS (Tata Institute of Social Sciences) in Mumbai to support women suffering from mental health disorders.
However, stigma and exclusion remains. She is not able to meet her two sons and she hides that she is on medication for schizophrenia, even from closed ones.
Shakti’s case, the stigma and the exclusion characterize the general case of people suffering from mental health disorders in the country. Such people are living on Indian streets ravaged by poverty and helplessness. In a country like India, the male to female ratio of mental health disorder is quite low compared to rich countries where it is 3:1 (in India it is 1.5:1).
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 depression in India. Another aspect is the existing infrastructure and workforce in India to address this health challenge. There are just about 40 mental institutions (out of which only nine are equipped to provide treatment for children) and fewer than 26,000 beds available for a nation comprising 1.50 billion people. The WHO report on the Mental Health Atlas reveals that there are just three psychiatrists, and an even lesser number of psychologists for every million people in India, which is 18 times lesser than the commonwealth norm of 5.6 psychiatrists per 100,000 people.
There are two main factors which women in India have to face. The first one is stigmatisation of mental health disorder. In India, it is of utmost importance that women do not bring shame to the family. If they are associated with any mental health disorder, then they are shunned. They are considered a disgrace to the family and made to feel as if they are not able to perform their expected roles.
Once a woman acts ‘abnormally’, she is very likely to be stigmatised. But how does an affected woman act then? In this regard, Renu Addlakha argues that, “one outcome of this gender-based differential access to mental health services is the higher rates of female utilisation of magico-religious systems, such as temple healing, native healers, exorcists and faith healers”.
The second factor is exclusion. There are women like Shakti who have lived on the streets and some who spend their whole lives there.
This ground reality of Indian women experiencing a mental health disorder is quite alarming. The number of suicides is increasing and it is a major concern whether India will be able to meet the UN sustainable goals objective to reduce suicides by 10%. There is no active suicide prevention policy by the government of India.
However, a proper legislation is present. A bill was passed in 2017 came into effect on 2018 which replaced the old law. According to the old law, Mental Health Act (1987), the review processes or appeal processes for mentally ill patients were far from realistic. The Mental Health Care Bill (2017) was introduced in the light of the provisions made under the United Nations Convention on the Rights of Persons with Disability (UNCRPD). The old law did little good in doing away with stigmatisation and exclusion. The new law decriminalises suicide, allows mentally ill patients to pick their caretaker and decide the course of their treatment.
A person with mental illness shall not be subjected to electroconvulsive therapy (ECT) therapy without the use of muscle relaxants and anaesthesia. Furthermore, ECT therapy will not be performed for minors. Another highlight of this Act is to protect the rights of a person with mental illness. The Government is advised to set up a Central Health Authority at national and State Health Authority at state level. The Section 2 (r) defines the term “mental illness” as a substantial disorder of thinking, which grossly impairs judgement, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life and includes mental conditions associated with the abuse of alcohol and drugs.
Therefore, there is a lot of work which has been done on paper. However, the ground reality continues to be pitch dark. Only 1% of India’s health annual budget is given to mental health and issues. There is inadequate architecture, thus, there is a need to reallocate the health budget.
Also there is ignorance about the mental health condition. Due to this the advance directive of choosing one’s medical treatment is quite difficult and long. The Bill also does not take into account factors such as poverty, the immediate environment of the individuals and other socio-cultural factors which affect an individual’s mental health.
According to research the Suicide helplines in India are quite inefficient. Most of them don’t work 24/7. If you google “suicide helpline in India” the contact number of one NGO’s helpline will flash on your screen. However if you call it, it never works. Such is the state of most helplines in India. There are many reports on the state of National Helplines by NGOs. However, there is no official helpline in the country.
Thus there is a need to revise the funding, and work to eliminate stigma, exclusion and achieve Sustainable Development Goal. We also need to focus on educating people and children especially in economically backward areas. If stigma persists, then there will be no effect of the good infrastructure and funding.
According to a recent survey, “Respondents were asked about their feelings towards people with mental illness. While there exists widespread sympathy towards sufferers, with more than 75% of participants stating they would always feel sympathetic towards them, they also exhibit feelings of fear (14% would always be fearful), hatred (28% feel hatred sometimes or always), and anger (43% feel angry sometimes or always) towards people with mental illness. More than a quarter admitted that they would always be ‘indifferent’ towards people with mental illness.”
We need more groups like Tarasha and more policies like Gatekeeper started by NIMHANS India. According to this policy, more than 500 people are trained to deal with Suicide Prevention. There must be a training programme like Gatekeeper in schools and offices to deal with this silent, yet deadly epidemic. This is because most of the time, families that should be peers to a suffering individual, do not know how the patient must be treated, they lack basic empathy.