India had a gnawing problem with mental health even before the advent of the pandemic. Mental disorders are among the leading causes of non-fatal disease burden in India. The Lancet study says, one in seven Indians were affected by mental disorders of varying severity in 2017. 197.3 million people had mental disorders in India, including 45.7 million with depressive disorders and 44.9 million with anxiety disorders.
The post-Covid landscape in India will be a fertile breeding ground for an increase in chronic stress, anxiety, depression, alcohol dependence and self-harm. The pandemic exposed the social and economic fissures in mass unemployment, depleted social safety nets, starvation, increase in gender-based violence, homelessness, alcoholism, loan defaults and millions slipping into poverty.
People who already have mental health issues find it hardest to deal with the uncertainty created by the pandemic. And it has already started showing symptoms in society. A leading suicide prevention advocate in India, Nelson Vinod Moses, said, “At-risk populations include the 150 million with pre-existing mental health issues, Covid-19 survivors, frontline medical workers, young people, differently-abled people, women, workers in the unorganized sector and the elderly.”
Past incident tells us that after the stock market crash of 1929, the suicide rate in the United States rose 50%; to 18.1 per 1,00,000 in 1928 from the 12.1 per 1,00,000 in 1920 and stayed at 15.4 per 1,00,000 between 1930 and 1940.
In 2008, researchers from the University of Oxford and the London School of Hygiene & Tropical Medicine noted an extra 10,000 “economic suicides” across the U.S., Canada and Europe, due to the financial crisis. These suicides were attributed to the economic hardships post-recession.
In a country like India with the highest number of poor and starved, and individuals with depression and anxiety, this pandemic is the perfect storm. In 2018, India reported 1,34,516 suicides. The World Health Organization (WHO) pegged 2016 suicides at 2,15,872, with a suicide rate of 16.5 suicides, against the global suicide rate of 10.5. History tells us that India should prepare for a large number of suicides or mental crises.
Suicides rise in India during the Covid-19 Crisis
3,32,424 is the fearsome and huge number of COVID-19 cases with 9,520 (as of 14 June, 2020) deaths being reported in India is complicating the situation.
“From two-year-olds to teenagers, anxiety and stress rise among all age groups.”
In India due to distress triggered by the nationwide lockdown. A new set of data compiled by a group of researchers revealed that 338 deaths have occurred from 19 March till 2 May and they are related to lockdown. The group comprised of public interest technologist Thejesh GN, activist Kanika Sharma and assistant professor of legal practice at Jindal Global School of Law Aman.
According to the data, due to loneliness and fear of testing positive, 80 people killed themselves. The suicides are followed by migrants dying in accidents on their way back home (51), deaths associated with withdrawal symptoms (45), and those related to starvation and financial distress (36).
Recently, many suicide incidents are making news headlines including students, famous personalities, farmers and politicians who have decided to end their life by suicide which is definitely a warning sign for India.
Countering distress during COVID-19
The coronavirus affects mental health in a dreadful manner and intensity throughout the world and also India at large. Furthermore, many psychologists across India offer counselling support during the COVID-19 lockdown round-the-clock and in many languages. Discussing uncertainty about their businesses and careers, interpersonal problems, coronavirus infection and even struggles to abstain from alcohol in many states.
Mastermind Foundation has taken this initiative to extend COVID-19 pan India free counselling service to the citizens of India. Many other organisations like the National Institute of Mental Health and Neuro Sciences (NIMHANS) and Mumbai-based Arpan are also coming forward to help people deal with mental wellbeing.
The Mental Healthcare Act, 2017 (MHCA)
- An Act that aims to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services. The Act is progressive, patient-centric, and rights-based.
- The Convention on Rights of Persons with Disabilities and its Optional Protocol was adopted on the 13 December, 2006, at United Nations Headquarters in New York and came into force on the 3 May, 2008. Once the Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities on the first day of October, 2007.
The MHCA guarantees every affected person access to mental healthcare and treatment from services run or funded by the government. It promises mental health care to all and introduced a suicide prevention policy. Countries like China have been able to significantly reduce suicides after they implemented a suicide prevention policy.
How much does India spend on mental healthcare and is it Enough?
The annual health expenditure of India is 1.15% of the gross domestic product, and the mental health budget is less than 1% of India’s total health budget. In the 2020–21 Budget, India spends only 1.6%, ₹67,489 crores, of its total estimated budget expenditure on public health. It is not only very low in comparison to the average global public health expenditure but is minuscule even in comparison to the expenditure of low-income countries.
If we look towards the other countries, the U.S. spends 17.5% of its GDP on healthcare, while Switzerland follows with a close second of 12.25%. France and Germany spend 11.45 and 11.27% respectively.
India’s investment in mental health — the last Union Budget slashed it by 20% from ₹50 crores to ₹40 crores. According to a study by the Indian Journal of Psychiatry, The conservative annual estimated cost on the government to implement the Mental Healthcare Act, 2017, would be ₹94,073 crores.
₹94,073 crores compared to the allocated ₹40 crores. It shows the lack of political will to address suicide prevention. Now it has to be seen how the government takes it forward.
Break the Silence
India’s share of the global number of suicide deaths has been rising every year because of the emotional and economic burden on our society. India will need to do a lot more to prevent the multifaceted suicide death in the society.
This is time to take proactive steps and leadership roles in suicide prevention. By spreading messages through films, making effective Mental Health Plan’s, through campaigns to raise awareness, the importance of suicide awareness and positive mental health to get it out in the open and community engagement toolkit, many lives can be saved.
“Mental health and suicide should be treated as a public health crisis that needs immediate fixing.”
States like Assam have set up toll-free centres to respond to mental health issues of quarantined and COVID-19 positive people and many states have provided access to free mental health counselling. But this should not be treated as a wave that tides over, rather an elephant in the room that everyone refuses to acknowledge.