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Only 0.75 Psychiatrists And Psychologists Per 100,000 People: Why India Remains Behind In Healthcare

Health is a fundamental human right, a global goal, and vital to the nation’s economic growth and internal stability. Physical and mental health have a bidirectional relationship. They are not separate entities and should be looked at in unison to understand the significance of mental health. One affects another; poor physical health can lead to an increased risk of mental health issues, likewise, poor mental health conditions can negatively impact physical health.

For the well-being of a human, both of these should be in a stable condition. Mental health is the basis for emotions, thinking, learning, communication, resilience, self-esteem, well-being and maintaining relationships. We should understand that mental well-being enhances recovery in a treatment process for physical illness.

According to the WHO (World Health Organisation), mental disorders are generally characterised by a combination of abnormal thoughts, behaviours, perceptions, emotions and relationships with others; all of which result in the dysfunction of the biological, psychological, social and occupational functioning of the affected persons as well their family members. There are multiple causes for mental health issues, including genetic, social, cultural, economic, political and environmental factors.

A mental illness can affect anyone, regardless of age, gender, social status, race, religion, income and geography. It can happen at any period over the life span of a human being: from childhood, adolescence, adult to old age. Three-fourths of all mental illnesses begins by the age of 24, which takes many forms. Some are common, while some are severe.

Common mental disorders are reported very frequently, but they are often misdiagnosed. This leads to mismanagement and results in long-term disability, e.g., phobia, anxiety disorders, obsessive-compulsive disorder and depression (excluding severe depression with psychotic symptoms). Severe mental illness requires intensive and prolonged care with more significant morbidity and mortality. This includes schizophrenia, psychosis, bipolar affective disorder and severe depression with psychotic symptoms.

According to National Mental Health Survey of 2016, conducted by NIMHANS (National Institute of Mental health and Neurosciences), lifetime prevalence of any mental morbidity is 13.67; among all of them, the majority of the mental and behavioural problems were due to the use of psychoactive substances like tobacco (20.89) and alcohol (4.65), followed by depressive disorders (5.25). One in every 20 people are suffering from depression in India.

According to The Lancet Psychiatry research in 2017, 14.3 % of the Indians are suffering from some form of mental illness. National Crime Record Bureau has revealed that 1,39,123 persons committed suicide in 2019, which is 3.4% more than the previous year. The Centre for Mental Health Law and Policy Director Dr Soumitra Pathare conducted research in 2018, revealing that 1,34,000 have committed suicide, and children, youth and women were more among them.

Embracing the world’s most significant economic power, countries including America have reported that nearly one in every five adults lives with a mental illness, which makes it a total of 51.5 million individuals with a mental disorder in 2019. The latest NIMH report estimates that only half of the people with mental illnesses receive treatment.

Mental health conditions are treatable. The treatment is based upon the affected individual’s signs and symptoms, medications, psychotherapy, psychiatric social work interventions and other psychosocial treatments. A comprehensive treatment plan advised by a multidisciplinary team will enhance recovery and the well-being of the affected individual with mental illness. This is generally done at various levels:

1) Individual level (medications, lifestyle modifications, coping skills, yoga, exercise, vocational guidance etc.)

2) Family level (educating the family about the illness, family support, care and address their burden, etc.) and

3) Community-level (reducing the stigma towards mental illness and its treatment, awareness programs, enhancing the support system, public health policies, advocacy, networking, etc.) Many individuals with mental health issues continue to function in their daily life activities.

Psychiatrists, clinical psychologists, psychiatric social workers, psychiatric nurses and other mental health clinicians help individuals and families understand mental illnesses and what they can do to control or cope with symptoms to improve the individual’s health, wellness, quality of life and function. It is also crucial that family members or friends recognise the changes or problems that a person does not see in themselves and provide support, empathy and advice, or take them to a mental health professional for a consultation.

There are several blockades to access to mental health treatment — low awareness about mental illness, strong beliefs and myths. Some myths say that mental illness is a result of bad deed or black magic and that there is no cure for mental illness. Some only believe in treatment by faith healers. Since healing requires a longer duration of treatment, the wrong perception towards a person’s with mental illness as a nuisance to the public, weak, harmful and dangerous.

Stigma is the foremost hindrance towards seeking help for mental health issues. This, in turn, contributes to the non-disclosure of an individual’s mental illness. Mental illness is nothing to be ashamed of; many people with a mental condition do not want to talk or share about their condition with others. We should understand that mental illness is a medical condition just like blood pressure, diabetes or heart disease and its treatment is easily available too.

The allocation of the national budget to the healthcare system is significantly decreasing every year. In 2020, the Central government allocated 5.7% for healthcare, which was lower than the last budget and only accounted for 1% of India’s GDP. The budget allocated for mental healthcare is 0.05% of the total healthcare budget, while the average percentage of the total healthcare budget allocated to mental health in developed countries is at least 5%.

As per WHO’s Global Health Workforce Alliance, 22·8 skilled health workers per 10,000 people are required in most countries to execute all essential health interventions. India’s mental health workforce is not up to the mark. A massive shortage of mental health professionals is also one of the challenging factors in the lack of mental healthcare services in India. Our country needs 13,500 psychiatrists and 20,250 clinical psychologists, whereas only 3,800 psychiatrists and 900 clinical psychologists are currently practising mental healthcare services, according to the Ministry of Health and Family Welfare.

A recent research finding from the Indian Journal of Psychiatry has revealed that India has 0.75 psychiatrists and psychologists per 100,000 people, while the desirable number is anything above three psychiatrists per 100,000 population. The national prevalence rates for ‘all mental disorders’ arrived at are 70.5 (rural) and 73 (rural + urban) per 1,000 population. The problem is critical in villages because of the high concentration of mental health specialists in urban areas. Except for Kerala, all other states fell short of the WHO’s requirement of at least one psychiatrist for every 100,000 persons.

Based on the country’s current population, India is currently short of 27,000 doctors; the prevalence of severe mental morbidity in India ranges from three to 10 per 1,000, which is more than five times the available bed strength, and the number of beds has increased to only about 21,000. Currently, for every 10 million people with a mental illness, there are only 30 psychiatrists, 17 nurses and five psychologists. Social workers constitute 0.07 % per 100,000 population. Healthcare systems have not yet adequately responded to the burden of mental health disorders due to multiple factors like shortage of funds, inadequate resources and workforce.

The treatment gap is increasing over time due to these factors. As per the NIMHANS NMHS-2016, the treatment gap for mental disorders ranged between 70-92% for different disorders — common mental disorder (85%), severe mental disorder (73.6%), psychosis (75.5%), bipolar affective disorder (70.4%), alcohol use disorder (86.3%) and tobacco use (91.8%). In low- and middle-income countries, around 76-85% of the people with mental health disorders are not receiving treatment for their mental health disorders, as per the WHO World Mental Health Survey.

Keeping this in mind, the WHO started Mental Health Gap Action Programme (mhGAP) in 2008 to promote mental health services at all levels. NIMHANS NMHS has recommended that an estimated 150 million persons need mental health intervention and care; less than 30 million are seeking care. According to the 30th section of the Mental Healthcare Act, 2017, the government shall take all measures to create awareness about mental health and illness, reducing the stigma associated with mental illness.

However, mental health literacy is still low. India should invest in mental health awareness; it is the need of the hour as per mental health professionals. Provisions of the Mental Healthcare Act, 2017, have been neglected by many states. For example, as per section 73 of the Act, all states shall constitute a mental health review board to check the number of mental health establishments and the number of persons with mental illness in the state.

These review boards hold the responsibility to supervise the functioning of the existing mental health institutions. If any irregularities are found, they have the right to cancel the license or impose fine on the institute. Many states have not implemented these; only 19 states have set up review boards and performed the prescribed activities. According to the WHO, more than 20% of the world’s population suffers from some form of mental illness and this number is growing in number globally.

The level of anxiety, fear, isolation, emotional distress and social distancing associated with the virus has become widespread as the world fights to bring Covid-19 under control. It is evident that the Covid-19 pandemic has impacted the mental health of individuals worldwide. Therefore, this year’s theme for World Mental health Day (October 10) was ‘mental health for all’ as it came when the entire world is being hassled by the Covid-19 pandemic, which has impacted the mental health of millions of people across the globe.

Rural health problems have worsened due to existing malpractices in the healthcare sector, magico-religious practices, and unsafe and unhygienic conditions. Mental healthcare centres should initiate integrated promotive, preventive, curative and rehabilitative services for the well-being of those in need. The scenario surrounding mental health has not changed much, especially in India. There is still a lot of stigma attached to mental illnesses and the number of mental healthcare professionals in the country remains abysmal. Addressing the lack of awareness, and enhancing the accessibility, availability, affordability of resources and infrastructure associated with mental health is the need of the hour.

Healthcare centres should function as one-stop information resource stations to provide information about legal aid, welfare benefits, legislation and suicide prevention. Proper implementation of national and district mental health programmes is mandatory. The rate of stigmatisation towards mental illness is high among the rural population. The Central government has recently started a national comprehensive free mental health helpline, KIRAN (1800 599 0019), to provide counselling for various mental health issues in 13 languages.

It is vital to initiate the Taluka-level Mental Health Programme (TMHP) across the country with adequate human resources including psychiatrists, psychologists and psychiatric social workers to deliver mental health services in rural areas. The TMHP can be helpful in enhancing the accessibility, availability and affordability of the rural people, too. It is vital to conduct awareness programmes about mental well-being and reduce stigma in the community.

It is vital to ensure mental health access to some vulnerable sections of the population, including children, women, older adults and persons with disabilities. Sensitising different stakeholders associated with the issue of mental health is essential. It is also essential to conduct awareness programmes, workshops and camps at schools, colleges, workplaces and communities using various communication modes such as television, social media, radio and print media about mental health.

New and innovative ways of approaching the cause should be incorporated to promote mental health awareness in the community. Celebrities from various fields should come forward to promote awareness about mental health. Inclusion of the curriculum about the basics of mental health in academics will help children be aware of their own well-being and maintain a healthy emotional outlook in life.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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