“You’re either fine or you’re insane”. “Mental disorder is a symptom of weakness”. “People with mental disorders are violent”. “You can prevent mental health disorders”. “People with mental disorders cannot handle everyday responsibilities”.
This is what people with mental disorders regularly hear, which is why I want to tell you more about this issue. At the same time, I want people reading this to ask questions: do we have enough resources to take care of persons with mental disorders or do we further aggravate the effects of mental disorders through our behaviour and social conditioning?
To write this article, I looked up many different studies. One of them estimated that one in seven Indians are affected by mental disorders of varying severity, with depression and anxiety being the most common ones. Once I ran through the number, I was astonished to look at things in perspective, as that’s more than 19 crore people in India.
The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. This figure includes 4.57 crore people with depressive disorders and 4.49 crore people with anxiety disorders.
Although there are effective measures and treatments, there does seem to be an extreme shortage of mental health workers like psychiatrists, psychologists and doctors. As reported in 2014, it was as low as “one in 1,00,000 people”. This means that, on average, for every 13,387 persons affected by mental disorders, only one doctor is qualified to deal with them effectively.
And while these numbers do seem alarming to the naked eye, it is worth mentioning that the World Health Organization (WHO), in 2017, labelled India as the world’s “most depressing country”.
According to the WHO, mental disorders comprise a broad range of problems with different symptoms. However, they are generally characterised by some combination of abnormal thoughts, emotions, behaviour and relationships with others. There are many different mental disorders with different presentations. These include:
Depression: characterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness, and poor concentration.
Bipolar disorder: which typically consists of both manic and depressive episodes separated by periods of normal mood.
Schizophrenia and other psychoses: characterised by distortions in thinking, perception, emotions, language, sense of self and behaviour dementia, in which there is deterioration in cognitive function (ability to process thought) beyond what might be expected from normal ageing.
Development disorders: which is an umbrella term covering intellectual disability and pervasive developmental disorders, including autism. These are characterised by impairment of skills across multiple developmental areas such as cognitive functioning and adaptive behaviour.
Mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions and community support. Other contributing factors include stress, genetics, nutrition, perinatal infections and exposure to environmental hazards.
The health systems have not yet adequately responded to the needs of people with mental disorders. Consequently, the gap between the need for treatment and its provision is wide not only in India but all over the world. In low and middle-income countries, between 76%–85% of people with mental disorders receive no treatment for their disorder.
A further compounding problem is the poor quality of care for many of those who do receive treatment. Also, to support health-care services, people with mental illness require social support and care. They often need help in accessing educational programmes that fit their needs and find employment and housing that enable them to live and be active in their local communities.
To provide the necessary assistance to persons with mental disorders, The Mental Health Care Bill 2013 was introduced to the Rajya Sabha in August 2013. Following 134 official amendments, it was finally passed in August 2016. The legislation aimed “to provide for mental health care and services for persons with mental illnesses and protect, promote and fulfil the rights of such persons during delivery of mental health care and services and for matters connected therewith or incidental thereto”.
The twin emphasis on providing care and promoting rights is critically important in India, as it is elsewhere. Therefore, this initiative is an exceptionally important one with real potential to improve the position of the mentally ill and enhance their experiences of good mental health, social justice, and liberty.
There is still a long way to go regarding normalising mental disorders; considering the ignorance in India, it won’t be easy. It is important to accept mental disorders as something that may or may not be a part of life and not let them rule your life through fear. It is up to us to create an environment where people feel safe to open up.
This article is written by JAF volunteer coordinator Yash Khandai, who is a student of Delhi University (DU). You can reach the Convenor of JAF Shameer Rishad on Twitter.