Mental Health


Decriminalising suicide attempt is the first and righteous step in inclusive mental health care in India maybe, but there still remains an awful lot of work to complete before the State and Society can rest easy. Mental Health care being a neglected sphere of engagement in public health administration the world over, the World Health Organisation misses no opportunity to reiterate the need for mental health. According to new estimates of WHO, the number of people living with depression increased by more than 18% between 2005 and 2015 ( says a Press Release by the World Health Organization dated 23rd February 2017. A lot remains to be done for inclusive mental health care in emerging economies: Seasoned mental health care professionals agree that there is a need for serious discourse to put mental health on the agenda of public health administration. One in four people in the world will be affected by mental or neurological disorders at some point in their lives. Treatments are available, but nearly two-thirds of people with a known mental disorder never seek help from a health professional.

Depressive disorders are already the fourth leading cause of the global disease burden. They are expected to rank second by 2020, behind ischaemic heart disease but ahead of all other diseases. Currently, more than 33% of countries allocate less than 1% of their total health budgets to mental health, with another 33% spending just 1% of their budgets on mental health. By the most conservative estimates, at least 5% of the population lives with a mental illness, which translates to over 50 million people.

A limited range of medicines is sufficient to treat the majority of mental disorders. About 25% of countries, however, do not have the three most commonly prescribed drugs used to treat schizophrenia, depression and epilepsy at the primary health care level. There is only one psychiatrist per 100 000 people in over half the countries in the world, and 40% of countries have less than one hospital bed reserved for mental disorders per 10 000 people.

More than 350 million people across the world – of all ages and from all communities – suffer from depression says a WHO estimate. In India approximately 70 million people are in need of mental health care but the number of trained and qualified psychiatrists is a woefully inadequate @ 11500. “There are more Indian psychiatrists in the US and the UK than in India,” concede psychiatrists in India.

While counselling centres have mushroomed across urban India there is a lack of standardisation in professional practise. It seems there is an unfortunate and even opportunistic emphasis on commercialisation in these unregulated counselling centres underscoring the need for a government body to license or accredit counsellors and therapists in the mental health field. Most of the support groups and group therapies are conducted by people who are not trained counsellors. There is an urgent need for proper IEC, i.e. information, education, and communication about the mental illness among the masses - rural and urban areas alike.

More support groups facilitated by trained counsellors and psychologists for various topics like addiction, grief, social anxiety etc are needed - the counsellors agree, nevertheless. Counselling has to be made available to parents in educational institutes as well. In fact counselling has to be made mandatory for parents whose children are lagging in studies or are in need of special attention for other reasons. Providing family therapy for these cases as well should be part of the Education goal and sensitive, responsive Public Administration.

Having a mental health hotline for every area – like a 911 / 112 can prevent violent crimes triggered by mental health issues – be it Post Traumatic Stress Disorder, domestic abuse or suicide… A Hotline can prevent suicides and violent crime with timely, professional intervention when there is a dedicated ambulance service and related infrastructure. Insurance cover for mental illness cannot come too soon. There is a need for a mental health care ambulance service. The need for better rehab facilities for various addictions in Taluqs or lowest rungs of public administration across the 600 odd districts in India needs to be underscored, because it will go a very long way in socio economic stability of a transitionary society, aver therapists. Family therapy has to be made more affordable, calling for subsidies and insurance coverage for mental health issues.

During a four-and-a-half-year-long MBBS course, only two weeks of clinical postings are dedicated to psychiatry. Psychiatry courses are also not considered lucrative enough by state governments.

Similarly there is a need for participation of mental health care professionals in progressive, inclusive and sensitive education. Topics like sexuality and suicide prevention have to be introduced for discussion in our education system. Counselling and therapy should be made compulsory in schools, colleges and companies with legislative backing - many institutions are still not following this rule in India. Institutions should be held accountable if they do not provide this. Hotlines available for schools and colleges can heal future generations.

Mental health care patients need livelihood security and to this end, legislation is necessary. The need for de-stigmatising mental health and to “accept hiring people with a history of mental disorder” will go a long way in destigmatising mental health care. Provision of sick leaves not only for physiological illness but also for many mental health issues will signal inclusive and progressive mental health care.

Reducing the wage gap for young counsellors as compared to their counterparts working in formal sectors like the IT industries for instance will encourage more people to take up work in mental health care sector.

Pre-adoption and pre-nuptial counselling are other areas that can stabilise the society to a large extent.

There is a dire need – aver counsellors – to relook anti dowry legislation in India, for some parts of it are considered draconian. The misuse of the dowry legislation by women causes immense emotional setback to families… and leads to tragic fallouts ruining the social fabric of whole communities – if you take into account the stigma attached to the accused.

More films, ads and print media campaigns have to be supported by the Chambers of Industry and commerce to create awareness and importance of mental health issues. Mental health camps should be organised in remote areas like Taluqs in all districts of India. It is possible to conduct interactive sessions with the infrastructure to be provided by Zilla Parishat chiefs (district administration officials). The positive impact of counsellors ready to interact with villagers online through the good offices of Zilla Parishat offices will make a significant difference in the hinterland. India has the infrastructure and capabilities for such path breaking initiatives. Infact Internet technology makes possible such interventions world over. Doctors, physiotherapists, chiropractors, nutritionists, teachers, etc have to be sensitised to the various mental health issues so that they may refer patients / students to go see a therapist / psychiatrist as soon as they sense a need.

More counsellors have to be trained to support specific needs of the LGBTQ community, people with disabilities, people suffering from STDs, sex workers, people suffering from terminal illnesses, elderly and also caregivers of the victims are in need of counselling and psychiatric interventions.

Awareness campaigns and training by mental health professional and psychiatric social workers on topics like AIDS, substance and sexual abuse, etc will make the difference between life and death for people prone to suicide and violent crimes associated with abuse. Thus the role of the Media is critical in such discourse.