In the patriarchal society of India most of the mental problems are either hidden between the four walls of the room or pretended to not have as in India it’s a social stigma. It’s time they need to be recognized and accepted by individuals themselves. It is not their differences that divide us. It is our inability to recognize, accept, and celebrate those differences. Having a mental disorder isn’t easy, and it’s even harder when people assume you can just get over it.
When put together these mental health disorders account for 15% of the total global burden of diseases. It won’t be an exaggeration to state that India indeed is staring at a mental health epidemic. When it comes to countries, India is the most depressed country in the world, according to the World Health Organisation, followed by China and the USA. India, China and the US are the most affected countries by anxiety, schizophrenia and bipolar disorder, according to WHO. A recent study reported in WHO, conducted for the NCMH (National Care Of Medical Health), states that at least 6.5 per cent of the Indian population suffers from some form of the serious mental disorder, with no discernible rural-urban differences as of 2018. Though there are effective measures and treatments, there is an extreme shortage of mental health workers like psychologists, psychiatrists, and doctors. As reported latest in 2014, it was as low as ”one in 100,000 people”. The average suicide rate in India is 10.9 for every lakh people and the majority of people who commit suicide are below 44 years of age. The numbers are very sad for India, where help does not come easy. Suicide is one of the biggest causes of deaths in the age group of 15-24. The report also threw light on another disturbing fact. Almost 80% people diagnosed with mental sickness do not seek any kind of treatment and there are 150 million more who need access to therapy and this is projected to increase by 20% by 2020. Interventions in the form of medicine, psychological and social help, can make a huge difference.
In April 2018, a study titled How India Perceives Mental Health across eight cities with 3,556 respondents provides an insight. It revealed that although 87% of the respondents were aware of mental illnesses, 71% used terms associated with stigma – “stupid”, “mad”, “crazy” and even “retard” – to describe mental illnesses.
One of the biggest reasons for depression today is the pressure to live up to the expectations of society, peers and social media followers. Success and acceptance have become paramount, often at the cost of one’s mental well-being. Earlier people could unwind in a communal social setting such as the joint family, the local barber, the coffee house adda, or common interest groups. With work pressure and long working hours, parents often find it difficult to engage adequately with children. The National Mental Health Survey 2015-16 published by the National Institute of Mental Health and Neurosciences, Bengaluru, estimated that nearly one in seven teenagers growing up in India’s metros could be suffering from mental health disorders. Currently 300 million cases have been reported in the world about depression particularly. However, it’s a known fact that a lot of it is not reported which is even more than 300 million probably. Worryingly, the age profile of mental health patients is getting younger. With work pressure and long working hours, parents often find it difficult to engage adequately with children. The National Mental Health Survey 2015-16 published by the National Institute of Mental Health and Neurosciences, Bengaluru, estimated that nearly one in seven teenagers growing up in India’s metros could be suffering from mental health disorders.
Another reason for depression, in a country with one of the highest smartphone and Internet penetrations in the world, is social isolation. Unlike interpersonal bonding that makes it more difficult to mask emotions, online interactions are often transient, leading to withdrawal. Even as technology is seen as a trigger for mental health problems, it can also prove to be a cost-effective solution for crisis intervention. Most present-day psychiatrists have some form of telephone counselling or virtual chat apps to reach out to those who need help.
Depression forces the body and the brain into a death trap.These stages have also been compared to severe forms of trauma and can be difficult to recover from. When the brain, pushed into extreme negativity declines its functioning power. Usually, the brain is equipped of handling stressful situations by releasing a high level of dopamine which pushes a person back to normal. When extreme depression hits the part of the brain which controls emotions and motivation, dopamine production goes for a toss making it hard for the body to process negativity. If left un diagnosed and untreated, depression can cause many problems, especially in adolescent cases. The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults. There’s no easy cure for depression but support and therapy is one of the most effective cures for depression. Often confused with sadness and pessimism, it is easy to mistake this mental disorder for just a “low point” in life. People experiencing depression can undergo intense emotions of anxiety, hopelessness, negativity and helplessness. Loved ones, caring for someone with depression, should get alert if they notice signs of severe depression, such as alcohol or drug abuse, sleep disturbance, thoughts of death or suicide or suicide attempts.
People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiety or panic, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if the person’s response is not appropriate for the situation, if the person cannot control the response, or if the anxiety interferes with normal functioning. Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias.
Mood disorders involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, bipolar disorder, and cyclothymic disorder.
Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations — the experience of images or sounds that are not real, such as hearing voices — and delusions, which are false fixed beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder.
Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the most common eating disorders.
People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Alcohol and drug are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships.
People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. In addition, the person’s patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the person’s normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder, and paranoid personality disorder.
People with Obsessive Compulsion Disorders are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands.
Post-traumatic stress disorder is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event, and tend to be emotionally numb.
Stress response syndromes occur when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stress-or may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job, or a problem with substance abuse. Stress response syndromes usually begin within three months of the event or situation and ends within six months after the stress-or stops or is eliminated.
People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents, or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or “split personality,” and de-personalization disorder are examples of dissociative disorders.
Factitious disorders are conditions in which a person knowingly and intentionally creates or complains of physical and/or emotional symptoms in order to place the individual in the role of a patient or a person in need of help.
A person with a somatic symptom disorder, formerly known as a psychosomatic disorder or somatoform disorder, experiences physical symptoms of an illness or of pain with an excessive and disproportionate level of distress, regardless of whether or not a doctor can find a medical cause for the symptoms.
People with tic disorders make sounds or display non purposeful body movements that are repeated, quick, sudden, and/or uncontrollable. (Sounds that are made involuntarily are called vocal tics.) Tourette’s syndrome is an example of a tic disorder.
When mental illness is present, the potential for crisis is never far from mind. Crisis episodes related to mental illness can feel incredibly overwhelming. There’s the initial shock, followed by a flood of questions—the most prominent of which is: “What can we do?” Like any other health crisis, it’s important to address a mental health emergency quickly and effectively. With mental health conditions, crises can be difficult to predict because, often, there are no warning signs. Crises can occur even when treatment plans have been followed and mental health professionals are involved. Unfortunately, unpredictability is the nature of mental illness. It’s time for India to utilize and empower it’s Emergency departments, Law enforcement officials, primary care physicians, court clerks where involuntary commitment processes are initiated.
Lack of awareness about the issue, the stigma associated with it, lack of trained professionals, inadequate funding and the low priority given in the healthcare budget are the reasons why people coping with mental health issues fail to receive the adequate amount of timely treatment. If merely making policies would have helped people, the issue of mental health would have been solved long ago.
More than 80% of people do not seek any professional help in India. Talk to anyone you know who has been through this and you’ll hear stories about shame, suffering, discrimination, and stigma.
There is a shortage of mental healthcare workers in India. According to the World Health Organisation, in 2011, there were 0·301 psychiatrists and 0·047 psychologists for every 100,000 patients suffering from a mental health disorder in India. A community-based solution inspired by Asha workers model can be adapted to serve the mentally ill population efficiently. Also, more and more professionals should be trained in this field to decrease the ever increasing gap.
According to the Human Right Watch, only 0.06 per cent of India’s health budget is devoted to mental health and available data suggests that state spending in this regard is abysmal.
People suffering from any kind of mental health issue are considered ‘lunatics’ by the people due to the lack of awareness, ignorance and blatant apathy. This leads to a vicious cycle of shame, suffering and not to mention, isolation of the patient. To end the stigma, there is a need to empower the people suffering from various mental health issue.
Steps should be taken to train and sensitize the community/society to deliver immediate mental healthcare intervention to the patients. Although the mechanics of the funding are yet to be spelled out, a public-private partnership between mental health professionals in the government and private hospitals to train physicians at the village and block level through video conferencing — to identify and provide basic treatment and drugs for depression and anxiety — could be the way out.
But not much has been done in the mental health sector by the government. A mental health act was first introduced by the British government in the year 1912 called lunary act. In India, the Mental Health Act was passed on 22 May 1987. The law was described in its opening paragraph as an act to consolidate and amend the law relating to the treatment and care of mentally ill persons, to make better provision with respect to their property and affairs and for matters connected therewith or incidental thereto. The Act superseded the previously existing national law governing the mental health issues, the Indian Lunacy Act of 1912. The Mental Health Care Act was passed on 7 April 2017, superseding this 1987 Act and was described in its opening paragraph as an act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfill the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto. It was passed by Rajya Sabha on 27th March 2017 and Loksabha on 30th March 2017. It was then commenced on 7th July 2018. It was first introduced by Ghulam Nabi Azad on 19th August 2013.
As per the information furnished by the Ministry of Health and Family Welfare the Mental Health Care Bill, 2013 seeked to consolidate the legislation s related to mental illness and improve the conditions in mental health facilities existing in the country while ensuring the process of appeal by a person admitted to a psychiatry institution, rehabilitation, reintegration with families and community in non-medical settings.The Bill addressed the issues of mental illness and capacity to make mental health care and treatment decisions; advance directive; nominated representative; rights of persons with mental illness; duties of appropriate government; central and state mental health authorities; mental health establishments; mental health review commission; admission, treatment and discharge. The Bill also consolidates the law regarding the responsibilities of other agencies, restriction to discharge functions by professionals not covered by professional offences and penalties. illness and promote their access to mental health care in the country. In the light of
above it was proposed to repeal the Mental Health Act (MHA), 1987 and bring in a new legislation.
The Statement of Objects and Reasons (SOR) of the Bill further stated that the Bill proposes to repeal the Mental Health Act, 1987.
Its objectives were to:
(i)protect and promote rights of the persons with mental illness during the delivery of health care in institutions and in the community;
(ii) ensure that health care, treatment and rehabilitation of the persons with mental illness, is provided in the least restrictive environment possible, and in a manner that does not intrude on their rights and dignity;
(iii) fulfill the obligations under the Constitution and the obligations under various International Conventions ratified by India;
(iv) regulate public and private mental health sectors within a rights framework to achieve the greatest public health good;
(v) improve accessibility to mental health care by mandating sufficient provision of quality public mental health services and non-discrimination in health insurance;
(vi) establish a mental health system integrated into all levels of general health care; and
(vii) promote principles of equity, efficiency and active participation of all stakeholders in decision making. It stated that mental illness be determined “in accordance with nationally and internationally accepted medical standards (including the latest edition of the International Classification of Disease of the World Health Organisation) as may be notified by the Central Government.”
Additionally, the Act asserted that no person or authority shall classify an individual as a person with mental illness unless in directly in relation with treatment of the illness. The act effectively decriminalized attempted suicide which was punishable under Section 309 of the Indian Penal Code. The Act seeked to fulfill India’s international obligation pursuant to the Convention on Rights of Persons with Disabilities and its Optional Protocol. It looked to empower persons suffering from mental illness, thus marking a departure from the Mental Health Act 1987. The 2017 Act recognizes the agency of people with mental illness, allowing them to make decisions regarding their health, given that they have the appropriate knowledge to do so. The Act aimed to safeguard the rights of the people with mental illness, along with access to healthcare and treatment without discrimination from the government. Additionally, insurers are now bound to make provisions for medical insurance for the treatment of mental illness on the same basis as is available for the treatment of physical ailments. The Mental Health Care Act 2017 included provisions for the registration of mental health related institutions and for the regulation of the sector. These measures include the necessity of setting up mental health establishments across the country to ensure that no person with mental illness will have to travel far for treatment, as well as the creation of a mental health review board which will act as a regulatory body. The Act restricted the usage of Electro convulsive therapy (ECT) to be used only in cases of emergency, and along with muscle relaxants and anesthesia. Further, ECT has additionally been prohibited to be used as viable therapy for minors.The responsibilities of other agencies such as the police with respect to people with mental illness was outlined in the 2017 Act. The Mental Health Care Act 2017 had additionally vouched to tackle stigma of mental illness, and has outlined some measures on how to achieve the same. However there is a lot left to be done.
So what difference is this act creating? None because the history of India’s interaction with victims of mental health disorders and governance has lost the common man’s faith perhaps has embarrassed the ideology of 1.3 billions.
There is a desperate need for mental health literacy. An ecosystem of care, empathy and inclusion requires involvement of politicians, celebrities, activists, scholars and citizens. Only then can we change the way we address mental illnesses. The conversation must start.
As a society we must now collectively stand by the survivors of mental health illnesses and empower them instead of neglecting them by culture proxy as a substance of arrogance. What’s culture? Culture is to respect the ethos of different community,to respect indifference, to be united in diversity & have love for all. At least that’s what Indian culture must be if it wishes to be notable example of a development in the 21st century. We cannot continue to eradicate our mental health illness citizens any longer. We have them respect which we give to other normal people of this nation.
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