The Reality of Mental Illness is Bigger Than a First-World Problem

May is the month of Mental Health.

[Women with perceived or actual psychosocial disabilities slept on the floor in the women’s ward of Thane Mental Hospital in the suburbs of Mumbai. | Photo Source: Wall Street Journal]

Myth: Mental illness is a first-world problem and, therefore, not present in India.
Debunked: According to a recent report in The Lancet launching the China-India Mental Health Alliance, in 2013, 31 million years of healthy life were lost to mental illness in India. By 2025, an estimated 38.1 million years of healthy life will be lost to mental illness in the country—a 23 percent increase.

Often labeled illusory or even a luxury concern, mental illnesses affect the global community. India is no exception, yet only about one in 10 Indians with mental health disorders receive evidence-based treatment. It is not that India’s people ‘don’t have time for mental illnesses,’ as per popular ‘third-world’ lens belief, but rather that the majority of those affected go undiagnosed and/or untreated due to inadequate healthcare, unawareness, and social stigmas. With a total population of over 2.5 billion, China and India make up 38 percent of the world population. The aim of the China-India Mental Health Alliance is to identify evidence-based solutions to their shared problems, which will be presented in three papers releasing over the coming year.

Based on an analysis of the Global Burden of Disease (2013), substance use disorders have been more common in men than woman—with drug dependence disorders more than twice as high for men than women and alcohol disorders nearly seven times higher for men than women. India contributes to 15 percent of the global mental, neurological, and substance use disorder burden. Changes in disability-adjusted life years (DALYs) for all mental, neurological, and substance use disorders—reflecting years of healthy life lost due to morbidity and mortality—are expected to increase more sharply in India than in China. For example, by 2025, the number of healthy years lost to dementia in India is projected to increase by 82 percent to 3.2 million.

As Dr. Vikram Patel, from the Public Health Foundation of India and co-founder and former director of the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine, has underscored that most people with mental disorders in India and China do not receive needed mental health treatment. There are merely 0-3 psychiatrists per 100,000 people in India. Although India’s District Mental Health Programme (DMHP) covers 200 districts, programmatic services waiver across states due to restricted funding, human resource shortages, and low motivation among service providers reduce the effectiveness of services. Inability to access mental help is another challenge, as up to 40 percent of patients must travel more than 10 kilometers to access DMHP services. Moreover, six states, mainly in the northern and eastern regions of India with a combined population of 56 million people, lack a single mental hospital.

In this regard, China has achieved greater progress in national mental health care coverage relative to India. Resulting in its investments to expand mental health services since 2000, China largely outperforms India on mental health resources, with eight times more mental hospital beds per person. After all, India’s proportion of its total health budget allocated to mental health remains low. In 2012-2013, only 1.3 percent of the Ministry of Health and Family Welfare expenditure was spent on the National Mental Health Programme.
But calculated facts aside, the face of India’s mental health that must also and equally be unmasked is that for its girls. Nearly 50 percent more Indian girls between 15 and 20 years of age have died due to self-harm, compared to boys of the same age group. According to the 2011 Census, there are fewer females in the country than males—due to various acts of gender-based discrimination—yet still, in 2013, the overall number of deaths among girls and women between 10 and 25 years of age due to self-harm was about 8 percent more than the number of deaths among similarly-aged males.

The most important factor in cases of girls committing suicide is “the denial to exercise their autonomy,” Patel said. “Many youth suicides are impulsive and emotional…The brains are not as well developed and they can do something that is lethal.”

Vandana Gopikumar, who runs The Banyan—a Chennai-based non-profit working with mentally challenged people—has further stated: “When a girl is 15 and is growing up, they are exposed to the limited resources as compared to boys. They feel a sense of rejection. There is also a strong correlation between domestic violence and alcoholism. When this cycle comes alive, it clearly influences the growing child’s mind.”

Dr. K John Vijay Sagar, from the Child and Adolescent Psychiatry Department at the National Institute of Mental Health and Neurosciences, advocates for children to be taught behavioural coping mechanisms as part of school curricula. Girls must be given the freedom to have a voice—in their academic pursuits, career choices, and peer relationships.

Authors of The Lancet’s papers have called for a holistic approach to providing more accessible, affordable, and acceptable mental health care in India and China. Action items include greater community engagement, increased support for community health workers, and collaboration among traditional and alternative medicine practitioners. India, however, necessitates large-scale policy-level changes to ensure sustainability—not only in funding structure, for state accountability, and encouraging services for adolescents, but also in initiating a deeper discourse on the sociocultural determinants of mental health.