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Pandemic is a wake-up call to build India’s mental healthcare infrastructure

India has been dubbed by the World Health Organisation (WHO) as the most depressed country in the world. The numbers themselves are pretty frightening,  writes Dr. Lovleen Malhotra for South Asia Monitor

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The deadly coronavirus has once again reminded us of the need to reset our healthcare systems and policies and scale up our healthcare infrastructure in a major way. From increasing the doctor-patient ratio to improving accessibility of healthcare and intensive care facilities, the pandemic has in many ways served as a wake-up call. However, amidst all this animated talk about the imperative of overhauling our physical health systems, there have been relatively muted conversations around mental health.

The lockdown, the economic downturn, a slew of job losses and the threat of the disease have combined to impact the mental health well-being of the population. Increasing incidence of anxiety, depression, domestic violence, and suicidal tendencies are being reported by mental health experts. COVID-19 crisis has therefore also uncovered the stark deficit of mental healthcare infrastructure in India, something we must wake up to.

India - the most depressed country in the world

India has been dubbed by the World Health Organisation (WHO) as the most depressed country in the world. The numbers themselves are pretty frightening. More than 90 million Indians constituting 7.5 percent of the country’s population are dealing with some kind of mental disorder. One in seven Indians were afflicted with mental illness in 2017 with depression and anxiety disorders being most pervasive, based on research conducted by Indian Council of Medical Research (ICMR) and published in the esteemed journal The Lancet Psychiatry. The same research also revealed that the prevalence of the mental disorder in India had doubled between 1990 and 2017 compounding the ‘health overload’ of our systems. Another survey conducted by National Institute of Mental Health and Neuro-Sciences (NIMHANS) found that about 150 million Indians required active intervention but less than 30 million were actually accessing help and treatment. The average suicide rate in India is 10.9 for every lakh people with the majority of those taking the extreme step being below 44 years of age.

Shortage of mental health professionals

Against such a depressing state of affairs, the number of health professionals in the country is abysmal. India has about one psychiatrist for about two lakh people against the prescribed ratio of about 1:8000-10,000. Against the demand for about 20,000 clinical psychologists, there are only about one thousand. Similarly, the number of psychiatric social workers and nurses is paltry.    

COVID-19, the resultant lockdowns, as well as the devastating economic impact, have uncovered a mental health crisis in the country. With the threat of the disease, job losses and uncertainty clouding every aspect of our lives, the mental health of many people have taken a hit. A study in Gujarat showed that cases of panic attacks have increased 44 percent while depression increased 27 percent during the lockdown. Data from counseling firms analyzed by a leading business newspaper found a 35-40 percent increase in the number of cases of stress and panic attacks in April in India. The loss of jobs for millions of Indians on account of coronavirus would have the country sitting on a mental health tinderbox. There are reports and indications that an overwhelming 130 million Indians are likely to lose their jobs with 40 percent of them being blue-collar, thanks to the virus. 

A mindboggling 42.5 percent of the employees in India’s corporate world already suffer from depression or an anxiety disorder, according to a study conducted by a British charity organisation in 2019. India’s economic losses owing to mental health conditions would amount to a whopping 1.03 trillion dollars between 2012 and 2030, based on a WHO estimate.

Road ahead

So, how should our government, health policymakers, and other related stakeholders respond to the crisis? 

Firstly, the authorities should launch a massive country-wide sensitisation and awareness campaign in order to educate people and remove the social stigma attached to any mental health condition. Just like Swachh Bharat Abhiyan (Clean India Mission), taking the help of both traditional and digital media, an extensive and sustained movement on the need to also pay heed to our mental health must be launched immediately.

Secondly, with every rupee that is spent on public health, at least 30-40 percent of it must be dedicated to building infrastructure and services for mental health patients. In the long run, a mentally healthy India would automatically reduce our healthcare expenditure considerably. It could also be taken as a preventive health strategy. A related measure would be to raise public investment in mental health research in the country. Suitable public-private partnership (PPP) models must be worked out.

Thirdly, health is a state subject. And therefore, state governments must come forward with their own budgets and plans in this regard.

Fourthly, in view of a severe shortage of trained psychiatrists, counselors, and mental health professionals, the pursuit of psychology – in particular health psychology – as a discipline in schools and colleges and as a career prospect, must be encouraged by the government and educationists. Fresh curricula and courses must be designed taking inspiration from course structures and subjects related to mental health from advanced countries.        

The need to de-stigmatise mental disorders, emotional disorders, general unhealthy and unwanted feelings, and suicidal thoughts is also very important.  

One of the main things, people should take away from this article is that employment matters but not more than our mental health. It matters for our economic livelihood. The financial uncertainty caused by the coronavirus pandemic, coupled with the pervasive sense of isolation exacerbated by stay-at-home orders, make this moment unprecedented - different from any other economic the downturn in recent history - and thus, potentially difficult to model based on past.

It’s useful to have a wake-up call on mental illness. Unemployment is going to have a very important impact on deaths related to suicide. We should see building up community-based mental health care services as a way to serve more people in need. All in all, if we take care of the mental health part, to a great extent, India’s physical health will take care of itself.

(The writer is a psychologist and medical counsellor in the Department of Aakash Healthcare Super Speciality Hospital, Dwarka, New Delhi. The views expressed are personal.)

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