Depression and mental health: How India can stop these silent deaths!

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Depression and mental health: How India can stop these silent deaths!

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Health has been defined by the World Health Organisation (WHO) as the "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

Hence, to promote the wellbeing of all human beings, the World Health Day is celebrated every year on April 7, marking the founding anniversary of WHO.

This day provides an opportunity for the organisation to rally action around a specific health topic of concern to people all over the world.

This year, the theme of the campaign is Depression: let's talk.

The condition has seen an alarming rise in the country, as more Indians than ever carry the burden of the illness today.

The accelerating indicators of depression in India -

Globally, the total number of people suffering from depression was estimated to exceed 300 million in 2015. This is about 4.4 per cent of the world's population. This is an 18 per cent increase between 2005 and 2015.

Untreated depression is the leading cause of more than 7,88,000 suicides that occur worldwide every year, roughly corresponding to one death in every 45 seconds.

In India, more than 58 million people (or 4.5 per cent) people suffer from depression. According to the Global Burden of Disease Study, depression became India's tenth-biggest cause of early deaths in 2015.

It moved up by two positions from twelfth in 2005.

Moreover, it is a matter of concern that it is more common among women (5.1 per cent) than men (3.6 per cent), and they are less likely to seek help or avail of treatment.

This is primarily because those suffering from depression find it difficult to come forward, and those around them find it difficult to recognise it.

Many in India still don't recognise depression as an ailment that can be treated and controlled.

According to the data, in 2016, psychiatrists wrote more than 9.4 million new prescriptions for anti-depressants. This has increased by 12 per cent from 8.4 million in 2015.

Similarly, the data provided by AIOCD Pharmasofttech AWACS, a pharmaceutical market research company, shows that the sale of these drugs has shot up by more than 30 per cent in the last four years - from Rs 760 crore in 2013 to Rs 1,093 crore in 2016.

Access to mental healthcare -

According to the National Mental Health Survey, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, it was reported that despite three out of four persons experiencing severe mental disorders, there are huge gaps in treatment.

This has been reported due to the stigma associated with mental disorders, and nearly 80 per cent of those with mental disorders had not received any treatment despite being ill for over 12 months.

The large gap in the treatment is the consequence of the poor implementation of the National Mental Health Programme (NMHP) which is largely responsible for this. The Programme was launched in 1982 by the Centre to ensure the availability and accessibility of minimum mental healthcare for all, to promote community participation to simulate self-help in the community.

The District Mental Health Programme (DMHP) which was launched under NMHP in 1996 with the objective for early detection and treatment, providing short-term training to general physicians, public awareness generation and monitoring. However, it covers merely 200 districts so far.

Moreover, there are over 443 public mental hospitals in India, but six states, mainly in the northern and eastern regions with a combined population of 56 million people, are without a single mental hospital, whereas other states have several mental hospitals. It is also noted that the NGOs that provide mental health services are also concentrated in the southern and western regions of the country.

After a national-level survey conducted in 2002, certain norms were fixed by the government, including doctor-patient ratio.

According to these norms, one psychiatrist, 1.5 clinical psychologist and two psychiatry social workers were considered per lakh population, and one nurse for a ward of 10 psychiatry beds.

However, the professional medical work force is severely scarce in India. It is about 0.3 per cent trained psychiatrists as opposed to 1 per cent requirement and 0.7 per cent clinical psychologists, when the need is for at least 1.5 per cent.

According to a Lok Sabha reply by the Minister of Health and Family Welfare in December 2015, there are about 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses nationwide.

This means there are about three psychiatrists per million people, which is 18 times fewer than the commonwealth norm of 5.6 psychiatrists per 1,00,000 people.

By these estimates, India is short of 66,200 psychiatrists. Similarly, based on the global average of 21.7 psychiatric nurses per 1,00,000 people, India needs 2,69,750 nurses.

It is also a matter of concern that the spending on the mental healthcare in India is merely 0.06 per cent of its health budget. This is less than Bangladesh (0.44 per cent).

According to a WHO report of 2011, most developed nations spend above 4 per cent of their budgets on mental-health research, infrastructure, frameworks and talent pool.

According to a study published in the Lancet, has projected that a US $147-billion investment in scaling up treatment for depression and anxiety could result in improved labour force participation and productivity worth $399 billion.

This global return on investment analysis has been based on the treatment costs and health outcomes of 36 countries between 2016 and 2030.

Therefore, a greater spending on the mental healthcare of the people is not only essential for the well-being of the people, but it will also positively impact the economy of the country.

Legislation on mental health -

The Mental Health Care Bill 2016 passed in Parliament, March 2017 decriminalises suicide and empowers the mentally-ill person to choose a mode of treatment, to refuse institutionalisation, and nominate somebody to ensure that their wishes are carried out.

Additionally, it also bans the use of degrading treatments such as shock therapy on children, and specifies that adults be subjected to them only after the administration of anaesthesia with the district medical board's consent.

The Bill also guarantees every person suffering from mental illness the right to affordable, accessible and quality mental health care and treatment from mental health services run or funded by government.

They also have the right to live with dignity and protection from cruel and inhuman treatment. With the above provisions in Bill, it is expected that the new legislation will assist in removing the stigma against depression and mental disorders from our society and would probably provide for mental health care.

The way forward -

The mental well-being of Indian citizens needs to be prioritised to meet the requirements and objectives laid down under the Mental Health Action Plan 2013-2020 of the WHO.

They have emphasised on an action plan for the world where "mental health is valued, promoted and protected. Additionally, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high quality, culturally-appropriate health and social care in a timely way to promote recovery, in order to attain the highest possible level of health and participate fully in society and at work, free from stigmatization and discrimination".

However, as it has been noted, the professional workforce for mental healthcare in India is not sufficient to address the rising demand.

Also it is a matter of concern that people aged 15-29 are highly susceptible to depression and other mental disorders, therefore, the government needs to advocate for higher awareness about mental health in schools and colleges.

In an article, Satyakant Trivedi, a psychiatrist, had recommended that it should be added to the school curriculum. As the children will be exposed to these disorders in their formative years, they will be able to seek help and speak out if subjected to depression later in their lives.

Shaibya Saldanha, co-founder of Enfold India, an NGO, also shared similar views and also emphasised on the need for better parenting during emotional crisis.

Moreover, universities and professional work environments in India still lack adequate counselling centres and well qualified trained counsellors and psychologists who can assist students and professionals at the initial stages of depression.

However, the measures to provide quality mental care help will not be possible without the adequate professionals spread evenly across the country.

Therefore, the government should first increase the budgetary spending on mental-health research, infrastructure, frameworks and talent pool to meet the global standards.

Secondly, more number of institutions and medical colleges need to be established to engage and train a greater number of psychiatrists, clinical psychologists, psychiatric social workers and psychiatric nurses, who can skilfully handle the mental health-related problems in India.

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