Mental health issues are silent killers; require serious public intervention

As the human race rises from the phoenix following the worst medical catastrophe of the century ( Covid-19) there are many wrecks spewed all around. The most visible debris scattered are millions affected by mental illness all over the earth, India included.

The mental health scenario before Covid-19 in India was no better with 1/7 mentally ill, according to the Ministry of Health in 2019, but it has become worse in the present circumstances. This is worse than the figure 1/8 for the entire world.

There has been a 17 % increase in the number of suicides between 2019 – 2021according to  National Crime Records Bureau (NCRB) data. In Mumbai alone, there has been a six time increase in deaths due to heart attacks in 2021. In 2019, it was 5849, in 2020 it was 5633 and in 2021 between January to June it was 17,880. (Source: M.C.G.M)

The most probable reason being attributed is that the emotional distress precipitated these deaths among those who had predisposing heart conditions and even others.

Multiple research reports across the world and India have demonstrated an increase in mental distress and illness with anxiety and depression being the most important culprits. 

What is the way forward ?

Following are a few proposals that can be useful !

Breaking walls , Building Bridges 

Across all disciplines there is a distinct echo that specialists and family physicians across board see a lot of patients suffering from depression and anxiety along with other physical illnesses and feel helpless in addressing them. Medical science has classified specialities based on specific organs with a definitive logic.

This is largely reductionistic in nature and the truth is that all the organs talk to each other in a complex manner and not necessarily in a linear fashion. It’s an orchestra and not multiple solo performances. Depression , heart disease and diabetes are closely related.

Cross referrals are poor between these three specialities as awareness of depression is very poor among Physicians, Cardiologists and Endocrinologists and even others.

It’s time that every patient entering a medical facility is screened for mental illness with the same vigour just as one is screened by the CISF at the airport and directed to different gates. Here screening can be done by a trained social worker. It would be so useful if Physicians and Mental health professionals work in the same cubicle.

Severe physically ill and those mentally ill will be seen separately but those with both the diseases can be seen together. This may look impossible but to contain the emotional pandemic, outlandish and seemingly impossible decisions need to be taken. 

All post graduate courses for Psychiatry and Medicine should have six months exposure with either disciplines. Students doing P.G in Psychiatry need to be exposed to community mental health for at least half a year.

This will help enhanced care and the stigma will also reduce. A similar innovation between Gynaecologists and Mental Health Professionals will work well as Depression in child bearing age and later is very high and the relationship is bidirectional. Every Resident in other branches including Surgery should have one six month tenure or a short tenure in Psychiatry.

Loneliness is a Disease and needs to be fought 

The “Social Cohesion Erosion” is the risk that has worsened globally, exclaims ‘The Global Risk Report ‘ by the World Economic Forum in  2022. In 2004 India reported 4.91 million to be lonely and living alone ( Vidhi Bubna 2020).

The centre for the study of developing societies stated in their research that 12 % of Indian youth feel depressed and 8 % lonely (CSDS 2017). In a survey across the world recently 84.2 % shared that they were worried and concerned about the world and only 15.8 % were positive and optimistic (WEF 2022). These factors have a negative impact on mental health. It is not surprising that India ranks 139 in the World Happiness Report in 2021. 

Loneliness is an adverse effect of rapid social change and globalization. ‘Disconnection’ and ‘alienation’ is bigger than HIV and COVID leading to loneliness. 

Loneliness can lead to Depression and vice versa. In India organisations as small as Community based organisations ( CBO’s) to as big as Corporates, PSU etc should help focus on ‘Reconnection’ through creative endeavours.

Majority of work places in India are hard on employees and demand long working hours here when the same groups have healthy work ethics abroad. This needs to be corrected by policy shifts. Reconnection cannot be facilitated when a large number of Indians work in long grueling ‘shifts’. This itself causes Mental distress and lifestyle diseases.

Support groups are an answer to fight alienation be it offline or online . I have conducted various support groups for those who have lost their family members in Covid and it has helped accelerate healing. In rural India this process exists in a crude form and needs to be revitalised.

The Central Govt has initiated massive programs with regards to water, cooking gas, cleanliness, beti bachao beti padao and many others. Fighting loneliness needs a political will and has to be a people’s movement across the length and breadth of India facilitated by Govts and people at large.

One example of social cohesion are states of Uttar Pradesh and Bihar where suicides have been the least across last many years. Probably despite incidents of strife the support system among the people may be better than other states. This sincerely needs to be examined for newer learnings.

UK, Japan have appointed a minister for loneliness, UAE has a minister for happiness . Germany has a ‘loneliness network ‘ to help seniors. Indian state of Madhya Pradesh has a minister for happiness.

India has formed new ministries to deal with different new issues. We need Mental Health Ministers at the Centre and the States along with commissioners in metros and districts to deal with the mental health pandemic.

Heath worker & government policies

Screening for disorders is not quantum physics. This can be easily carried out by Auxiliary Nurse Midwifery (ANMs) and ASHA workers along with other health workers. If they can do house to house screening for Malaria Dengue, Covid etc they can also screen for mental illness.

The step motherly treatment to mental health issues can be gauged by the fact that the Tuberculosis (TB) Program began in 1967, revised in 1997 and TB eradication program was launched in 2020. The detailed report of 2022 boasts of a title ‘Coming together to End TB Altogether whereas the Mental Health Policy is stuck in a traffic jam since its promulgation in 2014. 

The National Suicide Prevention policy does not exist though the state of Madhya Pradesh has made a modest beginning. More people die of suicide than TB in India.

The budgetary allocation for mental health by the Centre is interesting . The National Mental Health Program in 704 districts receives 6 % of the total Direct expenditure only (40 crore rupees ) out of 670 crores allocated. 

National Institute of Mental Health and Neuro-Sciences (NIMHANS) gets 560 crores yearly (84 %) and the Regional Institute of Mental Health receives 70 crore rupees ( 10 % ) . The National Mental Health Programme (NMHP) has under-utilised its funding whereas NIMHANS has used 100 % and more (Source: Budget for Mental Health: Indian Mental Health Observatory 2022 ) This under-utilisation points to the fact that NMHP needs to be revamped and invigorated.

Policies that affect mental health need to be aligned towards the mental health movement in the country. The National Education Policy has no mention of mental health at all for the students. Such gross errors need immediate correction.

Somehow, one feels that the policy makers and the powers have consistently given step motherly treatment to the mental health scenario in the country. There is a denial of the mammoth catastrophe and the actions taken reeks of tokenism !

The mental health of the country is one of the key variables that will decide the all-round progress of the country ! Let us join hands to herald a mental health movement!

The author is a psychiatrist in Dr L H Hiranandani Hospital, Powai

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