MENTAL HEALTH IS EVERYONE’S BUSINESS
Mental health problems are amongst the most important contributors to the global burden of disease and disability. Mental and neurological conditions account for 12.3% of disability adjusted years lost globally and 31% of all years lived with disability at all ages and in both sexes. In a sharp contrast to the magnitude of the issue, less than quarter of the people requiring mental health care receive necessary services in both Low and Medium Income Countries (LMICs) and High Income Countries (HICs). Mental health receives only 1% of funding from national health budgets around the world.
In India about 65-70 million people appear to be in need of mental health care. The availability and access to appropriate services, social stigma and community resistance prevent people from seeking help. Mental ill health eventually leads to poverty, homelessness and isolation. According to WHO, persons with disabilities are among the poorest and most marginalised.
The mental health-poverty nexus
For those with mental illness that do not have access to care, poverty and homelessness are a reality. A number of reasons give rise to the mental health - poverty nexus:
- A relative with mental illness means an extra mouth to feed for families already burdened by the effects of poverty.
- A lack of education means that many do not understand mental illness and therefore do not know when, where or how to seek help.
- Ignorance and misconceptions lead to a lack of acceptance within communities and discrimination from society and employment.
- A lack of options mean that many of the mentally ill in India are left redundant at home, unstimulated and misunderstood, sometimes facing emotional and physical abuse from those that are caring for them; with this background it is no wonder that many wander away from home.
Where are we today?
In India and other Low and Middle Income Countries, there is no organised approach to comprehensively address mental health care issues in a sustainable and cost effective manner. Poor public health infrastructure hinder the development of community based interventions. The District Mental Health Programme (DMHP) in India has remained largely inadequate; it is only implemented in the form of overburdened and isolated camps dispensing medication. As a result there is an overwhelming bias towards state tertiary care services that carry the legacy of asylums from the colonial era.
Less than 1% of the budget in India is allocated for mental health, with an overwhelming bias towards state tertiary care services that more often than not carry the legacy of asylums from the colonial era. An overwhelming 38% of beds in these state mental health hospitals, intended for acute care, are occupied by people who are living for over a year or more. This paucity in availability, affordability and quality of services, is further conflated by stigma, incongruence of services with prevailing sociocultural norms and socio-economic structural barriers may be persistent deterrents to addressing mental health.
The discourse around mental hospitals has been dominated by the deinstitutionalization movement. However, in India and other LMICs, owing to the endemic structural barriers, and poor support systems, mental hospitals serve a unique purpose. In this regard, it becomes critical to change the service paradigms and social architecture of these institutions (reduce bed strength, facilitate individualised and collaborative care, initiate peer audits), and inculcate values of user-centricity, responsiveness, and transparency into the care paradigm. The creation of a spectrum of care services, with the ability to respond to a client’s evolving needs is paramount.
Towards a pragmatic approach to mental health
Evidence of social determinants affecting mental health exists in plenty –homelessness, poverty and insufficient support systems, gender/age/caste discrimination etc., expose individuals to adverse experiences that can trigger mental health issues and the possibility of recovery. Work participation, quality of family relationships and community linkages, have proved to play an important role in the quality of mental health outcomes. Hence there is a critical need to cultivate multi-dimensional and multi-pronged approaches to address these issues at the individual, family and community levels.
There are very few qualified professionals available to offer mental health services. Data from a 2002 nationwide survey India shows only 2 psychiatrists, 1.5 clinical psychologists and 2 psychiatric social workers per 100,000 population. Even these resources fail as they often follow outdated approaches and rely exclusively on a biomedical construct of mental health without taking into consideration the complex social realities and social perceptions of mental illness.
National and International Milestones
Thus the urgent need to view mental ill health within broader frameworks of care that focus on promotion of wellbeing, social justice, equity and rights – the development paradigm. National and international organisations taking cognisance of this urgent need to initiate and reform mental health systems have strongly advocated for the integration of mental health into the Sustainable Development Goals 2020 (SDGs), reiterating its importance in the health and development discourse. The World Health Organisation (WHO) has underlined the need to focus on human resource development as a key strategy in pursuing this larger vision. The Government of India has introduced the Mental Health Policy and encourages the convergence of health and social sectors and public-private partnerships to develop inclusive and impactful programmes.
In this context, three critical issues need to be addressed for sectoral change in mental health:
- Development of human resources and capacities that focus on of personal recovery, justice and wellness
- Development of evidence to inform policy on unique cultural ecology of marginalised populations and justice oriented initiatives
- Diffusion of locally relevant, culturally sensitive and pragmatic approaches to care
The Banyan &BALM - PROMOTING SOCIAL INCLUSION
BALM is an effort in the direction towards equipping professional psychologists, researchers, analysts, entrepreneurs, social workers and community mental health workers in immersive social practice such that they may effectively grapple with complex situations. Coming from different socioeconomic backgrounds and cultural experiences, the students at BALM are schooled in maintaining passion for mental health studies and working strategically to meet society’s needs.