This year, like every year, October 10th was celebrated as World Mental Health Day. The theme this year was 'Mental health in an unequal world'. What is the relevance of this?
In India, every tenth person experiences mental discomfort at some point. In this, 0.8 are serious mental health patients (about a crore people). That is about crore families. When the mental health of one person deteriorates, the entire family is strained. In Kerala, this statistic is at 13.4.
Every year, the world loses 8 lakh people only to suicide. In India, the average number of suicides a year is 1,40,000 and in Kerala, 8,500. Kerala is ranked fifth countrywide in the number of suicides. Every day, 24 people on average die by suicide. In the 15-39 age group, suicide is the leading cause of death. In India, about 16 crore people are alcohol consumers. In this, 2.9 crore are addicted to alcohol, 3.1 crore consume cannabis and 25 lakh are addicted. There is no shortage of other drug use in the country either.
The treatment gap is the greatest villain to mental health. That is, of the people diagnosed with a mental illness, about 70-86 do not avail of treatment. Only 15 per cent receive proper treatment. The budget allotment for mental health in developing countries is less than two per cent. The reasons for not availing treatment include the lack of availability of treatment options, lack of awareness on mental illnesses, misconceptions about treatment, ostracisation faced by patients, fear of shame etc. This reduced availability is less sufficient for socially, financially or educationally backward communities and gender minorities.
The world is currently battling a crisis like never before. The various impacts of Covid-19 such as fear, doubt, loneliness, social distancing, insecurity, strain, wavering income, job-related confusion etc have further worsened mental health. The imbalance across the world further aggravated the treatment gap. This is because even as mental illnesses increased, investment and attention shifted to Covid and other physical ailments. The disruption in treatment availability due to the lockdown also paved way for the rise.
Gender minorities and mental health
Gender minorities face several issues from childhood which may include shaming, sexual violence, physical assault, ostracisation, confusion pertaining to one's identity in a cis-hetero world etc. The community faces several issues such as forced marriages, inability to complete education, ostracisation from family, inability to find a partner etc. The mental strain caused by these circumstances is immense. There is a need to address their mental health and ensure proper treatment.
The physical, mental and cyber violence against women including domestic violence due to dowry demands is fast surging countrywide. 350 murders were committed between 2017 and 2021 in the name of failed relationships or unreciprocated romantic interests. The reason for this is the male-dominated nature of society and the lack of accountability that has emerged with the advent of technology. The violent criminal who recently shook the conscience of Kerala might have been an undiagnosed, untreated patient with a personality disorder.
Children underwent the most mental health strain due to the Covid-19 pandemic.
- Lack of freedom (They were unable to travel or engage in games or other entertainments)
- Inability to meet or interact with peers, family and teachers
- News pertaining to Covid dominating mainstream media
All these reasons aggravated mental stress. Another major issue is digital dependence. Students spent hours on digital devices after education shifted online. Children engage with social media and the world of gaming even during class hours. They spent hours on phone claiming it to be for assignments.
The problems caused by these include,
- Lack of sleep
- Excess anger or destructive behaviour
- Teenagers have increased chances of using dating apps when young and falling prey to abuse and exploitation
323 child suicides were reported in 2020. This is higher than the statistics from past years. A large proportion of the Keralite population are still victims of superstition and unscientific practices. Even the educated population shows a lack of interest in availing treatment or seeking diagnosis from mental health professionals. Why go searching for examples outside? Misconceptions exist within the medical community itself. This creates a hindrance in the referral process. The result: valuable lives are lost in this process. Bridging the treatment gap, hence, is of utmost importance.
- As per the mental health law of 2017, receiving mental health support is a right. Both outpatient and inpatient services as well as free medicines are available. Mental health services are available starting from primary health centres.
- Those struggling with mental health issues must receive as much support and treatment as those struggling with physical illnesses.
- Insurance coverage must include mental ailments
- In case of violation of rights, free legal aid should be made available
- Mental health services are available 24*7 via Disha helpline number 1056
- Wrong representation about mental health illnesses and treatment in cinemas and media aggravates misconceptions and ostracisation. Awareness is compulsory to counter this.
- Mental health professionals must proactively engage with media and society. They must also offer proper knowledge and awareness besides treatment
Mental illness is like any other illness. We can bring those struggling with them back to normalcy with treatment and support. We can strive to ensure mental health for everyone without distinction in this highly unequal world.
(The Author is Psychiatrist & RMO, General Hospital, Alappuzha, Kerala)