Contents
- Introducing mental illness: what does it entail?
- Zooming into India - why should we investigate?
- What are some social determinants that contribute to India's mental illness prevalence?
- How have interventions been approached, and what is being done now?
- What does a professional have to say about South Asian mental health?
- Conclusion
- Sources
Firstly, what does mental illness entail?
Mental health, wellness, and illness - these terms have been used interchangeably to describe a plethora of mind-related issues, but they are not the same thing (McLean Hospital, 2021). While mental health (or wellness) encompasses social, emotional, and psychological well-being;, mental illness (or disorder) describes any set of conditions that affect a person’s behaviors, thoughts, feelings, or moods (McLean Hospital, 2021).
Let's Look at India
The number of people with mental illnesses is increasing throughout the world (WHO, 2022), and the country of India is no exception to this trend: the prevalence (which measures the number of people with a certain disease) of mental disorders to India’s total disease burden nearly doubled from 1990 to 2017 (Sagar et. al., 2019). Additionally, professionals recorded a staggering statistic - in 2017, one in every seven people had a mental disorder in India, which amounts to around 197 million people total (Sagar et. al, 2019). The onset of the COVID-19 pandemic has not helped the situation: numerous studies have seen a significant rise in the incidence (the number of new cases) of mental illness in India since 2020 (Mia & Griffiths, 2022).
Why care about India?
The Influence of Social Determinants on India's Mental Illness Prevalence
Determinant #1: Cultural and Social Norms
One social determinant that affects India’s mental disease burden is cultural and social norms. Like many South Asian groups, a number of Indian communities are collectivist: group values are prioritized over those of the individual, and there is an emphasis on familial cohesion and conformity (Karasz et. al., 2016). There is a lot of social stigma surrounding the vocality of mental illness struggles and seeking help for them: members of Indian communities are more likely to keep personal problems to themselves, as seeking outside help can be perceived by others as a failure of the family to solve the issue (Karasz et. al, 2016). A number of people, therefore, seek mental health services as a last resort, partly to keep a positive familial image (Karasz et. al, 2016). The pressures of adhering to this “family harmony” can put a lot of strain on those who are trying to seek help, which is why this particular social norm affects India’s burden of mental illness.
Determinant #2: Lack of Access to Healthcare Services
A second social determinant that affects India’s mental disease burden is the lack of access to health care services. Firstly, there is an inadequate amount of mental illness infrastructure: as of 2016, there are only 0.010 mental institutes per 100,000 population (WHO, 2016). In addition, India only has about 0.75 licensed psychiatrists per 100,000 population, which is considerably lower than the desired ratio of 3 psychiatrists per 100,000 population, and therefore points to an insufficient number of trained professionals (Garg et. al., 2019).
This preexisting lack of resources has been further exacerbated by the COVID-19 pandemic, as low numbers of healthcare facilities and professionals have pressured authorities to move resources away from mental health offices and towards alleviating COVID-19 infections (Mia & Griffiths, 2022). Furthermore, even if one were to gain access to these services, large swathes of India’s population end up in poverty due to high out-of-pocket health care costs and the consequences of low quality of care (Srivastava et. al., 2016). Therefore, sparse access to healthcare services, as well as the high expenditures associated with them, is a big factor behind India’s burden of mental illness.
The heavy weight of mental illness on India’s population is partially caused by cultural norms as well as a lack of resources. Interventions aimed towards alleviating prevalence of mental illness have evolved throughout history, which is what will be discussed next.
Public Health Interventions Aimed Towards Indian Mental Health
History and Advances Over Time
In the past, mental illness was treated by the community through methods such as physical restraint and Ayurvedic treatment, which is an ancient system of medicine. Mental hospitals came to India through British rule, but they often neglected patients and violated human rights (Thara & Padmavati, 2013).
To remedy these issues, the National Human Rights Commission (NHRC) created a set of guidelines to put psychiatric institutions on the right track with providing treatment (Thara & Padmavati, 2013). To this day, the NHRC periodically assesses hospitals throughout the country to confirm they are on par with these guidelines.
Besides NHRC involvement, judicial interventions have played a huge role in improving mental health facilities in India: resourcing of mental hospitals as well as reductions in involuntary admissions can be attributed to various judicial rulings. (Murthy et. al., 2016).
What policies and programs are currently in place?
Over time, there has been a growing focus throughout India to develop community mental healthcare structures to be more robust, as well as incorporate mental health into primary care (Thara & Padmavati, 2013). There have also been efforts to make medications widely available to the 85% of people suffering from clinical depression who are untreated (Singh, 2018), which involves ensuring equal access to mental health resources across different Indian communities (Thara & Padmavati, 2013). The passage of the Mental Healthcare Act in 2017 was a nod to the aforementioned priorities, as it decriminalized attempted suicide, barred solitary confinement of mentally unwell patients, allowed more training for medical professionals, and mandated insurance companies to provide mental health insurance (IBEF, 2010-2022).
Besides this policy, professionals have created and maintained a number of community-based mental health programs throughout Indian states to identify and support those who are experiencing a variety of mental illnesses. Volunteers with these programs execute various public health interventions, such as educating communities about mental disorders, identifying individuals who need counseling, as well as providing access to social care benefits (WHO, 2021).
Where does Indian mental health policy fall short?
While the Mental Healthcare Act in 2017 was an effort by India’s government to alleviate mental illness prevalence, it is apparent that many interventions have been only carried out at the interpersonal and community levels. There simply has not been much focus on what the government can do to change the structural inequalities surrounding mental illness prevalence and access to mental healthcare, forcing community workers to bear the brunt of uplifting mental illness in the areas they serve (Kaur, et. al, 2021).
Where do we go from here?
A community-based mental health study that would be beneficial to assessing India’s mentally ill population is investigating mothers and children, who are oftentimes left out during specific interventions. As around 22% of mothers in India suffer from postpartum depression, which is on the higher end of the global 10-30% range (Lanjewar et al, 2021), it is imperative to study the effects maternal depression has on both mothers and children.
An example of a Pakistani community intervention that looks at maternal depression is the Bachpan Study, which follows children and their mothers through birth, childhood, and adolescence to see how rates of depression fare (Bachpan Study, 2022). Led by Dr. Joanna Maselko of UNC’s Gillings School of Global Public Health, the study seeks to look at the effects of maternal depression on child development (Bachpan Study, 2022). Want to learn more about the Bachpan Study? Scroll below and watch an interview with Dr. Maselko herself!
Spotlight: A Conversation with Dr. Maselko
Dr. Joanna Maselko is an associate professor in the department of epidemiology at UNC'S Gillings School of Global Public Health, as well as a social epidemiologist. She has done lots of research in the global mental health field, and her current work looks at how specific social context influences developmental risk trajectories over the course of someone's life. You can learn more about her work with the Bachpan Study by clicking the button below.
Tying It All Together
India’s mental illness burden is substantial and a product of complex social factors, including cultural norms and a lack of access to resources. Throughout history, Indian mental illness institutes have shifted to reflect a change in attitudes surrounding mental wellness and disorders. This has been supported by the passage of sweeping policy as well as the involvement of various community mental health leaders, with an example being shown in the behind photo.
There have been improvements in India’s mental health sphere, but there is still a long way to go to ensure the equitable access of mental health resources to all of India’s diverse population.
Special thanks to Dr. Maselko for contributing to an informative interview, to my HBEH 520 classmates for providing constructive webpage feedback, and to Naya Villareal for providing valued guidance all throughout the Fall 2022 semester.
Sources
Bachpan Cohort. Bachpan Study. (2022). Retrieved November 14, 2022, from https://www.bachpanstudy.com/
Garg, K., Kumar, C. N., & Chandra, P. S. (2019). Number of psychiatrists in India: Baby steps forward, but a long way to go. Indian Journal of Psychiatry. Retrieved September 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341936/#:~:text=As%20is%20clear%20from%20the,700%20psychiatrists%20graduate%20every%20year.
India's mental health policy: IBEF. India Brand Equity Foundation. (2021). Retrieved September 28, 2022, from https://www.ibef.org/blogs/india-s-mental-health-policy#:~:text=It%20decriminalises%20suicide%2C%20disallows%20sterilisation,Authorities%20for%20training%20medical%20professionalsn
Karasz, A. (2016, November 15). Mental Health and Stress Among South Asians. Journal of Immigrant and Minority Health. Retrieved September 28, 2022, from https://doi.org/10.1007/s10903-016-0501-4
Kaur, A., Kallakuri, S., Kohrt, B., Heim, E., Gronholm, P., Thornicroft, G., Maulik, P. (2021).
Systematic review of interventions to reduce mental health stigma in India. Asian Journal of Psychiatry. Retrieved October 21, 2022 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116814/
Lanjewar, S., Nimkar, S., & Jungari, S. (2021). Depressed motherhood: Prevalence and covariates of maternal postpartum depression among urban mothers in India. Asian Journal of Psychiatry, 57, 102567. https://doi.org/10.1016/j.ajp.2021.102567
Mia, M. A., & Griffiths, M. D. (2022). Can South Asian countries cope with the mental health crisis associated with covid-19? International journal of mental health and addiction. Retrieved September 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886190/
Mitra, E. (2020, September 7). India didn't prioritize mental health before covid-19. Now it's paying the price. CNN. Retrieved September 28, 2022, from https://www.cnn.com/2020/09/06/india/india-mental-health-dst-intl-hnk/index.html
Sagar, R., Dandona, R., Gururaj, G., Dhaliwal, R. S., Singh, A., Ferrari, A., Dua, T., Ganguli, A., Varghese, M., Chakma, J. K., Kumar, G. A., Shaji, K. S., Ambekar, A., Rangaswamy, T., Vijayakumar, L., Agarwal, V., Krishnankutty, R. P., Bhatia, R., Charlson, F., … Dandona, L. (2020). The burden of mental disorders across the States of India: The global burden of disease study 1990–2017. The Lancet Psychiatry, 7(2), 148–161. https://doi.org/10.1016/s2215-0366(19)30475-4
Thara, R., & Padmavati, R. (2013, June). Community Mental Health Care in south asia. World psychiatry : official journal of the World Psychiatric Association (WPA). Retrieved September 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683272/#:~:text=South%20Asia%2C%20home%20to%2023,150%E2%80%93200%20million%20mentally%20ill
World Health Organization. (2021). Community-based mental health services using a rights-based approach. World Health Organization. Retrieved September 28, 2022, from https://www.who.int/news-room/feature-stories/detail/community-based-mental-health-services-using-a-rights-based-approach
World Health Organization. (n.d.). Gho | by category | facilities - data by country. World Health Organization. Retrieved September 28, 2022, from https://apps.who.int/gho/data/node.main.MHFAC?lang=en
World Health Organization. (n.d.). Mental health. World Health Organization. Retrieved September 28, 2022, from https://www.who.int/health-topics/mental-health#tab=tab_2
Yes, there is a big difference between mental health and mental illness. Mental Health vs. Mental Illness - What's the Difference? | McLean Hospital. (2021, January 3). Retrieved September 28, 2022, from https://www.mcleanhospital.org/essential/mental-health-mental-illness
Credits:
Created with images by Choat - "World mental health day concept: Silhouette alone woman standing on abstract of heaven background" • vetre - "Orange and green color powder splash. Concept for India independence day, 15th of august." • Zerophoto - "Location India. Blue pin on the map." • sonatalitravel - "Old ruined arch of Lotus Mahal at sunset, Hampi, Karnataka, India." • Kristin - "Holi Fest" • bongkarn - "Shot of a doctor showing a patient some information on a digital tablet" • Sunil Aralikatti - "The Vidhana Soudha located in Bangalore, is the seat of the state legislature of Karnataka" • Светлана Монякова - "Ingredients for homemade skin and hair care in bowls top view. Free space for text. Henna powder, dry chamomile, turmeric, cosmetic clay, and oil. Ayurvedic skin care products." • Choat - "World mental health day concept: Silhouette prayer praise God and bird flying on blurred candle light background" • jura_taranik - "Gadi Sagar temple on Gadisar lake Jaisalmer, India." • creativeimages - "portrait of loving Indian mother and daughter at village" • MelissaMN - "Khas Mahal with its intricate marble and stonework at the Red Fort in New Delhi India"