India can do more to provide better mental healthcare services to its citizens

By Prof Bejon Kumar Misra

It has been a challenging year for mental health across the world. The global pandemic has been genuinely difficult for many as it completely reshaped the way many of us view, manage, and maintain our emotional balance. There is also a growing concern that coronavirus survivors might be at an increased risk of developing post-traumatic stress disorder (PTSD) that would continue long after the epidemic finally fades out.

May is observed as the Mental Health Awareness Month while May 5th every year is celebrated as the World Maternal Mental Health Day, and it is also a worthy reminder that prioritizing our mental health is a 365-day affair. Just as everyone needs to address their physical health even when they are not physically ill, mental health is something everyone should think about, regardless of whether they are mentally distraught.

As per World Health Organization (WHO) estimates, 7.5 percent of Indians suffered from some or the other mental health disorders in 2020. This includes 56 million Indians who suffer from depression and another 38 million Indians who suffer from anxiety disorders. The global health body also predicted that roughly 20 percent Indians will suffer from mental illness by the end of the year 2020.

In India, the fear of getting infected or having vulnerable loved ones fall ill, especially young children, feelings of grief triggered by the sudden loss of loved ones to the virus and inability to say goodbye to the departed are causing mental health problems. Besides this, the struggle to arrange basic medical supplies, dearth of credible information on critical COVID resources, uncertainty over employment, housing, and the broader economic hardship that lie ahead are causing a lot of anxiety among people.

COVID-19 is causing anxiety, sadness, stress, and uncertainty among children, teenagers, and college students as well who are witnessing grief and calamity at a young age. They, like other vulnerable groups such as senior citizens with already existing challenges, run a high risk of developing mental health issues and need urgent psychological support.

Frontline workers face a significantly high risk of developing common mental disorders due to immense and unprecedented pressure for a prolonged period amid COVID-19 which is harming their emotional and mental well-being. This may compromise the quality and safety of care, breach protocols and guidelines, increase the risk of infections, and hamper the capacity of the health system and emergency response teams.

Though the variety and extent of the implications of COVID-19 on mental health are yet to be fully ascertained, millions of people will need new or additional mental health support as a direct result of the pandemic given the rapid spread of coronavirus infections in the country. This underscores the need for a robust preparation for a potential increase in demand for mental health services and ensure swift access to effective mental healthcare support to the needy at the Primary Health Care Centres and the Health & Wellness Centres to be set up under AYUSHMAN BHARAT.

India’s track record is dismal on mental healthcare. The proportional contribution of mental disorders to the total disease burden in India almost doubled between 1990 and 2017 with one in seven Indians reporting mental disorders of varying severity in 2017. However, all is not lost.

COVID-19 has further exposed glaring gaps in our mental healthcare system. These gaps need to be fixed effectively by a more systematic commitment to mental health and resourcing our existing health care systems to make mental healthcare accessible to all. This includes addressing the scarcity of mental health practitioners (MHPs), increasing the quality of the existing mental health professionals and enhancing the country’s total expenditure on healthcare to make mental healthcare services affordable.

The National Mental Health Programme, since its launch in 1982, has undergone multiple revisions in the last 3 decades to address issues and gaps. The program, long been criticized for being treatment-centric and ignoring preventive and promotive aspects, has undergone some welcome changes with the release of some noteworthy guidelines for prevention activities to address mental health in India.

These guidelines focus on different age groups, including older people and children, and cover a variety of issues ranging from managing mental health to addressing stigma and discrimination, managing alcohol-related and tobacco-related issues during the lockdown, and providing clinical guidelines for managing patients with mental health concerns.

Under this programme, initiatives like the creation of a national psychosocial behavioral helpline to improve mental health, release of written and audio-visual guidelines for the general population, people living with mental disorders, and healthcare providers to facilitate the management of mental health issues during the pandemic are laudable.

Although it will take time to assess the effects of the guidelines on mental health in India, these steps taken to reduce the risk of adverse mental health outcomes of the COVID-19 pandemic are certainly in the right direction. It shows the government’s intent to address the mental health impact of the pandemic on priority. In this context, the Union government has already issued guidelines asking COVID-19 facilities in the country to provide psychiatric consultation as a mandatory requirement prior to discharge and patients trained to manage at home with prompt availability of affordable medicines to ensure preventive care.

The focus of the government should now be on creating awareness and accessibility about these initiatives, addressing mental block with regard to online or teleconsultation, removal of stigma surrounding mental healthcare, and familiarizing people with technology to encourage needy people to access these services at their doorstep or on phone. It must act urgently as time is running out and the country may face another surge due to lack of infrastructure and trained mental health counselors.

Regular communication with people on what they need to know, be it related to the pandemic or their physical and mental wellbeing can help them deal with loss, grief, and anxiety amid COVID-19. The need of the hour is to create tools and techniques that provide reliable information round the clock on the evolving COVID situation besides addressing people’s concerns with regards to COVID critical resources, health and safety, and livelihood amongst others.

Common mental illnesses such as anxiety disorders and mood disorders are natural consequences of environmental factors such as trauma. These conditions are like any other medical illness and are highly treatable with medication and psychotherapy. In my view, this can be implemented and made accessible for all potential citizens in a short span of time.

These diseases, however, if not treated over time can cost the nation dearly in terms of loss of lives and productive work hours. India can do more to ensure that its citizen’s mental health care needs are met better and as per best standards and practices. Fred Rogers, a famous American television host, has rightly said that “Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary.”

(The author is Founder, Patient Safety & Access Initiative of India Foundation. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)