PCI India

Invisibility of Mental Health in Indian Healthcare System During and after Covid 19

Anuj

Mental health is one of the significant invisible health issues across the globe, which many people are talking about; still, there is no proper awareness. One out of five people is dealing with mental health issue still there is a stigma going on across the world; all this is happening because of a lack of proper knowledge and less attention from the health care system. According to WHO, “Mental Health is the state of well-being in which the individual realizes his or her abilities, can survive with the normal stresses of life, can work efficiently and fruitfully, and can make an impact to his or her community.” But if there is a slight change in state or conditions in which born, grow, work, live, and age can cause mental health issue to an individual, there are set of forces and system which also affect the mental health of an individual, i.e., economic policies and strategies, development agendas, social norms, social policies, and political procedures.

India is one of the major depressed countries. According to the world health Organisation (WHO), there are around 120 million Indians, i.e., 10 per cent of the whole country, increasing every day dealing with a mental disorder.  As per the survey done by the Indian Council of Medical Research (ICMR), which was published in the esteemed journal The Lancet Psychiatry, one in 7 people in India is dealing with mental illness, majorly depression, and anxiety disorder. It also showed that numbers had been doubled since the last decade.  According to a National Institute of Mental Health and Neuro Sciences (NIMHANS) survey, 150 million Indians need mental health care regularly, but only less than 30 million can access the treatment. On average, 2.2 lakh suicides happen in India every year, in which the majority is below the age of 44. (Khaitan, 2020) There has been a growth in the suicide rate in teens. Depression one of the main reasons for deaths by suicide.

Around 1.9 per cent of the population suffers from severe mental disorders like Schizophrenia, bipolar affective disorder (BPAD), mood disorders, neurotic or stress-related disorders, post-traumatic stress disorder, depression, anxiety disorders, psychoses, phobia, suicide, marital disharmony, sleep disorders, alcohol dependence and substance misuse and dementia, which are developing as common mental problems in the general population.

According to Baldev Singh, a volunteer counsellor with the MINDS Foundation, an Indian non-profit aiming to reduce mental health stigma. “People can talk about physical symptoms and illnesses, but it is difficult to express the feeling of depression or being low. People think that speaking about your feelings makes you weak, and Problems are pushed aside and minimized. Most of the middle-class families did not talk about negative feelings; also, they might compare it with someone else’s problem and make you feel guilty about it” 57% of people are not aware of any person with mental illness and 28% thinks there is no relation between suicide and mental health as per times report. (News18, 2020)

“The reason behind this stigmatized society is that there is a lack of awareness and knowledge in society about the concept of mental health. Also, the practice of psychiatry is majorly Western,” said Dr S.K. Chaturvedi, Head of Department at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore.

MENTAL HEALTHCARE SYSTEM IN INDIA

Indian mental health system faces two significant challenges, i.e., lack of proper knowledge about mental illness and lack of sufficient mental health services.  In the health care system, the number of skilled healthcare workers to provide mental health care to patients is abysmal. There is more Indian origin psychiatrist in the US than in India, which validates the previous statement. There is just one psychiatrist for every two-lakh people in India, which is way worse than the prescribed ration, i.e., 1:8000-10,000. There are just 9000 psychiatrists in India, and there is a shortage of around 18000 psychiatrists. There are only 100 clinical psychologists against the demand of 20,000. (Mitra, 2020)

Similarly, the availability of psychiatric social workers and nurses is minimal. There are just 49 child psychologists in total in the whole health sector. The lifetime prevalence of mental disorders is 13.7%, as per a recent survey. As per the parliamentary questionnaire of 2019, there are only 43 government mental health hospitals across 21 states in India. In all union territories, Delhi is the only place where there is a solitary mental hospital; in states like Uttarakhand, there is still no mental hospital.

According to the Indian Journal of Psychiatry, allocation to the National mental health program has come down from Rs.50 crore in 2018 to Rs.40crore in 2019, but only five crores were spent in both years. Also, even after a rise in the total health budget by 7 per cent, there is still no change in mental health care allocation.  To fully implement the Mental Healthcare Act 2017, there is an annual requirement of at least Rs94,073 crore annually, which seems lacking according to the government’s budget. (Deutsche Welle,2019)

In India, 80 % of the insurance sector does not cover mental health treatment in their policies. Location plays a prominent role in India to access mental health facilities in India. According to The Times of India report, 49% had a mental health facility within a radius of 20 km, but there is 26% reported that there is no mental health facility within a 50km radius. Also, 59% lacks de-addiction service in their area.

MENTAL HEALTH AND HEALTH CARE DURING PANDEMIC

Covid-19 has affected the mental health of many kids ranging from three to four-year-olds to adolescents. The covid-19 pandemic has affected every individual’s mental health of the whole country, ranging from a five-year-old kid to an 85-year-old person. As per the Indian Psychiatric Society study, 40% out of 1,685 participants were suffering from common mental health disorders, such as anxiety and depression, due to the pandemic.

Child and Adolescent: Children from all age groups were affected by the pandemic during a lockdown or after lockdown; behavioural issues are observed among children as they are getting aggressive and anxious about the virus and performance in their studies as they are mentally tired by attending classes and giving exams on screens as they spend around 6 hours a day regularly on computers. Students living away from family cannot cope with the burden are started committing suicide; according to the National Crime Records Bureau (NCRB) statistics, 28 suicide are happening every day among students.

Family dynamics: Family dynamics are the pattern of relating or interactions between family members, and each family has unique dynamics.  Due to this pandemic, there has been a hindrance in this dynamic; there has been a report of suicide due to family arguments among partners. Domestic violence is one of the significant issues which has been during the pandemic. There has been a rise in Domestic violence report to the National Crime Records Bureau (NCRB) by 40% in this pandemic, and victims of it were dealing with it for a more extended period before reporting it because of lockdown, and there is no place to go.

Jobseeker and job workers: COVID-19 and devastating economic impact played a great game in causing a mental health crisis in the country. Sitting the whole day working on a computer at home complemented the disruption caused to individuals’ mental health. According to a study done in Gujarat, there has been a 44 per cent rise in panic attacks and a 27 per cent rise in depression among job workers in the country. In 2019, the British charity organization reported that 42.5 per cent of the employees were already suffering from depressions and anxiety disorder in India. Jobseeker was also hit by this pandemic as there has been a rise in the country’s unemployment rate and individuals seeking a job have no place to go and managing their budget without any income was also the cause of disruption in mental health individual. WHO estimated that India would have an economic loss due to mental health conditions of 1.03 trillion dollars between 2012 and 2030.

Front line workers: Frontline workers like doctors, nurses, community health workers, sanitation workers, police officers, and other volunteers across the country are tackling an entirely unprecedented and challenging situation making impossible decisions and are working under extreme pressures in danger of coronavirus. Working under such a complicated condition with limited resources is not just affecting their personal and family life but also causing mental health problems like depression, post-traumatic stress disorder, and even suicidal ideation (Cheng et al., 2004; Duan & Zhu, 2020; Greenberg et al., 2020; Litz et al., 2009; Williamson et al., 2018). front line healthcare workers are facing the stigma of their neighbourhoods. There are many cases of harassment from house owners or society, violence against doctors and other health workers at the workplace, social isolation, and discrimination has been seen.

Mental health patient: As per the research conducted by the Suicide Prevention in India Foundation (SPIF), there has been an increase in self-harm among patients of health professionals surveyed. Also, due to the pandemic, access to mental healthcare is affected. Patients below the poverty line (BPL) used to access free services from government hospitals had lost psychotropic medication as they could not afford it anywhere else, along with drug discontinuation and related relapses. Community mental health services in India: The pandemic and beyond Kumar T M – Indian J soc psychiatry,” 2020)

As per the online survey conducted by SPIF ((Suicide Prevention India Foundation), across the country:

• “Self-harm, suicide ideation/death wish increases”: around  65% of the therapists observed that there is an increase in the number of people who have self-harmed in this pandemic; similarly, 71% of therapists think that more people will have an expression of suicidal ideation or a death wish for themselves post the outbreak.
• “Increasing relapse rates”: Approx. 6 out of 10 surveyed therapists told that individuals who previously recovered or were making a recovery are now relapsing again.
• “More people seeking therapy”: 68.6% of surveyed therapists reported an increase in people seeking therapy for a longer time frame after the pandemic hit.
• “First-time therapy seekers rise”: 54.7% of surveyed therapists tell that there has been a rise in first-time therapy seekers since the outbreak of the pandemic.
• “Caregiver fatigue heightens”: 62.3% of therapists experience caregiver fatigue by providing telepsychiatry, mostly during a pandemic.

With the country’s current scenario, it can be concluded that the wake-up call for each of us as post-pandemic trauma will worsen than the current situation if not attended to properly. With the rise in the unemployment rate, the predicted death will be higher, making the condition worse. Mental health should be studied from its grass root to understand and deal with mental health issues effectively. Also, more allocation of resources toward the mental health system is required to reduce a psychiatrist and psychologist’s current ratio to a patient. More programs should be arranged to spread awareness regarding mental health. The same can be organized at the school level and college to better understand at the student level. Like Swachh Bharat Abhiyan (Clean India Mission) campaign, there is a need for a mental health campaign, too, with massive promotion on all levels. Around 30 – 40% of the public health budget should be spent on mental health so that the act, which was launched in 2017, can be fulfilled and citizens get better infrastructure and services quickly. In the long run, there will be a reduction in the mental healthcare budget, as there will be a decline in the future’s mental health problems. There is a need for DE stigmatization of mental disorder, general mental issues, emotional disorders, unwanted feelings, and suicidal thoughts so that the discrimination in society ends and one can express his/her feeling freely.

REFERENCES: