Commentary: A Critical Analysis Of The Mental Health Policies Of India

The very ethos of the National Mental Health policy is to prevent mental illnesses, promote mental health, destigmatise the notion of mental illnesses, enable the socio-economic integration of those suffering from mental illnesses, providing adequate care and facilities for rehabilitation and cure of mental health issues. 

However, it does not lay adequate emphasis on the steps to actually prevent mental illnesses from compounding in the first place, leading to the necessary implementation of the above-mentioned goals. This is included in their vision board but is not chalked down in detail in the policy.

There is more attention paid to factors such as decriminalising suicide and ensuring equality as far as the socio-economic status of those suffering are concerned, which in itself is highly relevant and necessary, although I believe this is stemming from a socio-cultural approach and not as much from a psychological approach.

The balance between the two can be made by employing a “psycho-social approach”, that is by paying equal attention to the factors of preventing mental illnesses by offering better training to the professionals in the field, educating all sections of the society on what mental health issues are, where they stem from and if not prevented and cured in the right time, what the consequences could be as well as familiarising them with the methods of cure and the step by step procedure of enabling the same and offering effective and affordable treatment.

Even though better access to mental health facilities is promised in the policy, the various sources of recent research tell a different story. Accessibility is secondary in this domain, since awareness in itself has not been adequately spread. Due to the unbroken, magnanimous stigma and the fear attached to it, individuals of our society are still refraining from speaking about it or embracing it, in order to effectively find a cure and eradicate it.

To everyone’s surprise, the section of the society which is seen to supress matters of mental health issues more, are the middle and upper classes, which include the educated, working class and privileged individuals. According to facts and data, most of these people can afford full time and proper treatment, given the relatively high expenses of mental health facilities, which not all of them avail due to the fear of being subjected to societal judgment, which proves the very fact that the policy has not succeeded in effectively breaking the stigma surrounding it, in our country. This mind-set is expected out of the uneducated sections of the society, hence unaware, but through this instance it can be understood that education in itself does not play as much of a role as the societal view does. In order to attempt to break the stigma, efforts need to be made to normalise mental health issues and bring it at par with physical health problems.

Mental illnesses should fall under the category of non-communicable diseases, a pitch which was earlier rejected on the grounds that mental illnesses are not as much of a threat to an individual as a cardiovascular disease would be. The point here that is not understood is that mental illnesses are major and significant co-morbidities to any adverse communicable or non-communicable disease. For instance, people battling cancer will certainly face a road-block in their route to recovery if they are also battling acute depression alongside it (or due to it), physically making recovery slow and difficult.

Individuals suffering from such adverse diseases are bound to face repercussions negatively impacting their mental health, leading to comorbidities like anxiety, mood disorders or anger management issues etc. The existence of the two together cancel out any step taken forward.

In order to cure the physical disease in focus, the mental distress attached to it also needs to be effectively dealt with. It is also a fact that individuals with acute depression are prone to diseases like type 2 diabetes and other heart related issues.

There should also be compulsory mental health professionals actively present in the intensive care units in both public and private hospitals. In order to normalise people seeking help and taking treatment for their mental illnesses, they need to normalised and pitched alongside any other physical ailment which requires cure.

Just as there are health drives in rural areas, educating the uneducated masses about the advancement of medicine and the necessity of vaccinations etc., there should also be regular mental health drives where volunteers sent out by the government educate the people about the vices of undiagnosed mental disorders and what they must do to beat it.

This is extremely necessary and relevant as those suffering is bracketed into a category of “insane”, dictated by the society surrounding them. This not only further depreciates their socio-economic status but also leads them to be outcasted by the society.

Following this as an example, anyone else suffering in such societies is type casted and not considered equal, beating the entire point of the policy to promote equity in this domain. As clearly stated in the policy that awareness is more essential in this class, since social circumstances like poverty, homelessness and marginalisation make them increasingly more vulnerable and prone to mental illnesses, active steps should be taken to try and eradicate it through educating the masses and offering care.

Just like the country managed to break the stigma surrounding diseases such as polio and tuberculosis, with effective implementation of certain basic measures, over time, the walls surrounding the stigma of mental health are also bound to crack, crumble and fall.

The government should appoint more professionals understanding mental health at all levels, especially at the economically downtrodden level, where their services would be required for free. Since mental health facilities are so expensive, most people cannot afford it, especially not in the long run, which was mentioned in the policy to be made available for sustainable care. Since its still a domain which isn’t tapped into, it isn’t effectively implemented either. The medication and other treatments should be made cheaper for those really in need, while basic counselling and follow up should be state funded and free for the needy.

The budget set aside for mental health facilities is clearly inadequate and isn’t put to substantial use. There isn’t sufficient emphasis laid on non-medical private rehabilitation centres, which needs to change since some mental illnesses do not require immediate medication or any medication at all, they require consistent and regular therapy and the availability of personals for follow-ups. These institutions need to be positively advertised and inbred into the minds of the masses.

An enthused government effort in the form of the Mental Healthcare Act 2017 and a diverse set of mental health programs with their individual successes indicate our capability to improve.

However, coordination and far sight can prevent these from merely being experiments conducted on a small segment of the population. Recently, India has promised to partner with the USA to exchange information in combating the mental health crisis. Via the agreement, signed in February 2020, the USA has agreed to share its mental health research with India, while it gains access to traditional Indian medicine and therapy to counter mental illnesses.

Dr. Bharat Vatvani, a leading psychologist and winner of the Ramon Magsaysay award, aptly commented on India, “There is hope, concern, and compassion for the mentally ill misdirected.” There is a positive change in mental healthcare in India with an improvement of government policies and increased awareness through public outreach programs. Now, we need thorough research on the impact of these policies on mental health issues in India.

Mental disorders were the second leading cause of disease burden in terms of years lived with disability (YLDs) and the sixth leading cause of disability-adjusted life-years (DALYs) in the world in 2017, posing a serious challenge to health systems, particularly in low-income and middle-income countries.

Mental health is being recognised as one of the priority areas in health policies around the world and has also been included in the Sustainable Development Goals. On understanding the grave impact of poor mental health on an entire society and its economy, a developing country like India, needs to certainly prioritise it.

According to a study, Globally, 20% of young people experience mental disorders. In India, only 7.3% of its 365 million youth report such problems. Although public stigma associated with mental health problems particularly affects help-seeking among young people, the extent of stigma among young people in India is unknown.

Describing and characterizing public stigma among young people will inform targeted interventions to address such stigma in India, and globally. Thus, we examined the magnitude and manifestations of public stigma, and synthesised evidence of recommendations to reduce mental-health-related stigma among young people in India.

People with mental disorders are vulnerable to abuse and violation of their basic rights. Such abuse or violation may occur from diverse elements in society including institutions, family members, caregivers, professionals, friends, unrelated members of the community, and law enforcing agencies.

This sets an imperative for a protective mechanism to ensure appropriate, adequate, timely, and humane health care services. Such protective mechanisms include legislative provisions and policies to ensure that the rights of this vulnerable group are protected.

In the undeniable context that every society needs laws in various areas to maintain the well-being of its people, mental health care is one such important area that requires appropriate legislation.

Written by Nabhit Kapur.