- Nishtha Khurana
In India, mental health has been given little importance, save for the last few decades. Progress has been slow, and there is urgent need to update and advance in order to curb the monstrous rate at which people are experiencing mental health issues. Keeping in mind the current scenario and the events of 2020, it has become especially important to reflect on our existing mental health policies.
The earliest evidence of mental hospitals in India can be traced back to the 13th century. Hospitals were established to provide better care for the mentally ill, but the lack of focus on the infrastructure deteriorated their condition promptly, and the immoral treatment practices led the community to believe that nothing good could come out of this. People’s belief that mental illness is an act of the “devil”, or “against God” grew stronger, and those who suffered from mental illness were described as criminals, or even witches.
This led to more deinstitutionalization, and hampered community advancement.
Since the pre independence era, the overarching British influence on the ideology of our country persists at the grass root level . The idea of having mental hospitals or asylums is important, but there are few good institutions within well- developed cities. The assumption that people who suffer from mental health disorders are deviants and a danger to the society drives us to build these asylums far away in the outskirts with poor resources to reintegrate into the society, leading to further isolation and no respect for their fundamental rights The fiscal investment made in building these asylums is so minuscule that these people cannot even experience a basic standard of living.
A number of conferences and workshops conducted in the late 80’s brought to light the aspect that needed the maximum level of transformation. For instance: The Bangalore conference in 1988 finalized that mental hospitals should function as therapeutic centres for the betterment of community health.
The Erwadi Mental Home Fire of 2001
In 2001, a faith based mental home in Tamil Nadu which housed 28 inmates with severe mental health problems caught fire. The inmates being chained to the walls were charred to death. ‘Treatment’ apparatus for physical and mental illnesses consisted of holy water from the dargah and oil from a burning lamp. The treatment also included frequent caning and beatings to "drive away evil". During the day, patients were tied to trees with thick ropes. At night, they were tied to their beds with iron chains. Patients were to await divine commands in their dreams to go back home. This was purported to take anything from two months to several years.
After the Erwadi incident, all such asylums were shut down and brought greater attention to major issues that came to light, such as the civil rights of mental health patients as per the National Human Rights Commission (NHRC).
The 2017 Mental Health Act has attempted to address many of these problems. There has been an exponential increase in the number of organizations providing legal aid, resocialization services, employment opportunities for those belonging to the lower economic classes having to deal with a family member experiencing a mental health disorder, or any beneficiary of these services regardless of class.
The operationalised definitions about various mental health terms allows for more nuanced discussions. The act also lays down proper guidelines regarding consent, treatment, confidentiality, and client rights. It is certainly a major turning point for India, where the last legal reform occurred in 1987.
The way forward
It is also encouraging to see so many vocational programs and employment opportunities now available for people with developmental and intellectual conditions like Downs’ syndrome. Observationally, the hospitality sector seems also to have been welcoming including these people in the workforce.
In my personal experience dating back to the year of 2017, while volunteering with a not-for-profit in Delhi, I trained individuals in vocational skills so that they become employable and could have an equal footing during campus recruitment drives as those considered ‘abled’.
In India, the proportion of beds per 10,000 patients in psychiatric hospitals is 1.490, and 0.823 in general hospitals, indicative of the infrastructural shortage. Fresh statistics show that there are only 0.3 psychiatrists, 0.12 Nurses, 0.07 psychologists, 0.07 social workers per a population of 100,000. The economic loss that our country bears due to the existing mental health conditions is 1.03 trillion of 2010 dollars.
Sweeping mental health issues under the carpet harms both the afflicted individuals and the economy. The deep-rooted stigma and taboo attached to this particular form of health has the potential to create huge gaps between productivity and economic growth in each sector of the economy. The psychiatric morbidity in working and non-working women is as high as 38 and 26 percent respectively. The struggle to maintain a work-life balance, to achieve an independent identity are have additive effects to the existing discrimination and gap faced by this gender.
The proposition to provide more funds, creating inclusive places is a good way to show off how our country deals with such issues but there is a need for improved accountability. Even in present times, the Act of 2017 mentions a clause of Advance Directive (AD) which implies that a patient will have a choice to decide the matter of treatment. The Act presumes that the patients have sufficient knowledge in regard to the various treatment options available, which is hard to imagine, especially in an Indian setting. The Act also fails to provide the full list of treatment options available so that a decision can be taken by the individual without any misinformation.
India being the 5th largest economy leaves a lot opportunity for improvement when it comes to the mental health landscape. It is not only about normalizing mental health issues and allowing people to live with dignity; the urgent need is to create a bigger agenda about mental health. Non- profit organizations, students, and professionals have been and still are still working tirelessly towards achieving this goal. An urgent need to appeal for increased funding from the government still persists.
Half-baked knowledge is a bigger problem than no knowledge at all. To be educated about mental health should be a part of the curriculum in schools, which in turn provides insight into these issues and the state and availability of mental health services and the civil rights associated with it in our country. The system which spreads knowledge about the same needs to be under the scanner constantly as there are rapid developments happening around the world and being outdated is not an option anymore.
Comments like “How could he have depression? He was successful, rich, and had great social support, yet it is unbelievable” betrays a lack of understanding of mental health conditions. The American Psychiatric Association and the World Health Organization have created the Diagnostic Statistical Manual of Mental Disorders (DSM) and the International Classification of diseases (ICD) respectively, and employs a large number of mental health professionals and researchers to studying and constantly update the criteria for each mental disorder. Years of work and research go into making them accessible and easily understandable for everyone. To continue to treats mental health conditions and the people suffering from it with derogation is unfathomable.
Besides campaigning for awareness, we, as individuals, need to be better informed and contribute our bit towards destigmatization. We must use social media to educate our extended families and peers, transforming it into a platform to talk about mental health and leverage change. Being discerning with the information we consume, doing a thorough background check into mental health service providers and the therapies they offer is just the tip of the iceberg. To create more openness about these issues requires a change as small as talking to people with more kindness, and becoming more mindful of our own mental health and those around us. A trade secret that the professionals of this field adhere by is empathy - a quality that we should imbibe in ourselves universally. A little empathy might just save a life.
A step forward is good enough if only it is implemented in its best capacity. Basic access to mental healthcare is essential for each individual, but the knowledge of it needs to be spread at an exponential rate. The primary prevention systems at the core need to have a stronger hold in our society.
A better tomorrow awaits for which our present self needs to be more informed, alert and kind.
Nishtha Khurana is a Mental Health Advocate at Nolmë Labs. She is currently completing her Masters degree in Clinical Psychology, and wishes to contribute to improving the current mental health scenario of India. Putting on some old rock music while baking is her ideal way to relax.