Back in April, Prime Minister Narendra Modi, who addresses the nation every month on his radio programme, Mann ki Baat, surprised his audience by talking about mental illness, a topic Indians tiptoe around awkwardly. For the listeners, it was difficult to accept that they were being asked to open up about something they have been conditioned to brush under the carpet. This is because mental illness, much like menstruation, remains a taboo topic in the country because of a lack of awareness among educators, caregivers and society at large.
One in four people in the world will be affected by mental or neurological disorders at some point in their lives, as per the World Health Organization (WHO). Currently, around 450 million people in the world are suffering from such conditions. In India, a country with a population nearing 1.5 billion, the WHO estimates that the number of people affected by depressive disorders alone is around 4.5%—roughly 56 million people. In 2005, only 3% of the Indian population suffered from common mental disorders, as per a 2005 report by the National Commission on Macroeconomics and Health. The report added that around 2% (10-20 million people) of the population suffered from severe mental disorders such as schizophrenia and bipolar disorder. Many cases of depression are categorised under ‘reactive depression’, which is different from other disorders like persistent depressive disorder, bipolar disorder and psychotic depressive disorder.
Reactive depression is a state of depression precipitated by severe traumatic events in a person’s life, but it’s not the same as post-traumatic stress. There are a variety of symptoms that people with reactive depression may experience, as everyone reacts differently to stressful events. Some people, for instance, may experience appetite changes, while others may experience intense anxiety and may turn to drugs and alcohol for relief. Depressive disorder is a serious medical illness that negatively affect how one feels, and the way one thinks and acts. The disorder causes feelings of sadness and/or loss of interest in activities once enjoyed, leading to a variety of emotional and physical problems. It’s a misconception, though, that these disorders are caused only by emotional trauma, says Uday Sinha, head of department, psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi. There could be a variety of factors at play, he says. In the past 10 years, Sinha says, IHBAS has documented a 55.09% increase in the number of psychological and psychiatric disorders being reported—over five lakh people sought treatment in 2016 compared to a little over two lakh in 2006.
Causes & triggers
Sumit Kumar, assistant professor, psychiatry, IHBAS, attributes these rise in numbers to the rapid changes in one’s ‘bio-psycho-social’ (BPS) environment. The BPS model, as per Kumar, can be studied to assess the possible triggers to most mental disorders diagnosed under psychological and psychiatric categories. As per his research, biological factors in the model contribute to a 50% predisposition towards mental disorders that are further triggered by changes in the social or psychological spectrum that people find hard to cope with. “Any situation that requires a healthy coping mechanism may be a stressor towards developing a mental disorder in case of failure,” Kumar explains.
The BPS model marks changes in our environment that we are all familiar with—long working hours, sleep deprivation, unhealthy diet and a lack of leisure time. But, as Kumar points out, more specific changes in the familial set-up (rise in the number of nuclear families), increased isolation, virtual dependence and a general lack of physical upkeep result in a weak support system and a low immune system, both of which should be taken care of in order to be holistically healthy. Kumar also expresses concern over the frequency of mental disorders in children and young adults, the growth of which, he says, has outpaced the growth of mental disorders in adults. Research, he says, is underway to study the leading factors behind the increasing diagnosis of attention deficit hyperactive disorder, autism and conduct disorder in younger patients nowadays. The marked difference in the number of registered cases can also be observed in other institutes such as Sharda Hospital, Greater Noida, which has a dedicated mental health wing since it commenced operations in 2005.
The outpatient department receives almost 70 patients per day today in comparison to the 10 or 20 patients who used to trickle in more than a decade ago. “We see more and more people coming in for help now because of early identification,” says Abhay Singh Tomar, consultant psychiatrist, Sharda Hospital. In his five-year stint at the hospital, he has treated patients from both rural and urban set-ups, but has observed a greater number of urban cases. “They (urban patients) are more aware and come in even with less severe problems, whereas the rural footfall consists mostly of extreme cases of neurotic and psychotic disorders,” says Tomar, adding that treating rural patients proves to be more difficult because of their lack of awareness. More often than not, rural cases come in at the very last stage after having been to faith healers and quacks, complicating their condition even more, says Tomar. Psychiatric illnesses are chronic and their remedies generally take longer to take effect, which may often dissuade someone coming from the interiors of the region, especially for treatment, as per Tomar. It’s essential, hence, to create social acceptance towards mental illness, says Tomar.
The social acceptance that Tomar mentions is now slowly making its way into the mainstream. This has largely been possible thanks to some celebrities who have come out in the open, relating their own struggles with mental disorders. Actor Deepika Padukone, for instance, made headlines two years ago when she spoke about her struggle with depression, how she sought professional help and recovered with medication and therapy. The public reaction ranged from offering support to lauding her for talking about her illness publicly and even tagging it as a promotional stunt. Padukone went on to found The Live, Love, Laugh Foundation (TLLLF), a mental health awareness organisation, the same year. Soon, other celebrities such as Anushka Sharma, Manisha Koirala and Honey Singh also came out with their own stories of depression, anxiety and rehabilitation, bringing more mainstream media coverage to the issue. Kumar of IHBAS tags this outpouring of confessions as the ‘social modelling effect’, which, by definition, means behaviour that gains social acceptance due to awareness or education and becomes a regular practice once it’s deemed appropriate. This effect has the potential to reach many more people, encouraging them to seek help, says Anna Chandy, chairperson, TLLLF.
Chandy says she has observed an alarming trend online. More and more people these days engage with strangers on virtual platforms who troll, bully and send hate messages. Since the younger generation is more in tandem with social media, this impacts them in a negative way. It is, hence, essential to educate them early on about mental health and de-stigmatise professional help, therapy and medication, she says. This requires a concentrated and cohesive effort from the media, the government, local communities, religious and spiritual leaders, educators and mental health professionals, says Chandy. While it’s true that celebrities talking about their battles with mental disorders has thrown the spotlight on the issue, experts say their reach has only been confined to urban centres. “There is no influence of celebrities below the poverty line,” says Amarendra Singh of Varanasi’s Government Mental Hospital. Singh has a point. Mental healthcare and awareness take a backseat in rural areas, where the bigger crisis at hand is the socio-economic condition of the people. Farmer suicides happen because of mental problems that go untreated, he says. Awareness in rural areas can be achieved by empowering village panchayats, the state authorities and those working at the grassroots level, with information, funds and supplies, Singh says.
The country took a huge leap forward this year in March when the government passed the Mental Healthcare Act, 2017, which provides mental healthcare and services for persons with mental illness and provisions to protect, promote and fulfill the rights of such persons during the delivery of mental healthcare and services. It not only turned Section 309 on its head by decriminalising suicide, it also ensured that the law now gives people the right to access treatment from government agencies at no charge for the mentally ill, the homeless and poor. The Act defines the criteria to avail the said provision—without any religious, gender or caste bias—and gives mentally ill people the right to give an ‘advance directive’ as to how they would want to be treated, by whom they would want to be taken care of and the right to appoint a nominated representative to negotiate on their behalf. The Act reinstates the dignity of the mentally ill by providing for their inclusion in society, rehabilitation in case of abandonment by family or homelessness, and free legal service to exercise this right. The Act also lays down duties for the government, directing it to create awareness about the Act, to take measures to provide for the human resource required to execute the Act and to coordinate with state ministries for smooth implementation. As per the law, the Act is to come into force the day it receives the President’s assent or the day the Act completes nine months from the date of its inception in March. “It looks great on paper, but it will require tremendous effort from the government to see it through,” says Ajay Nihalani, psychiatrist, Vidyasagar Institute of Mental Health and Neuro Sciences, New Delhi.
He feels that the government should collaborate with the private sector for this. Apart from the government, other oganisations already working towards tackling depression and mental illness include The Banyan, Chennai, that started in 1993. It provides access to care and rehabilitation, delivers community awareness and instigates policy advocacy and research. The NGO treats as many as 3,000 patients annually. Then there is Kolkata-based Anjali. Ratnaboli Ray, the founder of the NGO that works with patients suffering from psychotic disorders, says growing up with two schizophrenic aunts made her empathetic to mental illness at a very young age. Her organisation works towards making mental health institutions and systems inclusive, building community ecosystems for mental healthcare and well-being, and ending stigma, violation and discrimination associated with mental health in India. They have several programmes that include therapy, shelter, relaxation and rehabilitation for patients who are referred to them by government institutes. Another organisation, AASRA, in Mumbai is a crisis intervention centre for the lonely, distressed and suicidal. AASRA provides a 24×7 helpline run by trained professionals who deal with suicidal callers on a daily basis. Since inception, AASRA’s helpline services have been accessed by over three lakh callers, as per the website. There has been an exponential increase in the number of callers over the past few years, says a volunteer, adding that they attribute this to growing awareness among the youth, or the social modelling effect. Along with these NGOs, Mumbai-based Manav Foundation and Shraddha Rehabilitation Foundation also work towards making a difference in the lives of those who suffer from mental illness by reaching out to them with their volunteer work.
By Ananaya Banerjee