The stigma surrounding the term ‘mental health’ is especially severe in Indian culture, where any deviation from the so-called ‘normal’ is viewed with a negative pair of lenses. Why do people hesitate to seek help? Are there enough mental health professionals in our country? Is information about mental illnesses easily accessible to the public for them to make informed decisions? What is the way forward? These are some of the issues that Anushka Banerjee, a Junior Research Fellow at the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru addresses in this article.
“Oh, so you work with crazy people, do you? I hope you don’t end up going mad along with the rest of them!” chortles a distant relative, upon hearing that I work at the National Institute of Mental Health and Neurosciences (NIMHANS). I sigh and choose not to take his words to heart. Statements like this one are commonplace in India, where insensitivity, myths and misrepresentations around mental illnesses are a dime a dozen. Talking about mental health continues to be heavily stigmatized in India, where people worry more about what their neighbours will say rather than their doctor. A sharp rebuttal is usually enough to silence self-styled jokers who choose to make fun of people struggling with mental health disorders. But what happens if patients themselves choose not to see a doctor, because of this stigma?
Dhruva Ithal, a clinician-researcher in the Department of Psychiatry at NIMHANS, says that patients are usually extremely hesitant in seeking medical advice for mental illnesses. “Most people are generally unable to muster up the courage to visit a doctor until their situation becomes quite dire. Patients suffering from psychosis (a condition which causes people to lose touch with reality; e.g., schizophrenia ) usually approach doctors only when they see their loved ones being affected by their behaviour. Patients with neurosis (a class of mental disorders that is characterized by feelings of distress; e.g., depression or anxiety) are hesitant to see a doctor because they don’t believe their problem is serious enough to warrant a visit to the clinic,” says Ithal.
Another reason for delays in seeking medical attention may be when symptoms in a patient coincide with gender stereotypes prevalent in our society. For instance, a woman’s excessive cleaning (a symptom of someone with obsessive compulsive disorder (OCD)) or a man’s addiction to alcohol may be perceived as ‘normal behaviour’. In reality however, a person battling with addiction cannot stop at will, similar to someone with OCD preferring neatness. Both conditions can be extremely distressing for patients and their families, and require medical intervention. But patients themselves, and people around them, may not deem medical intervention as necessary in such situations (as stereotypes dictate that women should actively keep their households clean, and drinking in men is common).
As a psychiatric social worker at NIMHANS, Anand Jose Kannampuzha has encountered many types of myths pertaining to mental disorders. “People try to ‘explain away’ their symptoms in different manners. Patients suffering from addiction issues will make excuses for their behaviour, like saying it is ‘a way to deal with stress’. Patients with psychosis often believe in spiritual or religious reasons for their behaviour. Some think they are possessed by a supernatural force. Others believe that their families are cursed, and generation after generation will suffer the same consequences, when this ‘curse’ could simply be a heritable condition being passed down from parents to their children,” he says.
The idiosyncrasies of select individuals lead to staggering collective consequences. The National Mental Health Survey of 2015 – 16 revealed that “nearly 15% of adults in India are in need of active interventions for one or more mental health issues”.
A foundation for public healthcare systems pertaining to mental health has existed in India, but it needs to be further developed. The Government of India introduced the National Mental Health Program in 1982 to develop manpower, modernize departments for mental health specialties in medical colleges, provide aid to upgrade mental hospitals, and set up district mental health programmes.
A comprehensive report from 2011-12 on the state-wise status of schemes shows that many states succeeded in providing citizens with access to psychiatrists, suicide prevention clinics, and counseling. However, several district mental health programmes were shut down after running for a few years. It may have been difficult to recruit trained professionals due to a severe shortage of mental health professionals in the country. In a 2019 letter to the editor of the Indian Journal of Psychiatry, psychiatrists from NIMHANS estimated that there are only 0.75 psychiatrists per 100,000 persons in India, when ideally, it should be between 3 – 5. Findings such as these, and from the National Mental Health Survey, led to a revamping of the National Mental Health Program, with the introduction of the Mental Health Care Act of 2017. This act aims to recognise and protect the rights of people with mental illnesses. It allows people to make decisions regarding their health, given that they have the appropriate knowledge to do so. It also decriminalized suicide attempts, in order to provide people opportunities for rehabilitation. Such steps are a welcome option for patients to have a voice in their psychiatric treatments, and general mental well-being.
To go forward from here, an important facet is the provision of comprehensive and easily accessible information. Both Ithal and Jose agree that spreading awareness about mental illnesses is the best way to prevent myths from spreading. “There should be primary centres in towns and villages, where people can approach doctors easily,” says Ithal. Jose adds, “The reach of social media is incredible. A lot of information is spread even in small places through mediums like films, WhatsApp and Facebook. I think it’s important that the correct information about mental illnesses be provided through these agencies.” Many people might be unaware of the provision of such programmes and schemes, either due to lack of information or misrepresentation of mental illnesses in our society. This could be one of the reasons that many of the programs were unable to run long term.
Addressing the importance of easily accessible and understandable information about current research being done in this field, V. Sowmya, a doctoral researcher in the Molecular Genetics Lab at NIMHANS, says, “I have seen patients being much more open to the idea of treatment once we explain the intricacies of the illness to them and tell them about the research we do. The hope that we may someday be able to treat these disorders using data we collected from them makes them understand the importance of their contributions.” She also stressed upon the need for more qualified healthcare professionals and primary mental health care centres in small cities and towns. “It often becomes difficult for patients and their families to travel to institutions like NIMHANS for follow-up appointments, which often leads to discontinuation of the treatment,” she says.
It is extremely important that awareness and information about mental illnesses penetrates not just our cities and towns, but also the most remote villages. Pertinent information, access to treatment, and starting conversations about mental health cannot be limited to just metropolitan cities. India is on the brink of a mental health crisis and it is important for government programs, non-government organizations, professionals, and local volunteers to come together and make sure our citizens are informed about what they are experiencing and that help is right around the corner.