Every story has a past and the story of mental health is no different. It took us some hundred-odd years to move from the Lunacy Act of 1912 to the Mental Health Act of 1987 and then to Mental Healthcare Act of 2017. But in these 100 years, mental health has been badly ignored and relegated to an insignificant appendage. Mental healthcare gives a gloomy and dark picture. The real picture of mental hospitals, psychiatric wards, and mental retardation homes is a tale of neglect, abuse, victimisation, violation of rights, depravity, and the dark and denied part of ourselves which we want to do away with. Progress has been made, the chained patients are now drugged with obedience, but the abandoned women, children, are still witnessing the hell. The taboos around mental illness and the unsaid fear of a mentally ill, lead one to either negate, deny or ridicule a person who suffers from mental illness. A visit to a mental hospital should be a must for people to understand the dark underbelly of civil society.
Our performance today hasn’t improved. According to WHO (2020), the mental health workforce in India is not up to the mark and there is a huge shortage of psychiatrists and psychologists in the country as compared to the number of people suffering from mental health issues in India. WHO states that in India, (per 100,000 population) there are psychiatrists (0.3), nurses (0.12), psychologists (0.07), and social workers (0.07), while the required number is anything above three psychiatrists and psychologists per 100,000 population. WHO also estimates that about 7.5 percent of Indians suffer from some kind of mental disorder and has also predicted that by the end of 2020 and 2021, almost 20 percent of India will suffer from some kind of mental illness. According to the numbers, 56 million Indians suffer from depression and another 38 million Indians suffer from anxiety disorders. India also accounts for 36.6 percent of suicides globally, and that suicide has surpassed maternal mortality as the leading cause of death among women and teenage girls aged between 15 and 19 years. Further according to WHO, the burden of mental health problems is of the tune of 2,443 disability-adjusted life years (DALYs), per 100,000 population and years lived with disability (YLDs), and the age-adjusted suicide rate per 100,000 population is 21.1. WHO also estimates that, in India, the economic loss, due to mental health conditions between 2012 and 2030, is $1.03 trillion.
In simple words, this data depicts certain concerns and the first concern is the demand of mental health professionals that far exceeds the supply and the gap is humungous. Second, mental health problems are almost becoming a pandemic. Third, mental health problems lead to poor quality of life and are debilitating, and it also hinders performance and causes economic loss to the nation.
What exactly does mental illness and health mean? When one talks about mental health, we presume we are talking of all those people going to the psychiatric wards and hospitals totally crippled with their suffering and not able to function normally, and we are right. But this is not the whole picture, mental health also includes many children, adolescents, adults, and old people who are able to carry on their daily routines, hold a job, go to school, but are having difficulty coping with the problems of everyday living and thereby their quality of life and happiness is affected. Mental health also includes coping strategies, lifestyle measures that we take for a healthy and happy life. Mental health encompasses both health and illness. It includes those we call mentally ill and all those who are going about their daily life with visibly obvious issues of coping and adjustment. And mental health includes all the population irrespective of age and gender because we all need training in managing effectively our emotions, thoughts, and behavior to better our lives and those of others around us.
Determinants of mental health include individual attributes such as the ability to manage one’s thoughts, emotions, behaviors, and interactions with others. In addition, social, cultural, economic, political, and environmental factors have a role to play as do the specific psychological and personality and genetic factors. And mental health affects all of us equally, be it children, adolescents, adults, elders, and even animals. Positive mental health is a need for all life forms. It is the basis of happiness and also the reason for living.
It is ironic that we take care of our physical body and right from our birth, we are taught how to eat, what to eat, how to dress, how to look, how much to weigh, and many other things through socialisation, but all our life what troubles us are our emotions, thoughts and consequent behaviour. When it comes to a person’s physical health, people are so conscious and aware these days—they also have access to a lot more things to maintain their health, they know everything about superfoods, the latest diet trends or workouts, but when it comes to mental health, the awareness just isn’t there. So many people aren’t even aware that they may be suffering from some form of mental health issue. So many people aren’t even aware that happiness is the result of a healthy mind.
We are literate as far as our body is concerned, but emotionally, mentally, and spiritually we are illiterate. We have been taught how to manage and beautify our body, but no one has taught us how to handle and deal with our thoughts and emotions. Nobody has taught us how to have a beautiful and peaceful mind. Happiness is a by-product of our mental state, it is contemplating that we rank 139 out of 149 countries as per the happiness index ranking. The biggest myth that people believe is that thoughts, emotions, and personality are all innate and unchangeable, whereas the truth is that they are not inborn and permanent, but through training and practice one can have control over them.
Our personality, attitudes, and other psychological aspects are all skills that can be acquired. This needs to start right from childhood. The other myth is that the mind, emotions, and thoughts have no role in maintaining body health. All physiological diseases have a psychological origin. Psychosomatic diseases are the direct result of stress, that is psychological factors affecting the body. Some examples are heart attack, asthma, and many more which are fatal and can cause death. If something is psychosomatic, it does not mean it is not life-threatening.
What then is the answer to all of that? How does one move forward? How does one ensure that all programs are structured for the rural and urban population? How does one bring about change and how does one effectively reach out to all those that require counseling by mental health professionals? How do we train and produce more mental health professionals? How does one educate, train and empower people emotionally, mentally so that they can improve the quality of their life? How does one create awareness and increase the acceptability of the mentally ill, differently-abled, or challenged to make them socially inclusive and friendly?
What we propose in a nutshell is a three-pronged approach to mental health literacy:
1) Create awareness and build acceptance about mental health, mental illness, psychological wellness, and well-being by building inclusive classrooms, workplaces and make diversity a way of life for the urban as well as rural population.
2) To provide counselling and mental health services to people who are also contextualised and customised.
3) Capacity buildingand scaling through training and skilling, we can increase the number of mental health workers so that mental health services can be made available to the entire society.
We can build a mentally literate society through the following endeavours:
Psychological Counselling and Psychotherapy: Talking is therapeutic and cathartic if we provide a safe space for people to talk without any fear of being judged, ridiculed, or admonished about right and wrong in complete confidentiality and secrecy. It can be both individual and group counseling and therapy.
The counselling should be contextual and accompanied by Western techniques, and it should be culture-specific too. It should be in various areas: Mental Health Counselling; Relationship and Family Counselling; Guidance and Career Counselling; Rehabilitation Counselling; Educational Counselling; Substance Abuse Counselling and Sports Counselling
Psychological/Psychometric Assessment and Testing: A wide range of scientific, standardized tests, measures, and psychological instruments can be used to measure and test various aspects of one’s behaviour, personality, attitude, mental status, aptitude, career interests, career skills, relationships, adjustment, leadership skills, emotional intelligence, social intelligence, etc.
Child and Adolescent Care: Life skills training, employability training, psychological assessment to know themselves, and positive psychology training can be given to enable and empower them with the skills, knowledge, and techniques needed to live a fulfilling and productive life.
Research, Assessment, and Development: An intellectual foundation is necessary and research is the answer. One needs to specifically focus on Indic systems and solutions where at least in psychology not much has been done. The psychological counseling and therapy and everything else that is followed is very western knowledge-centric and that is one of the reasons why psychology, unlike the west, has not made itself an indispensable part of the mind space of the individual, community, and society. By working and doing innovative, contextual, culture-specific, and applied research in this realm, we can hope to find answers to making mental health an indispensable part of everyone’s life.
Life Skills Training/Behavioural Skills Training/PersonalityEnhancement Training: We have not learned nor been ever taught how to manage our emotions and thoughts to lead a healthy life. Through training in emotional intelligence, social intelligence, spiritual intelligence, and more we seek to empower individuals- children, youth, adults, and elders to live with dignity, respect, and self-reliance while helping others to do the same. With the help of positive psychology, mindfulness, we can improve the quality of life, increase the happiness and wellbeing index of the person, and then eventually the nation.
Capacity Building through Counselling Skills Learning Programme: In a scenario where the number of people suffering from mental illness far exceeds the number of mental professionals available how does one scale up so that one can reach villages too along with the cities. The way out is capacity building of primary healthcare workers, teachers, and community members. Teachers are the first people who can be the torch bearers in ensuring mental health becomes a household term. School is where discrimination and abuse of differently-abled people begin. Students are beaten, ridiculed especially children with learning disabilities because of lack of knowledge. Training teachers in counseling skills, psychological first aid, and crisis intervention will not only help in easing the pain of the children, youth, adults, and elders who are facing the challenges but will also help in building inclusive classrooms and communities and accepting diversity. Internships and mentoring can be other modes of capacity building.
Community Focused Projects, and Volunteering: What mental health needs is social action research and interventions based on the primary research to make long-lasting and deliverable changes and build an inclusive, diverse community, and a society that makes psychological wellness, happiness, quality of life, and mental health literacy as the benchmark for a progressive society.
Dr Chavi Bhargava Sharma is a psychologist with more than 29 years of expertise in the area. She is also an educational entrepreneur who is involved in academics and research.