AIR spotlight summary on “World Mental Health Day”.
Mental Health Day is observed every year on 10th October to raise awareness about mental health issues around the world and mobilising effort of mental health. Suicide is not a crime, but a kind of mental disorder.
Stigma of mental illness
- At one point of time the stigma of mental illness was all around the globe. It still exist all around the globe, but is significantly less in Europe, US and some of the developed countries because of the awareness programmes and the science having reached. In some parts of Asia and Africa the stigma still continues.
- The major focus is on reducing the stigma of mental illness, mainly on not misunderstanding any psychiatric problem or mental health problem as severe mental disorder or lunacy. People with bipolar disorder and schizophrenia are significantly disturbed, danger to self or others, and socially embarrassing. These were referred to as lunacy.
- 100 or 150 years ago society was not concerned about the welfare of people with mental illness. They were put in asylums and mental hospitals for the society’s safety. In the last 50 years treatment methods are available for mental illness which is significant in the last 20 years. Reducing the stigma is very important.
- Respecting the human rights of the persons who are living with mental illness is important. One of the notable examples is the depression and their commonly noted complication is the suicide behaviour.
Common mental disorders
- Bipolar disorder and schizophrenia used to be called psychosis. Their frequency in the human population is not very large. These are genetically and biologically caused, their frequency remain to be about 2 to 3 percent of human population. The other group called neurosis, depression, anxiety, phobia, obsessive disorder these are referred to as common mental disorders. This will vary according to the culture, developmental stage of the society, the social values, the family system and other economic factors.
- In India the common mental disorders is estimated to be 6 to 8 percent. In Europe and US it is around 20 percent. Global estimate says one in four persons may have life time risk of mental illness anytime. Indian data indicates mental illness less common including depression. It is one in ten people. Depression is a condition where the person feels totally negative about oneself, losing all hope and confidence, and doesn’t believe the life is worth living. The common complication is suicide behaviour.
- There is a specific character of suicide behaviour. It does not occur in high income countries but it may be familiar to Indian culture. As per WHO data more than 8 lakh people die every year due to suicide.
- In old age a lot of problems of the body and the mind increase. With the longer life expectancy, what was not a major public health concern is now a major public health concern. The early onset of intellectual decay and memory deficit occurs in dementia.
- Dementia requires lot of care. Families are breaking up and there are not many to look after the elderly.
- Mental retardation is now called intellectual impairment is when the child generally at birth because of genetic reasons has limited intellectual capacity. Lot of people with intellectual impairment can be trained and rehabilitated to bring out the best potential. There is no treatment for intellectual impairment or retardation.
- Till date suicide was a criminal offence under section 309 of IPC, now the government is planning to delete this section. This is very positive development in the right direction. It should have happened 2 or 3 decades ago.
- Indeed the Supreme Court in 1990s in one judgement which read down section 309. But then for technical constitutional reasons the other 5 judge bench said that decriminalising suicide should not be done by judiciary, it should be done by parliament.
- The idea is that somebody attempting suicide should be seen as a person in need of help, mostly with a psychiatric disorder and the suicide behaviour is seen as a cry for help. Because section 309 was applicable many individuals, their family members, hospitals and doctors rarely ever reported the suicide attempts.
- If we don’t report and help the person go for help, the attempts keep recurring, where the decriminalisation in the new mental health care bill, 2016 is extremely progressive step.
Depression as a significant public health problem
- Every day sadness, feeling of low or negative thoughts need not be seen as depression. Depression as a clinical disease would be significant impairment of one’s life, sustained feeling of low mood, negative thoughts and decreased activities. Once there is a classical symptoms of negative thoughts, and decreased efficiency of work for more than 4 weeks can be seen as clinical depression.
- Depression is a significant public health problem as common as road injury, cardiac problems, cancer and even more than that. It is easily treatable and preventable.
- WHO says depression is the leading cause of disability worldwide and is a major contributor for the overall burden. More women are affected by depression than men.
- With long term medical conditions like kidney and heart problems etc, there is associated depression. Because of the physical illness people also develop depression. The recognition of the overlap of physical and mental health is important. If we treat depression with physical illness well then the physical illness in fact performs better.
- The data suggests that the people with diabetes and heart problems will fare much better if the associated depression is identified and treated.
National Mental health Programme
- National Mental health Programme in India was one of the first in the world. Unfortunately for various reasons of funding, social attitudes, and basic lack of human resource it got delayed in the first 20 to 25 years. In the last few years it has picked up again.
- Currently National Mental health Programme is available in most states although not in all districts. The new Mental Health care Bill, 2016 does provide mental health care as a basic right. So every state should provide minimal mental health care to everyone who requires.
- State mental health institutions, general hospitals, private practice, and NGOs can together help achieve the dream of mental health care for all.
- WHO says if we don’t act urgently, by 2030 depression will be the leading illness globally.