By Our Correspondent / New Delhi
A survey in urban and rural regions conducted across seven states of North India analysing access to mental healthcare, awareness and attitudes has revealed that over 150 million Indians are suffering from mental illness in need of active interventions.
This study seeks to develop a further understanding of challenges in access to mental health care by studying a population spread across a wide area and age-groups which would ordinarily be expected to be informed and in a position to seek medical treatment if needed.”
On the eve of the World Mental Health Day, findings of a survey of 10,233 individuals in urban and rural regions conducted across seven states of North India analysing access to mental healthcare, awareness and attitudes was released.
The independent study, largest of its kind, highlights areas to bridge a wide treatment gap and provides compelling insights.
The study was conducted by CIMBS, New Delhi in collaboration with the World Federation for Mental Health (WFMH) which announced “Mental Health Promotion and Suicide Prevention” as the theme for the World Mental Health Day being observed on October 10th. The study is also supported by the World Dignity Project.
Dr Sunil Mittal, Senior Psychiatrist & Director, WFMH leading its initiatives in India, said “The National Mental Health Survey (2016) estimates the lifetime prevalence of mental illness in India of 13.7% and over 150 million Indians with mental illness in need of active interventions. This study seeks to develop a further understanding of challenges in access to mental health care by studying a population spread across a wide area and age-groups which would ordinarily be expected to be informed and in a position to seek medical treatment if needed.”
A surprising 80% of individuals surveyed either did not have health insurance or thought mental health treatment was not covered by their insurance. Dr Shobhana Mittal, Psychiatrist at CIMBS shared, “Costs can be a significant deterrent to healthcare, especially in case of chronic illnesses. Only 26% of individuals in the study felt that the government provided adequate support to those with mental illness. Despite this, there is a lack of preparedness for mental health; only 8% of respondents were aware whether their health insurance covered mental health treatment costs, while 9% were covered under a government scheme.”
Exploring the issue of lack of adequate facilities, Dr Sunil Mittal added,” Although 43% had knowledge of a person with mental illness within their family or friends, of them, nearly 20% reported no mental health facility or clinic even within a 50 km radius of their residence. Overall, only 49% had a mental health facility within a 20 km radius. Similarly, while 48% had a person with a known addiction in their family or friends, 59% had no de-addiction service near their house. Such distances are deterrents that contribute to a wide treatment gap.”
“There seems to be poor awareness of the Mental Healthcare Act, 2017 which directs insurance companies to provide coverage for mental health on equal basis as physical illnesses. Still, we see many patients delay treatment because they are unaware of this,” she added.
“28% did not consider attempting or committing suicide a sign of an underlying mental illness. India’s suicide rate of 17.8 per 100,000 is significantly higher than the global average of 10.5 per 100,000. Every year 2.2 lakh lives are lost to suicide in India, and India contributes 28% to all global suicides despite only 18% of the global population. For every suicide, it is estimated 25 more are attempted,” said Dr Shobhana Mittal. “Since a significant proportion of attempted suicides are not identified as a mental health issue, they are less likely to be met with intervention to address underlying mental health issues, “she added.
“The study adopted a ground-up approach seeking inputs from those it surveyed for strategies appropriate for improving access to mental healthcare in the respondents own regions. The data is detailed and interesting. We’ve analysed nearly 6,000 responses and once completed we hope to publish recommendations,” said Mitali Srivastava, Senior Psychologist at CIMBS.
This raises practical issues for caregivers facilitating treatment for persons with mental illnesses who feel there is a disconnect between on-ground realities and governmental policies. Citing instances requiring emergency treatment, Namrata Gupta, a caregiver for both her son and her husband, raised the issue of inadequate facilities, lack of support and excessive formalities which make accessing care even more difficult. “The nature of the caregivers’ role is invisible and complex, much like mental illness itself. The entire journey is laden with fears, insecurities, trauma, isolation and dysfunctionality. To add to it, the new laws do not cater to the concerns and needs of caregivers and their voice,” she says.
Srishti Jaju, Clinical Psychologist at CIMBS commented, “Availability of facilities has been an issue, and an overwhelming 87% individual’s favoured use of technology to try to bridge this divide by using mobile phones, apps, and tele-medicine.”
“The National Mental Health Programme was launched in 1982 to address inadequate mental health infrastructure and in 1996 a mental health service was planned in every district. Yet, decades later, infrastructure remains inadequate,” said Mrinal Kanwar, a Supreme Court lawyer actively involved in mental health advocacy.
The nearest mental health service to a respondent was equally likely to be a government or a private sector service. This trend is unlike other medical fields where an estimated 85% of healthcare is handled by the private sector, suggesting that the growth of mental health establishments in the non-governmental sector has been slow. In fact, the National Mental Health Survey, 2016 remarks on the lack of a delineated role for private institutions and practitioners despite their availability.
“There is a need for well-thought guidelines for a participatory approach to encourage non-governmental and private entities and address concerns regarding medico-legal issues in mental health service delivery, without which it is difficult to bridge the huge treatment gap that exists today. Similarly, innovation and adoption of technology like tele-medicine need to be promoted”, added lawyer Mrinal Kanwar.
Lacks of awareness of one’s rights have other consequences as well, explained Mrinal Kanwar, “The new law provides many rights for individuals, such as Advance Directives, which cannot be exercised unless individuals are aware and prepared.”
On misconceptions about mental health, Dr Sunil Mittal said, “Nearly 1 in 6 suffers from mental health issues, and it is amongst the most common chronic disorders. 49% respondents felt mental health issues were not common, and 57% individuals did not know of anyone with mental health issues, an indicator of difficulty in recognising symptoms in near and dear ones.”
“Surprisingly, even amongst those who had close interactions with a person with mental illness, 35% thought mental health issues were uncommon suggesting conversations on mental illness remains taboo. This could possibly be explained by 41% of those who had a person with mental illness amongst their near and dear ones feeling that other people were insensitive and likely to ridicule a patient,” he added. “Even 44% of those who had an addict in their family or friend circle believed mental health issues were uncommon in their city,” said Mitali Srivastava.
“55% of respondents felt people with mental illnesses are considered dangerous. This is a misconception; those with mental illness are more likely to get abused or victimized by others rather than inflicting danger to others. This perception is also encouraged by the portrayal of mental illnesses in popular culture such as cinema”, said Dr Deepali Bansal, Psychiatrist at CIMBS.
“It was interesting to note that only 43% felt that a person dealing with a mental health issue was likely to be taken to a hospital, while 44% felt the person may be counselled by family members or taken to a local healer or a baba/ tantric,” said Mitali Srivastava.
61% of respondents felt laws should make it easier for patients (22%) and caregivers (39%) to get treatment. Such respondents include some who may be unfamiliar with legal provisions, and also others who have had difficult experiences. “I, as a caregiver, feel stuck between my loved ones who need treatment and the formalities and laws being laid down,” says caregiver Namrata Gupta.
The top three suggestions for promoting mental healthcare including, opening of more mental health facilities (37%), easier process for caregivers to facilitate treatment for persons with mental illness (28%) and public social campaigns (24%).