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Access to mental health care: Disparity among Indians

Introduction

Mental health and its awareness have become a concerning problem that requires a great deal of attention. The worrisome prevalence of mental health disorders connected to accessibility is increasing as the population and lifestyle change dramatically. Unlike basic physical healthcare, mental health has long been stigmatized, and the current societal climate only serves to exacerbate the problem.

Many social groups lack basic mental health resources, and despite extensive efforts, only a small percentage of them have gained access. Despite significant advancements in technology and medicine, as well as significant interventions in people’s mindsets, fear, judgmental views, taboos, attitudes, and so on are unavoidable among the general population. Several additional variables contribute to the uneven distribution of mental health resources across the country.

In the following article, we will discuss the many factors that have hampered the expansion of mental health access and how this has impacted people in general, as well as a few strategies for ensuring mental health access to all.

Stigma to mental health has been caused due by 3 main factors:

  • The illness goes untreated for many years.
  • Treatment is not met with proper requirements in rural areas.
  • Families of patients use alternative methods of treatment like faith healing, allopathy etc.

Causes and consequences 

There are numerous reasons for the enormous discrepancy in mental health access. A shortage of mental health experts might be one of them. Even though this area has advanced significantly, it is still stigmatized, and only a small percentage of people choose it as their primary career route. In remote regions, mental health professionals are hard to come by, and the cost barrier makes matters even worse. Unlike physiological disorders, many individuals are still ignorant of the importance of mental health. Because of a lack of mental health knowledge, many people go untreated because they believe their emotional or mental state is normal.

People are frequently hesitant to seek mental health treatment because of the stigma attached to it. Being mentally sick, or simply talking about mental health, is still taboo leading to even greater negligence in seeking assistance.

In the NCHB poll, 31% of respondents stated they wanted to get mental health treatment but were afraid about what others might say. Although 29% stated they received mental healthcare, they lied about going to a mental health centre. These are only a few reasons why individuals do not seek mental health treatment or why there is a discrepancy in mental health care availability. Several additional factors, such as lack of government resources, lack of adequate awareness and instruction beginning in elementary school, and parents who refuse to enable their children to seek mental health treatment, and so on also play significant roles.

All of this resulted in individuals not obtaining the correct or necessary mental health care, resulting in poor parenting, poor peer connections, aberrant societal functioning, and so on. Not only that, but it also hurts the youth, working-class and further. Not obtaining adequate mental healthcare can result in a large number of people going untreated, which can lead to an increase in suicide rates, depression, and other mental disorders.

Pupils who require assistance may be unable to absorb or comprehend the principles being taught, and as a result, students may be denied adequate education on a mass scale, resulting in a vicious cycle of mental illness. It’s time for us to stand up and take individual steps to ensure that we have equitable access to mental health care.

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Barriers involved in access 

The World Health Organization (WHO) states Indians have high rate of depression compared to other countries. Depression and anxiety related disorders are some of the major prevalent mental health issues in our society. Physical injuries are identifiable and visible. Mental illnesses on the other hand are not easily recognised or acknowledged.

Often, symptoms are dismissed as attitude issues. Clinical anxiety could be rejected as worrying too much, A person going through depression might be called lazy. Even serious symptoms are dismissed by the person suffering or those around them. Most of the times, people mistake their emotional or mental status for normal, not realizing that these are clinical symptoms.

Mental health is often misunderstood; families view members with mental illnesses as someone who stain the family’s reputation or dignity. The stigma associated with mental illness, make individual hesitant to seek help, for he/she is seen as weak or fundamentally flawed individual. Age old beliefs cause people to look at mentally ill people as possessed. Spiritual leaders, folk doctors and elders of the family are often approached for spiritual ‘treatment’ instead of medical intervention.

Understanding the stigmas and barriers help us to renovate our policies and programs towards better mental health access.

Mental health access in India

The Government of India passed the Mental Healthcare Bill 2016 which gives mental healthcare and services for people with mental illness. The bill has decriminalized suicide. The Bill passed to legislation in the year 2017 at the Lok Sabha. The bill assures the following:

  1. Citizen shall have right to access mental health care and treatment provided by the government.
  2. Treatment for people is assured for those who are poor/ below the poverty line.
  3. The decriminalization of suicide is also stated. The individual shall have been assumed to be under stress. No punishment shall follow suit. (No liability to punishment under Code 309)
  4. The Government also must provide mental health care and reduce the risk of attempted suicide.
  5. The person diagnosed with a mental illness can choose their preferred mode of treatment and also nominate a representative.

Further, the GOI will set Central Mental Health Authority at national level and a State Mental Health Authority in every state.  The rights of the individuals who are undergoing treatment shall be protected at all times as well. The passing of this bill was an important step in replacing and renewing features of the previous edition of the bill (1987).

As of 2020, three years from the implementation of the above act, some of its provisions haven’t been implemented, reducing quality of mental health care in India. The governmental institutions has not been assigning enough funds for the budget of mental health. India spends 0.05% for mental health while most developed countries have an annual budget of  4-5%. The importance of access to such facilities was fueled by the COVID 19 pandemic wherein the lockdowns, curbs and restrictions had hindered access to care and facilities. People lost their loved ones to the pandemic and personally had to cope with the loss alone at times. Further, depression, anxiety and other issues were left unchecked for many, thereby harming them.

Awareness and solutions

For the large Indian population to improve its mental health, we must enhance mental health awareness which will generate its demand. With awareness, it can be expected that people will acknowledge mental illnesses, access treatment and will adopt preventive measures. Most chronic mental illness begin before 24 years of age when most individuals are a part of the educational system. From including mental health awareness in curricula, removing discrimination to empowering stakeholders for early detection and involving simple interventions; the educational system yields many opportunities for enhancing mental health awareness.

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An allied District Mental Health Programme (DMHP) aims towards increasing awareness and treatment of mental health disorders at the community level (with handover to primary care physicians in consultation with high institutes) undertaking targeted interventions to increase awareness of mental health among students. MNHS reports show that only two states – Gujarat and Kerala – have funds for mental health infrastructure. As of 2021, state-wise budget documents indicate that only nine states have actually explicitly indicated expenditure on mental health awareness programme or infrastructure.

Progressive government policies working with a good engaged media, vibrant educational system and creative crowd-sourcing might together help fighting the blight of mental illnesses.

Conclusion

Due to the rise in the number of cases involving mental health especially during the pandemic, it is more important than ever to give as much assistance as possible and to make mental health care available to everyone, regardless of their circumstances. As educated individuals, we must take this up as a cause to raise awareness, educate our peers, and lobby the government to make more decisions in favour of the disadvantaged. We can make mental health accessible to everyone if we work together and have a more comfortable environment for all.

References

Bernadine, M. (2021). Understanding India’s mental health crisis.

 

Coffey, D., Gupta, A., & Mungikar, M (2020). Mental health disparities in India. Retrieved from

https://www.ideasforindia.in/topics/social-identity/mental-health-disparities-in-india.html

 

Das (2017). India has a new mental healthcare law, and here’s all you need to know about it

 

Goyal, R. (2020).Three years on, India’s progressive Mental Healthcare Act is dogged by gaps         

 in implementation. Retrieved from https://scroll.in/article/975401/three-years-on-indias-

progressive-mental-healthcare-act-is-dogged-by-gaps-in-implementation

 

Heath, S (2019). Key Barriers Limiting Patient Access to Mental Healthcare. Patient

Engagement HIT. Retrieved from https://patientengagementhit.com/news/key-barriers-

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Mental Healthcare Bill decriminalising suicide passed by Parliament

 

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Psychiatry, Vol 58 (3) 244-249.

 

Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, et al. Barriers to

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Varma, A., & Fernanades, T (2020). Public Mental Health in India Is an Issue of Rights and   

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Authors of the article

  1. Gaurav Umesh, V. Sai Deepika and Suha Rehma are currently pursuing their BSc Psychology degree from MCHP, MAHE, Manipal. They love expressing their creativity by organizing awareness based social events, conducting quizzes, and love reading books to enhance their knowledge
  1. Dr. Deepa Rasquinha is an Assistant Professor in Department of Clinical Psychology, MCHP, MAHE, Manipal. In her 17 years of experience she has been involved in teaching, counselling and research. She specializes in Gerontology. As an avid writer, she is being writing both in print and e media to create awareness about mental health through various topics.

Image Source: Polina Simmerman by Pexels

 

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