Mental Health in India

More than 122 thousand people committed suicide in 2007, which corresponds to 14 people killing themselves, every hour in the country. One among five, of these people was a housewife. One in four patients, who visit any health centre, suffers from at least one mental or neurological or behavioural disorder. However, in the absence of any policy on concerns related to mental health care, most of these disorders are neither diagnosed nor treated.

Health is a state subject. WHO defines 'Health' as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Mental health is an integral part of this definition.

Present both in rural and urban areas, in developed as well as the developing countries, a mental illness is hard to detect. Once detected, there is often denial by the patient and the people associated with the person, in taking corrective action.

India is in the last six months of the 10th five-year plan. The progress and the transition of its health policies over the years is evident. The Human Immunodeficiency Virus (HIV) control and prevention schemes are taken in a big way by the government, also, the Indian pharmaceutical industry has enjoyed spectacular growth.

The gradual shift from the public health care to private health care system has stemmed medical “brain drain” by giving rise to a massive unorganised health sector. Yet, mental health has remained neglected in this country. Ten five year plans down, there is no policy on mental illness in India

Seeking medical assistance for mental disorders is avoided due to the stigma attached. As a result, most people fall back on the religious and spiritual healing. Those unaware of mental problems, believe the victim's is 'possessed' by a spirit and rely on practices like chanting mantras and drinking holy water, for relief. Mental health experts have often pointed that alternative healing methods may prove helpful for curing minor mental disorders. In severe cases it delays treatment, which may prove fatal.

Abuse of tranquilizers, drugs or alcohol are escape mechanisms mentally ill use, which may eventually become addictions. 91 million alcohol related disorders and 15 million drug abuse disorders, worldwide, were recorded by World Health Organisation (WHO) in 2002. 154 million people in the world, suffer from depression. Alcohol and drug dependence only worsens their situation.

The reluctance to awareness of mental health, plagues both, the afflicted and the physicians. Neither Psychiatry nor Psychology are popular fields of study among doctors. According to the WHO, in 2005 seven to eight million Indians faced serious mental illness and mental disability, yet there were hardly 3,500 psychiatrists in India. They too, were concentrated largely in the south. That works out to 0.4 psychiatrists per 100,000 mentally ill people. The ratio of trained psychiatric nurses to mentally ill people was even poorer at 0.04 per 100,000. Psychologists and social workers fare no better. They are 0.02 per 100,000 patients.

The apathy of the Indian government with regard to the mental health of its people can be seen in governmental hospitals and research institutes. The hospital buildings are in a dilapidated state. Due to a fund crunch, mental health research is minimum. The hospitals are grossly understaffed and the employees working for the care of the mentally ill are not trained for the same.

Health spending, in India, was just 0.83% in 2001, according to WHO. An extensive National Health Policy (NHP) was launched by the National Democratic Alliance (NDA) government in 2002, which has a mention of the need for a mental health programme in the country. It says, "Mental health institutions are woefully deficient in physical infrastructure and trained manpower. NHP-2002 will address itself to these deficiencies in the public health sector."

With the NDA government uprooted from power in 2003 and United Progressive Alliance (UPA) nearing the end of their five years at Centre, neither the "physical infrastructure" nor the "trained manpower" at the mental health institutions has seen any improvement. The condition has, in fact, worsened.

In 2001, 28 inmates of Moideen Badusha Mental Home in Erwadi, Tamil Nadu were burnt alive in a fire. They couldn’t escape as they were tied in chains.

Then, the State government closed down unauthorized treatment centres and transferred patients to mental hospitals. A Judicial enquiry probing the incident recommended that five mental health hospitals be set up in the state, including one exclusively for women. The Supreme Court ordered the establishment of one Central government run hospital and one State government run mental health hospital (separate from establishing psychiatric wards in existing hospitals), in each state. Strict enforcement of licensing and regulatory provisions on private psychiatric hospitals was also imposed.

But these government orders have done the Erwadi rescued patients no good. They continue to live in misery, isolated and ostracised. Of the 571 persons who were rescued, 152 were sent to the Government Institute of Mental Health (IMH) in Chennai, the only government hospital for the mentally challenged in Tamil Nadu. The deaths of inmates due to diarrhoea in October 2001, the collapse of the main building a month later, and some incidents of violent inmates killing each other, brought to light the abysmal conditions at the IMH.

An IMH psychiatrist said that the IMH is like a concentration camp. There are no doctors. Patients with physical complications are referred to other government hospitals. Some of the 21 wards do not have toilets. Like in jails, lunch is served at 1 p.m. and dinner at 4 p.m. At 5 p.m. all patients are locked in their wards until 8.30 a.m. the next morning, when they are given breakfast.

A water-borne disease outbreak in IMH in November this year killed four inmates and left 25 with diarrhoea.

No consent, oral or written, of a patient is required for admission for medical treatment. There are no methods to check for involuntary treatment of patients in a psychiatric facility. Also, Indian penal laws still regard attempted suicide a criminal act leaving the mentally ill, vulnerable to harassment.

Mental disorders are the maximum in people aged 15-44 years, which is economically the most productive section of the community. Farmer suicides remain a major cause of worry in the country. The number of mentally ill people untreated, is huge, especially in the rural areas. Suicide rates stay high in Puducherry, Maharashtra, Andhra Pradesh, West Bengal and Tamil Nadu. Tamil Nadu accounts for 11 per cent of suicides in India