Mental Health is Finally on the Agenda of Political Parties
Congress and CPM promise to implement Mental Healthcare Act 2017
Rarely does mental health make it to the agenda of political parties in India. In these elections however, something has changed. The need to improve mental healthcare support in the country has made it to the manifestos of political parties. Both the CPI-M and the Congress have both promised to implement the Mental Healthcare Act, 2017 and National Mental Health Policy, 2014 along with appropriate budgetary allocations.
The Citizen spoke with Dr Soumitra Pathare, the director of the Centre for Mental Health Law and Policy and member of the #BridgeTheCareGap Alliance, about their campaign which led to the inclusion of mental healthcare in the election agenda, and the mental healthcare challenges faced by India.
'Could you tell us a little about the ‘Bridge the care gap’ campaign - what was the idea behind it, what does it aim to achieve?
The campaign started in November-December 2018. A group of organisations and individuals initiated the process of forming a cross-sectoral alliance and then invited other organisations and individuals working in the mental health sector to join. More than 30 organizations now support the #BridgeTheCareGap campaign.
We realised that we could speed up the implementation of both the National Mental Health Policy and the Act by sensitising policymakers and politicians on how the needs of the mental healthcare sector can be addressed by effective implementation of the Policy and the Act.
The other important aspect of the campaign is to raise awareness amongst policy makers and politicians that mental health is an inter-sectoral issue. Its not purely a health issue and many solutions often lie outside the medical sector.
What were your discussions with policymakers like?
Since the general election was around the corner, as a first step the campaign decided to lobby political parties. It was a challenge getting through to political parties, especially to those who are tasked with drafting the manifestos. Another challenge was convincing those drafting the manifesto to recognise the importance of mental health.
Not many politicians or parties realise the importance of addressing mental health issues. We also saw during these interactions that politicians did not see patients or practitioners of mental health as a constituency, and how addressing their needs could lead to electoral benefits for them and their parties. We hope this will change over time.
The number of suicides in India has been steadily growing, with nothing done about it. Why?
It’s a very, very serious problem. India accounts for nearly 30% of suicides in the world, while we only account for 17% of the world’s population. We have a huge problem of youth suicides: amongst women under the age of 30, suicide is the number one cause of death, ahead of maternal mortality, and the number 2 cause of death amongst young men of a similar age.
Just to put things in perspective: We have fewer than 50,000 HIV-related deaths, around 65,000 deaths due to malaria each year. See the amount of health sector effort and investment that is put into the prevention and treatment for HIV and malaria.
On the other hand, we have nearly 250,000 suicide deaths each year, but we do nothing at all for suicide prevention.
There’s an omerta (tacit silence) about all mental health problems in India. Somehow the stigma and discrimination attached to mental illness means that we as a society don’t want to talk about it. But the problem is not going away and the more we ignore it, the worse it gets.
There’s also the huge economic cost of mental illness, mainly from loss of productivity. The treatment costs are a relatively small contributor to the total economic costs, at less than 25%.
A lot of people are unable to access mental health services, because of the cost. Apart from making medical care affordable, what are the other aspects of costing that need to be considered?
The cost of treatment is only one factor for access. A more important factor is the sheer lack of availability of any mental health facilities outside the large cities and towns. Many people have to travel long distances to access medical care. In many instances, the amount of money spent by families on travel, actually exceeds the cost of treatment!
Increasing the availability and range of mental healthcare especially in rural areas and small towns has to be given priority. The Mental Healthcare Act mandates that a range of mental health services including outpatient, inpatient care, rehabilitation, child and adolescent services and old age services should be available in each district in the country. This would be a good start.
While the MHC Act is somewhat on the lines of the rights based framework, on the ground things are very different. Interventions continue to be purely medical and the stigma and stereotyping still very much exists. What are the holes that need to be plugged to bridge the gap between what objectives of MHCA and the ground reality?
We need to see mental health as an inter-sectoral issue. Many people with severe mental illness not only require medicines and medical treatment, but also need access to rehabilitation, especially livelihood options. Children with mental health problems don’t just need doctors and psychiatric treatment but also inclusive education.
Unfortunately, our services tend to work in silos – so the health, education, employment sectors don’t necessarily talk to each other and work in co-ordination with each other. Breaking down these silos is probably the most important thing we need to do to address the totality of needs of persons with mental health problems.
There is no conversation about prevention, awareness, community based support systems. What are your thoughts on this?
Mental health services have come to mean only curative services, i.e. outpatients, beds, hospitals etc. We have forgotten promotion, prevention and rehabilitation. Furthermore, some of the issues such as suicides and attempted suicides don’t have a curative solution, and prevention is the only intervention which will be effective.
Given the paucity of curative services, we should actually invest more on promotion and prevention. There are evidence based prevention strategies which are available and can be implemented, but unfortunately the entire mental health discourse in our country has focused on mental hospitals and medicines.
As a doctor and an activist, do you think under the prevailing circumstances, looking at just the medical aspects of mental health while ignoring the social and culture is enough?
Of course, you can’t ignore social aspects. For example, farmer suicides cannot be addressed unless you address the issue of rural financial distress and debt. Similarly, we cannot address suicides in young adolescents unless we address exam stress. Both these issues, debt as well as exam stress are actually outside of the health sector. There may also be religious reasons for the stigma around mental health issues. There are solutions, but unless we take an inter-sectoral approach to addressing mental health we will be always be fighting with our backs to the wall.
Studies show that a lack of social security contributes to mental distress. Currently when we are seeing so much unemployment, price rise, violence, economic distress - how much of an impact do you think all these factors are having on the overall mental health of the nation?
Economic distress as well as social unrest leads to huge increase in mental health problems. And mental health problems reinforce economic problems for individuals (due to the inability to work) and also increase distress at the individual and family level. Research has shown this over many decades in many countries around the world. For example, after the economic crisis in Greece, suicide rates increased by 25 percent!