NEW DELHI: Mental health remains neglected in India, as over 150 million Indians are in need of mental health care interventions, both short term and long term. India’s latest National Mental Health Survey (NMHS) 2015-16 categorically states that “India needs to talk about mental health.” Every sixth person in the country needs mental health help. The survey also showed a high correlation between low income and mental illnesses.

Attending the 22nd Convocation of National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru held on December 30 last year, President Ram Nath Kovind spoke about the current mental health state of the country and said that India might be facing a possible mental health epidemic and emphasized on the need to provide mental healthcare facilities to those suffering from mental disorders by the year 2022.

Even Bollywood actress Deepika Padukone opened up to the country about her struggle with depression last year. Padukone talked about the difficulties she had to face and how she managed to overcome that with a good support system around her and proper therapy and medication.

Now, here is where the problem lies. People like Padukone have the option to find a therapist and afford medications for their mental healthcare. In a country of 1 million people, every sixth person is in need of such facilities and majority of these people belong to the underprivileged section. India does need to talk about mental health. India especially needs to talk about mental health among the underprivileged.

The National Mental Health Policy (NHMP) was introduced in the country in 1982 to curb the lack of mental health facilities available in India. It’s main objective is to not only treat mental illnesses but improve general mental health conditions and promote positive mental health among the people. So, why is India still lacking as compared to other countries in terms of mental health poses a huge question regarding the execution and implementation of these policies.

Most of the mental health centres in the country are funded to focus solely on the biological effects of mental illnesses rather than look at it from a psychosocial perspective. Research has shown that mental disorders are highly common among people with the lowest levels of education and standard of living. Studies have also indicated that people coming from a lower socio-economic background are at a higher risk of suffering from a host of mental illnesses as compared to people belonging to a higher socio-economic background.

“By 2020, India is pipped to be the country with the highest amount of population of people with depression and anxiety.”, says Manisha Shastri, a social worker trained in Disability and Mental Health rehabilitation.

“One of the primary causes of poor facilities that we have in this country is that there is no awareness and that we don’t take mental health seriously. There are a lot of myths, stereotypes and stigma and people still don’t understand how it is caused and what it really is.”, Shastri reiterates.

One of the main objectives of the NHMP is “to increase access to mental healthcare services to vulnerable groups, especially the homeless, person(s) in remote areas, difficult terrains and economically/socially/educationally deprived sections” of the country.

“We don’t have any data on the trends and prevalence of mental illness in the country, so how can intervention or policy be formulated and expected to be effective?”, says Shastri, who is currently working in the area of advocacy and policy formation.

“It’s a vicious cycle. There are studies which show that poor social security and lack of access to basic necessities like education, healthcare, housing, etc, are factors that contribute to a lot of mental and emotional distress. We have a huge population in the country who live with such uncertainties, which cause mental distress. Also, sometimes people tend to have a genetic disposition towards it so the environment triggers the disposition and it becomes a vicious cycle that they get caught on to.”, she explains.

Although there are centres available that provide people with mental healthcare facilities, like The Live Laugh Love Foundation, started by Deepika Padukone; India still lacks facilities and centres that work specifically for the underprivileged/vulnerable sections of the society.

One such centre operating in Delhi, Manas Foundation, works to meet the growing needs for community-based mental healthcare. One of the main aims of the foundation is to mainstream mental healthcare through therapeutic interventions and creating awareness so as to enable the marginalized and diverse communities to lead psychologically healthy lives. The foundation also seeks to understand mental health from an all-around psychosocial perspective.

Krita Rout, Project Manager for the foundation, says, “You don’t tell someone suffering from chronic heart disease or diabetes to snap out of it. You can’t say that to a person suffering from a mental illness”, talking about the sensitization needed to deal with mental illness in the country.

Also, another one of the major reasons as to why the people from lower socioeconomic backgrounds are affected the most, as Shastri explains, is the extensive costs that they are unable to bear.

“The hospitals do not make it any easier for them. The process is expensive. You need to have a lot of time and money to buy medications and go for therapy and avail such facilities. You don’t have those options in rural or semi-urban areas. Even in cities, the numbers for them are so low. So lack of facilities, availability and affordability all of these are factors that affect not just people belonging to lower socioeconomic backgrounds but people in general. We have one psychiatrist for 3,00,000 people which is a horrible number to have. It’s not an ideal ratio that even the World Health Organization suggests.”

With the increasing need to remove stigma and increase sensitization towards mental disorders, the need for NGOs that focus on that is also increasing. Currently India does not have very many organizations that focus on this aspect too much. There are a few centres around the country, like Manas in New Delhi and the Banyan in Chennai but there is a need for even more of such NGOs.

Talking about NGOs and centres working on trying to remove the stigma attached to mental illness, Shastri explains that not most NGOs or organizations do that.

She says, “With regards to whether centres working with organizations try to address these issues or not; when they’re working with the client directly, they don’t. It is more client-centric so they don’t work on sensitizing the community. When they do community work, they do some amount of community sensitization. But even that is very medical; like how to deal with a person suffering from mental illness or how to deal with the medication. It’s not so much about engaging with a person with a mental illness. It doesn’t build an empathy or an understanding about it. It doesn’t address the stigma because it does not bust any of the myths regarding mental illness.”

With the possibility of being the country with the highest population of people suffering from depression and anxiety by 2020, we, as a country, need to talk about mental health more openly. Also, being a country where majority of the population still falls below the poverty line, the need to remove stigma and provide better mental healthcare facilities for the poor is increasing tenfold. To quote President Kovind, “India is facing a possible mental health epidemic.”

However, with the introduction of the Mental Healthcare Bill passed by the Government on March 27, there is still hope for the deprived sections to get better access to such services and ease of affordability of the same. The bill came in lieu of Prime Minister, Narendra Modi’s message in the monthly Mann ki Baat series. The bill seeks to guarantee certain rights to people suffering from mental illnesses. It has also made provisions to provide free treatment for the homeless and those who fall in the below poverty line category, even in the absence of a Below Poverty Line (BPL) card.

With many more people speaking up and talking about their mental health after Deepika Padukone, there is still some hope left to better the conditions for people who belong to the deprived section and suffer from mental disorders.