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- World Mental Health Day is celebrated every year on October 10. The theme for this year is “make mental health and well-being for all a global priority”.
- Studies have found that 7% of postpartum mothers are at increased risk of suicide. A 2017 study found that one in five mothers suffers from depression in countries like India.
- The most significant barriers to improving perinatal mental health are an acute shortage of skilled mental healthcare providers, minimal budget allocation and lack of a clear roadmap.
- Several social factors amplify the chances of Indian mothers becoming depressed, including patriarchal social values, preference for male children and domestic violence.
World Mental Health Day is celebrated on October 10, as designated by the World Federation of Mental Health nearly three decades ago, to spread awareness and increase sensitivity towards mental health issues. But while the focus on mental health has expanded in many dimensions in this time, many people with mental illnesses lack access to treatment and continue to suffer in silence for fear of being typecast at home and in society.
In her Union budget speech in February 2022, finance minister Nirmala Sitharaman announced the launch of a ‘National Tele-Mental Health Programme’. This programme will establish 23 tele-mental-health centres around the country to provide 24/7 mental health services for all.
This is a commendable initiative but more importantly it signals that the national government is aware of the need to improve mental healthcare services in India’s public health milieu. This is pertinent in the context of COVID-19 – as is this year’s theme for Mental Health Day: “make mental health and well-being for all a global priority”.
At this time, we must make urgent efforts to achieve good mental health for all – but especially for vulnerable population groups such as women.
Crucial years
The perinatal period, which consists of pregnancy and the first year of childbirth, is a crucial period in the lives of childbearing women. In this phase, complex hormonal changes take place while the new mother’s responsibilities increase. Without adequate social support at this time, these women are at higher risk of developing mental illnesses.
Worldwide, studies have found that some 10% of pregnant women and 7% of postpartum mothers are at increased risk of suicide. A 2017 study found that one in five mothers suffers from depression in developing countries like India. The COVID-19 pandemic and increasingly frequent climate emergencies will only have further exacerbated their suffering.
India started its first National Mental Health Programme, in 1982, and subsequently many new mental health initiatives – including the mental health policy in 2014 and the Mental Healthcare Act in 2017 – to strengthen mental health service-delivery at the primary-care level. Its District Mental Health Programme also decentralised mental healthcare up to the district level, although considerable inter-district variations persist.
On the other hand, the most significant barriers today to improving perinatal mental health are an acute shortage of skilled mental healthcare providers, minimal budget allocation and lack of a clear roadmap. There are only 0.3 psychiatrists and two mental health workers per one-lakh population in India, and they are concentrated in the urban areas.
The 2015-2016 National Mental Health Survey found that more than 80% of mentally ill persons in the country don’t receive any treatment. None of the existing programmes screens for mental illnesses or need for mental care among perinatal mothers.
India’s maternal mortality has declined in the last decade – but the rise in maternal depression (and suicidal ideation and suicide) threatens to reverse this trend. Untreated depression endangers a mother’s life and health as well as leads to adverse birth outcomes and poor nutritional and cognitive development of their children.
Stressors
Several social factors amplify the chances of Indian mothers becoming stressed and depressed, including patriarchal social values, preference for male children and domestic violence. A 2016 analysis reported that adolescents and young mothers have a higher risk of poor mental health.
A common tradition of ‘patrilocality’ in many south Asian countries, including India, expects married girls to relocate to where their husband’s family is. In these cases, early motherhood responsibilities among young Indian mothers make them vulnerable to depression, since they are often yet to settle down in a new environment, among new people and customs, with inchoate social support.
In addition, ignorance and profuse stigma linked to mental illness discourage women from seeking support. Often, mothers or their family members don’t recognise the symptoms of depression. Many families also glorify motherhood and highlight its sacrificial nature, rendering mothers with depression insecure about seeking support, even from close family members, for fear of being typecast as a bad mother.
Add to this women’s general lack of access to resources and the decision-making power required within families to avail healthcare.
The trend towards nuclear families doesn’t spare mothers either: caregiving remains the preserve of women for the most part, which in turn makes a work-life balance harder to achieve. Women working in urban locales also don’t have childcare arrangements at the workplace. Most women who work in India are engaged in the informal sector, where they lack formal work benefits like maternity leave.
It would seem that everywhere new mothers turn, the options range from abysmal to far from ideal.
Stepping stone
There is a clear need to strengthen India’s mental healthcare infrastructure. In 2015, the WHO had recommended the ‘Thinking Healthy’ programme to deliver perinatal depression care services in low- and middle-income countries. This programme proposed to have community health workers deliver low-intensity psychosocial therapy, with the option to refer care-seekers to specialists when required. The PRIME project by the Sangath NGO has demonstrated that such an effort – of non-specialist-led mental healthcare intervention – would be feasible in India.
Another study, published in 2017 and also involving Sangath, reported that peer-group women delivering perinatal depression interventions in India and Pakistan, after training and under supervision, also worked to improve the mental well-being of young mothers.
Researchers had proposed in another article the same year that perinatal mental healthcare services ought to be integrated with existing maternal health programmes, so the latter could take advantage of the former’s robust infrastructure in India.
The National Institute of Mental Health and Neurosciences, Bengaluru, recently prepared a training manual for auxiliary nurse midwives (ANMs) to support mothers’ mental health needs during the perinatal period. Such a manual makes important progress towards developing a stepped-care model – in which trained and supervised ANMs can help close the mental health treatment gap among Indian mothers.
In sum, there have been some promising advancements towards availing timely good-quality mental healthcare for India’s mothers and the population at large – even as there remain many barriers to overcome. Ultimately, effective implementation backed by strong political commitment and stewardship will be essential to promote the importance of and improve perinatal mental health in India.
Deepanjali Behera is an assistant professor at the School of Public Health, Kalinga Institute of Industrial Technology Deemed-to-be University, Bhubaneswar, and a PhD candidate at the School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai. M. Sivakami is a professor here.