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Mental health is often associated with a lot of stigma and discrimination. There is little comprehensive data on the prevalence of psychological disorders around the world. But estimates suggest one in seven people on the planet have mental or substance-use disorders, and 4% have anxiety disorders. At present, over 36 million people around the world have had COVID-19, which further impacts mental health.
In the last few months, India has also experienced a lot of disappointment – in the form of farmers’ and students’ suicides, bullying and trolling, economic collapse, public protests, human rights abuses, and deaths due to COVID-19 and the lockdown. All this should prompt us to think if we are actually in a state of good mental health.
In India, the prevalence of mental illness among adolescents has been estimated to be around 7.3%. There are many factors that fuel the development of a psychological disorder, which can go on to affect a person’s daily functioning as well as cause them impairing distress. A person’s upbringing, parenting styles, interaction with others and their immediate environment can all influence their roles and responsibilities in society.
Insensitive media coverage of sensitive issues like suicides and rape, competitive pressures to do well on exams or secure important jobs, divine and hateful narratives on the social media have all bee on the rise of late. We shouldn’t be surprised if the entire society is affected by these forces. The COVID-19 pandemic has simply been added on as an additional stressor.
Mental health can’t be a state of exclusion. And the purpose of promoting mental health is not the same as treating mental illness. The presence of a mental illness implies the absence of mental health – but the absence of mental illness does not imply the presence of mental health. We need to create more awareness about mental health to help people understand that mental illness and mental health are different. This way, we can understand the separate implications of mental health and mental illness without any confusion, avoid miscommunication and misconceptions, and ultimately reduce the stigma attached to mental illness.
During the start of the COVID-19 pandemic, most people paid more attention than usual to improve their physical health, especially to develop their immune systems. However, there were few measures and little awareness regarding the people’s mental wellbeing. Exhortations to the people to pay attention to their physical health should, in parallel, have been accompanied by messages about strengthening the mental health of individuals as well as society as a whole. As the saying goes, physical health adds years to your life, whereas mental health adds life to those years.
This said, we can’t suddenly start promoting mental health overnight. It is definitely not a single-day programme. Ideally, it should begin with youngsters, in the form of a collective effort at the community level. And it can’t be led by a single or few health clinics. Good mental health is achieved with the help of good parenting, a good education, economic awareness, encouraging independence, and social and gender equality and liberty. Responsibility, concern, commitment and moral values should be taught as early as possible, both within and without the academic system.
Focus on improving the mental health of society is equally important.
When we say one is in a state of mental health, it means they are in good health psychologically; mental health by itself is already a positive term. But when one says one is suffering from a psychological disorder, it means that there is some irregularity, disturbance or interruption of the mind’s normal functions. Society fears illnesses, in this case the diagnosis of a psychological disorder. This is where the neglect of one’s mental health begins. Almost everyone at some point in their lives has experienced feeling mentally unhealthy.
In low- and middle-income countries, more than 75% of people with mental, neurological and substance-use disorders receive no treatment for their condition – due to stigma, discrimination, punitive legislation and human-rights issues. There was limited access to good quality and affordable mental healthcare in India before the pandemic, and the situation has only become worse since.
This year, the theme of World Mental Health Day 2020 is ‘mental health for all’. Delivery of mental health services is inadequate in India, being mostly concentrated in urban areas. A majority of the Indian population lies towards the lower part of the socioeconomic status spectrum. They are more vulnerable to developing mental illnesses – but at the same time have poorer access to doctors, therapists and medicines. We need to address this mental-health treatment gap. There is already an increasing recognition that India needs to build a stronger primary healthcare system.
“We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning,” as WHO director-general Dr Tedros Adhanom Ghebreyesus has said. “Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.”
India’s spending on healthcare is low, and spending on mental healthcare is only a smaller subset of this expense. In addition, there aren’t enough psychiatrists to address the high productivity loss caused by mental illness. We also need to find innovative ways to create initiatives to strengthen psychosocial support for people. In all, the COVID-19 pandemic should be taken as a wake-up call to address these deficiencies and provide equal, affordable and good-quality mental healthcare services for all.
Dr Sivabalan Elangovan is a psychiatrist in Chennai.