Inequalities In The Mental Health System

“We need to start identifying the triggers that aggravate mental health issues in our society – bullying, social media negativity and anxiety, gender based violence, substance abuse, stigma around issues such as maternal issues, etc., and we need to speak up about these more and get to the source of the problems.”

~ Sanam Saeed.

WHO estimates that about 7.5% of Indians suffer from some mental disorder and predicts that by the end of this year roughly 20% of India will suffer from mental illnesses. India also accounts for 36.6% of suicides globally. Nowadays everybody wants to be physically fit, it is questionable if it includes mental health. No, most Indians would prefer to move ahead with mental illness than receive mental health treatment. 

To an Indian Household, mental health is regarded as taboo. Discussing one’s mental health distress is not encouraged. If one dares to bring this up during dinner time, they are told to ‘be positive’, ‘it’s just a phase’, ‘it’s all in your head’! Mental health help-seeking is shunned and one probably suffers to a great extent from the psychological distress building inside. So, can we put all the burden of mental health issues on the Indian family systems alone?

Societies play a role in shaping the mental health systems, too. They either pretend that one didn’t voice their mental distress or would exclude you from its normal functioning. People with mental health illnesses are subjected to poverty, unemployment, homelessness & incarceration. Society doesn’t approve of the presence of mentally ill people and thus, they experience a great deal of loneliness and discrimination. This further aggravates the problem. 

Our society also has their fair share in causing inequalities in psychiatric/psychological care. Mental health literacy is very poor in India. Though mental health practitioners have been imparting awareness about the same, only a small percentage have been able to access it. Affordability issues and inaccessibility of mental health care are some of the main reasons why people avoid going for therapy. This reinforces the notion that caring for mental health is a ‘luxury’ thus, limiting the economically weaker people from seeking help. However, a lot of people begin to “practice” as a mental health professional without proper credentials, simply doing some certificate courses and thus further exacerbating the problem. A primary problem is the absence of a central mental health board or council to regulate the system and it’s professionals. 

One should not forget that while all these social institutions have a role, the major stakeholder is the state.  The callous nature of the state is turning a blind eye upon the mental health care systems in their financial regulation. The lack of funds for psychiatric care makes the systems suffer at a greater scale. Even though the figures are well published, the state attempts to ignore the status of mental health care disparities across the country, allotting only 400 million rupees for national mental health programmes . The annual health expenditure of India is 1.15% of the gross domestic product, and the mental health budget is <1% of India’s total health budget which is not sufficient.  Moreover, the implementation of these programmes are also questionable like in the case of insurance for mental health issues, one finds it very difficult to garner support even though there is an act mandating it.

What is it that can be done to decrease the mental health disparities? One should understand that mental health is part of their health and express their mental distresses quite openly. The family systems should be able to accept and support these people just like how they would support someone down with some physical illness. Showing compassion and empathy to those suffering from mental health issues will encourage more help-seeking behaviours. Having a place where mentally ill people can reside, work or use for recreation will help create an identity for them. Mental health systems should have centralised standards of ethical practice, ensuring an accessible mental health care system. The state can also help by proactively including mental health in their economical plans. The state can also help make pro-mental health laws and legislation. After All, each one is responsible for the sustainable & emotional well being of the people in our country.

– Urveez Kakalia and Absy Sam.