On April 1, 2018, 36-year-old Venkannagari Radhika Reddy, a Telugu news channel anchor, returned home at around 10.40 pm after reading the Sunday night news bulletin. She left her bag in her apartment, went to the terrace and jumped to her death. A suicide note found in Reddy’s bag indicated that she was taking this extreme step due to depression. “My brain is my enemy,” she wrote in the note. According to a colleague, Reddy had divorced her husband six months back. Since then, she had been living with her parents, sister and 14-year-old autistic son.
Reddy’s tragic death reinitiated conversations about a group of invisible and seldom spoken about diseases which affect millions of Indians every year – major and minor mental illnesses. According to a report published by the World Health Organization (WHO) in April 2017, depression affected an estimated 57 million people in India (4.5% of the population and 18% of the globally estimated 322 million people battling depression). Another 38 million people suffered from anxiety disorders.
In India, depression and anxiety disorders comprise the two diagnostic categories considered common mental disorders (CMDs). Although depression influences the onset and outcome of numerous diseases, the most severe impact of the condition manifests as suicide.
Recently, The Live Love Laugh Foundation (TLLLF) – founded by actress Deepika Padukone – published a report titled “How India Perceives Mental Health” to assess public perceptions about mental health in eight Indian cities. The survey found that a majority of the respondents associated mental illnesses with severe psychiatric disorders such as schizophrenia, Alzheimer’s disease and obsessive compulsive disorder (OCD). While 87% respondents showed high awareness levels about mental illnesses, a sizeable number were highly judgmental of mentally ill people, using derogatory terms like “retard”, “crazy / mad / stupid” and “careless / irresponsible” to refer to them.
Significant economic burden of mental illnesses
An earlier study undertaken by the World Economic Forum and Harvard T.H. Chan School of Public Health estimated that between 2012 and 2030, India’s economic burden of mental illness would cumulatively add up to US$1.03 trillion (22% of the economic output). Depression and other mental illnesses lead to significant impairments in work-related functions, loss of productivity, absenteeism and premature death. Despite the economic progress achieved in the last few decades, public spending on mental health care has remained abysmally low. India’s budgetary allocation for mental health care is miniscule – it is even lower than Bangladesh’s layout on mental health care for its citizens.
The situation is made worse due to an acute shortage of mental health professionals. Previous data tabled by the Ministry of Health and Family Welfare in Parliament highlighted that India had 3,827 psychiatrists and 898 clinical psychologists, whereas the estimated requirements were 13,500 and 20,250, respectively. Majority of these professionals were situated in urban areas. Experts suggest that this shortage is caused by a lack of focus in medical institutions and within the government. Unlike many other disciplines, there is no separate exam for psychiatry at the MBBS level, and limited attention is given to mental health training. Accordingly, students are disinclined to take up psychiatry.
Growing awareness and the road ahead
As per a study done to evaluate various indicators of mental health care available, India currently ranks 11th among the 15 South-Asian countries. But all is not yet lost. In the face of ground realities which speak of extreme social stigma and alarmingly poor infrastructure, the Mental Health Act passed by the Parliament in 2017 is a step forward in the country’s readiness to combat mental health issues. Another step forward is the coming together of the National Centre for Biological Sciences, Institute for Stem Cell Biology and Regenerative Medicine (NCBS-inStem) and NIMHANS to conduct what is being called the first systematic research study of mechanisms of mental health disorders in India.
With awareness growing, albeit to a miniscule extent, the conversation around mental health has taken a more open and public space in the last few years. Adding to the encouraging atmosphere are the efforts of budding entrepreneurs who are working towards making mental healthcare more accessible and affordable. Startups like ePsyclinic, YOURDost, InnerHour, HealthEminds, Trijog and others are working to bridge the gap by providing easy access to psychiatric help and counseling through online platforms such as mobile applications, web and video chat portals, and phone calls.
Experts opine that the long-standing social stigma around mental health will continue to be the toughest challenge to overcome. A paradigm shift in our attitude towards mental healthcare remains the prime need of the hour.