Everyone has health: mental health and physical health. Yet, history is witness to the fact that health is mostly taken to mean physical health, and mental health has not received due importance. As is rightly said, “Without mental health there can be no true physical health.”

India is a country with a largely young, aspirational population of a billion plus people that has already reached Mars, yet mental health remains stigmatised. Mental health is not an absolute: it is a spectrum, with wellness and illness being its two ends, and every human being falls somewhere on this spectrum.

It is the endeavour of both the government and society to maintain the mental well-being of its people and to ensure access to health care for those falling on the illness end. Stigma is an unseen barrier that restricts citizens from accessing mental health care, and one that has no place in India in the 21st century.

Mental health conditions and mental illnesses/disorders are not understood well mostly due to the lack of tools to study the human brain and the neurological correlates of thought and behaviour. Historically, inferences about mental disorders have been drawn from the symptoms and manifestations of the disorders. The factors that cause disability in People with Mental Illness (PwMI) are mostly invisible, and this has given rise to the belief that mental disorders are choices that PwMI make, whereas the truth is that mental disorders are illnesses that can happen to anyone. The severely disabling mental illnesses are stigmatised in the extreme as madness.

The stigma-inducing view of mental illness is increasingly getting challenged by the recent advancements in neuroscience research and imaging technologies which are helping researchers ‘see’ areas of the brain affected in various classes of mental disorders. Studies have documented changes in the brain structure, chemical balance as well as the neural-electrical pathways in the brains of people diagnosed with the commonest of mental disorders — Major Depressive Disorder. It may take decades of research for neuroscientists to fully understand what causes mental disorders, but as the research findings keep coming out, stigma will keep getting reduced.

Dramatic change in treatment

Prior to the 20th century, the treatment and management of mental disorders was difficult and limited by the medication and technology available, and often, cruel and inhuman practices like lobotomy and blood-letting were used for treating mental illness. This has changed dramatically over the last half-century where commonly occurring mental disorders, and even some severely disabling ones, are managed well with the aid of medication, psychotherapy and alternative therapies, thus enabling PwMI to live well-adjusted, functional and productive lives.

Existing therapies involving stimulation of the brain have been made safer, and experimental therapies are being studied for safety and efficacy, with a view to main-streaming them as future treatment options. Technologies of the future like AI are being harnessed in the development of mental health apps that are helping bridge the gap created by the shortage of trained psychotherapists, especially for young people who find accessing therapy difficult for various reasons like affordability, lack of support from parents and fear of judgment by peers.

The 21st century is also the most enabling era for PwMI in India. India has one of the most progressive pieces of legislation in the world in respect of mental health — the Mental Health Care Act (MHCA) 2017, that forms the cornerstone of the protection of the rights of PwMI. The MHCA 2017 owes its origin to the Convention on Rights of Persons with Disabilities and its Optional Protocol to which India is a signatory. The MHCA 2017 is widely supported by the mental health community because of its rights-based approach and empowering provisions like the pronouncement of Advanced Directives by the PwMI. The MHCA needs to be further translated into better lives for PwMI who continue to face challenges of survival, employment and social acceptance.

Severely disabled PwMI are institutionalised in dehumanising conditions, often chained and tonsured against their will. De-institutionalisation of PwMI is another challenge as families, across socio-economic strata, refuse to accommodate the PwMI even after they have recovered functionality and have manageable disability. The government has been working on solutions for these challenges and several measures have been taken by various government agencies. The current Rights of People with Disabilities (RPwD) Act includes mental disability in the list of disabilities covered under the Act. The RPwD Act thus, by extension, provides protection to PwMI in employment opportunities.

The Ministry of Social Justice and Empowerment and NIMHANS, Bengaluru, run helplines for people in mental distress while AIIMS, New Delhi, has just announced the setting up of a web portal for accessing mental health care. Mental illnesses are also covered under Ayushman Bharat. Several civil society organisations have also been playing stellar roles in mental health care.

Covid effect

The Covid-19 pandemic has had several fallouts, one of which has been its impact on mental health. The fear of contracting the virus has caused much distress thereby leading to a rise in anxiety levels. The pandemic has thrown normal life completely out of gear. Human contact has become limited and screen time has increased for people of all ages. Children are no longer able to meet their peers and play freely.

The elderly have been greatly affected too and face loneliness. Work-from-home has removed the boundaries between work and home, and maintaining the work-life balance has become difficult for everyone. Health care workers are particularly vulnerable to the pandemic and to mental distress. The impact that the new normal has had on people’s mental health is undeniable; but this is also an opportunity to pay greater attention to mental health.

Society faces several other challenges when it comes to mental health — superstitions, for example. Fear of discrimination at the workplace, fear of losing employment, and fear of social ostracisation are what make the PwMI stay mostly silent about their situation. Since people with mental disorders do not share their lived experiences, there is no opportunity for the social stigma and stereotypes of mental illness to get challenged and for truth to emerge. Ultimately, social stigma and silence create a vicious cycle that seems difficult to break.

The National Mental Health Survey 2015-16, conducted by NIMHANS, Bengaluru, states that every sixth person in India is in need of help with mental health conditions. This is another indicator that we need to shine the spotlight firmly on mental health. Celebrities and common citizens opening up and initiating conversations around mental health are helping to erase the stigma related to mental health; so are new research findings about the human brain and its functioning.

Ultimately, every human mind is unique; but human lives exist in a social environment. Let us remember to make the world a kinder place where minds flower unwilted by the harsh sun of mental illness — especially in 21st century India.

The writer is CEO, NITI Aayog. Views are personal

 

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