A case for democratisation of mental health

 

In the event of a global pandemic, and the looming dawn of a post-pandemic era we are made to face some difficult questions; most puzzling of them being how we are to deal with the mental health crisis, the pandemic has created. It is projected that the spike in mental health issues would be unprecedented in the approaching months, with Covid-19 itself having psychological implications. India, which accounts for more than a third of the female suicides globally, nearly a fourth of all male suicides and suicide being the leading cause of death for young Indians even before the pandemic, should take the challenge at hand as an opportunity to revise its policies on mental health. Mental health access should be made democratic through modes of inclusion, updating, and grass-roots activity.

   The existing mental health infrastructure is deeply biased against several sections of society. The economic, caste and language barriers that exist in the Indian context are either overlooked or blatantly excluded from the mental healthcare system that exists as of now and is made evident by the shocking numbers of suicides in rural and tribal regions. The female experience in the mental healthcare framework of India is appalling too. There have been accounts of women being abandoned in psychiatric hospitals, and sexual exploitation of mentally ill women. These accounts are a harrowing and clear depiction of how the marginalised are made to suffer in the current healthcare system.

The existing conditions of the Indian mental healthcare are not adequate to accommodate the existing patients, let alone admit new ones. There are only 37 Government psychiatric hospitals in India, all of them almost functioning like jails and performing outdated treatment methods like Electro Convulse Therapy (ECT). This was explored by the reputed news agency VICE News in their 2015 documentary “Locked Up and Forgotten: India’s Mental Health Crisis”. To add to the misery, there are not enough workers or funds in the mental healthcare system of India. There are only about 3,500 psychiatric doctors in contrast to the required 13,000 to achieve an ideal ratio of 1 psychiatrist per 8,000 to 10,000 people; the current ratio stands at 1 psychiatrist for more than 2,00,000 people. 

To achieve real and plausible change in the existing system and to truly democratise the mental healthcare framework, the Government will have to focus its effort on grassroots movements at the gram-panchayat level. There are issues like faith healing treatments, exploitive religious practices, black magic, torture of the mentally ill, discrimination against the mentally ill, and a lack of awareness about available help, all of which can only be dealt with at this level of attention through consistent awareness programmes. The existing healthcare framework and healthcare workers at the local governing level like midwives, Anganwadi workers, and ASHA workers can be trained to cater to the mental healthcare needs of people living in remote areas. Figures like Dr Vikram Patel has worked towards similar programmes that have had a significant positive impact even in the existing system. There have also been significant strides towards the democratisation of mental healthcare apparatus in the neighbouring country of Nepal. 

            There will also be challenges in the face of a large scale change of the existing system. More Government involvement and funding would mean that there would be a large reallocation of funds which would have to be taken from the already inadequately funded healthcare system. The overhaul would also take significant amounts of time and effort before the beneficiaries could get access to it. There will also be a general difficulty to engage the public in the changed system as there would be a hesitance, doubt to join awareness programmes and avail the benefits. 

Despite the difficulties that would arise, the overhaul of the existing mental healthcare apparatus of India is an unavoidable and urgent need. Changes would mean that the historically disadvantaged get access to an essential service that has been denied to them. The retraining of healthcare workers at the Local Government level would provide millions of women with stable jobs and income. The alarming rates of suicide in India could also be brought under control with the democratisation of the mental healthcare system.

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