Home-care relief in offing for patients with mental disorders

The World Mental Health day was observed recently and there is no better occasion to discuss the problems associated with this widespread illness. Considering the complexities the modern living have been adding to the cornucopia of mental ailments, new diseases and new definitions are being added at periodic intervals.

One of the most widespread mental disorders is depressive disorder or depression, estimated to affect 350 million individuals globally. The World Health Organisation estimates that depression will be the largest cause of disability worldwide by 2020.

Moreover, mental illnesses will catch up with, and possibly overshadow, heart disease as the world’s biggest health concern by 2025. Although depression could afflict anyone, young or old, it should be noted that the condition can be treated.

In India, around 130 million people – around 7 per cent of the populace – are estimated to suffer from some form of mental ailments, with more than 90 per cent not receiving any treatment.

The country’s psychiatrist-population ratio is also an abysmal one for every million people. Recently, Union health minister Ghulam Nabi Azad acknowledged a nationwide shortfall of psychiatrists, clinical psychologists, psychiatric social workers and psychiatric nurses. Furthermore, against 30,000 beds needed for the mentally ill, barely a few hundred are available.

These statistics are disquieting and indicate societal neglect of a serious problem. Since mental illness can increasingly disrupt an individual’s equilibrium at home and affect productivity levels at the workplace, it is important to recognise the signs and symptoms of mental ailments so that the victim is treated well in time.

Unfortunately, most families ignore the early signs, oblivious to the dangerous consequences of mental illness. One of the most perilous outcomes of depression can be suicide. As per a 2012 Lancet study, suicide is the second-highest cause of death among the youth, which could be triggered by multiple causes, including depression and substance abuse.

From one million annual suicides globally, more than 90 per cent are associated with mental ailments, according to WHO statistics. Suicide is among the top 20 leading causes of death for all ages worldwide, with almost 3,000 people committing suicide every day on average. An estimated 11 attempted suicides take place for every suicide death – ample indication that suicides are a major preventable public health problem.

Negative fallout

Despite such findings, including the negative fallout on workplace productivity, not much is done to promote employee health and mental wellbeing. According to a 2011-2012 Towers Watson India Health and Productivity Survey, only 13 per cent employers directly address issues such as the stigma of seeking help for mental health problems.

Fortunately, the government has taken cognizance of the problem, going by its decision to offer free treatment at government or public super-specialty hospitals to BPL (below the poverty line) people.

This became possible after the ministry of health included patients with mental disorders under the Rashtriya Arogya Nidhi (RAN) scheme. Hitherto, RAN only provided financial assistance to BPL persons afflicted with major life-threatening diseases, such as cancer and cardiovascular ailments.

While treatments exist for many mental disorders, research is underway for ailments that lack cures or to ensure better therapy regimens for the treatable illnesses.

Nearly 200 medicines are presently under development by innovative research pharmaceutical companies, covering diseases related to anxiety, depression and schizophrenia, as well as addictive disorders such as alcohol or drug dependency. All the drugs are presently either undergoing clinical trials or awaiting approval from the US Food and Drug Administration (FDA).

Over the past 50 years, such innovative biopharmaceutical research has changed perceptions of mental disorders as a subject of shame and apprehension that were largely untreatable to one calling for sensitivity and understanding, which are often highly treatable. A dramatic transformation for patients is that treatment regimens now allow them to have highly productive lives and be treated at home, rather than suffer the trauma of being under institutional care.

Among medicines under trials to cure or control mental ailments are one to potentially treat various symptoms linked with schizophrenia, ensuring minimal side effects; and an intranasal medication for anxiety that improves symptoms within minutes of being administered. Medicines under development include those for depression, addictive disorders, anxiety disorders, cognitive disorders, attention-deficit hyperactivity disorder, development disorders, eating disorders, schizophrenia, sleep disorders and others.

Considering the wide ramifications of mental illnesses, as well as their impact in disrupting individual families at the micro level and national productivity at the macro level, it is important to encourage further research in new drug discoveries for such disorders. While the government’s move to include mental illness in RAN is laudable, more needs to be done to ensure such disorders are detected at the initial stage and patients placed under home treatment at the earliest, rather than delaying this to the extent that institutionalised care becomes inevitable.

 Let us remember that with the stress and strain of modern-day life, mental disorders could strike anybody – even within our own families. To prevent such an eventuality, it’s best to read the signs early and ensure the ailment is stopped dead in its track by seeking medical help in the first instance and then following the prescribed treatment regimen.

Backed by global research for innovative medicines, awareness within families about mental ailments could ensure institutionalized care for such disorders soon becomes a thing of the past.

(The writer is a professor of psychiatry at the Nimhans, Bangalore)