Mental healthcare trapped in stigma, inadequacies

Kamala* (40) was meeting her daughter’s school counsellor. She had been called to inform of her daughter’s emotional outbursts.

“She is just looking for attention,’’ Kamala told the counsellor.

A single parent from Belagavi, Kamala did not have the time or patience to deal with her child’s behaviour. The school counsellor, who had to cater to hundreds of students, couldn’t follow it up.

The young girl’s life was falling apart.

Desperate for an emotional anchor, she entered into a relationship. In the next two years, she changed four partners. She started staying out for days together.

It was then Kamala decided to approach her daughter’s college (she was now in college), only to realise that she had been ignoring her daughter’s emotional needs all along.

“The relationships had only increased the girl’s burden, mentally and physically,” said the counsellor, who worked with the mother and the child for over two years to put their life back on the track. “But how many schools and colleges can provide this kind of support?’’

Mental healthcare across the country, especially in rural areas, is riddled with hurdles, including poor awareness, lack of access to professional help, inadequate support from family, societal stigma and financial constraints, myths and shortage of mental health professionals.

According to the World Health Organisation (WHO), mental health accounts for 16% of the global burden of disease and injury in people aged 10-19 years. Depression is one of the leading causes of illness and disability in adolescents. Suicide is the third leading cause of deaths in 15-19 years as per WHO.

In India, the National Mental Health Survey indicates that one in 20 people suffer from depression.

Early intervention

With no timely intervention at hand, young people are desperate for help. “An important challenge is that parents fail to understand the concerns from the child’s perspective,” said Dr Bino Thomas, Associate Professor, Child and Adolescent Psychiatry, The National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru. “The need would be to facilitate a paradigm shift in the attitude towards treatment with a broader family and system focused framework and understanding.”

According to Dr Thomas, there is no exclusive residential care for children with mental illness in Karnataka and this affects aftercare and rehabilitation oriented interventions for children and adolescents.

He also said that the number of patients at the in-patient adolescent psychiatry centre at NIMHANS, the first such centre in the country, is increasing by the year.

“There is a lack of professionals and facilities, especially in places outside Bangaluru. Kerala has recently launched parenting clinics in villages and Karnataka should have such facilities to ensure that happiness and well-being don’t become a luxury for children,” he informed.

Meanwhile, the onslaught of Covid-19 has fuelled mental health problems.

In March of 2020, when lockdown had just been imposed, Asha* (21), a psychology student, was struggling with her personal battles. She would break down randomly and had anger issues.

“I was slipping into clinical depression and needed to see a therapist. But every time I broached the subject with my parents, we ended up quarrelling. They would tell me that there was no need for counselling and ask me to ‘mingle more with family members’”.

Forced to cope on her own, Asha stopped trying to convince her family.

No support structure

Bindu Bai, a therapist and counsellor in Bengaluru, said the common barriers to mental healthcare access include limited availability of mental healthcare services, the high cost of accessing them, and the lack of awareness about mental illness coupled with social stigma.

“The high cost of psychiatric treatment, often due to high prices of medication, poses significant financial barriers. Mental illness often prevents patients from seeking and adhering to treatment, as patients may attempt to distance themselves from the labels that mark them for social exclusion,” she said.

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Jessica*, was extremely quiet as a child, neither expressing her feelings nor asking for anything. When she was in the first grade, her dad took her to a psychiatrist. “I was diagnosed as a late bloomer,” she said.

All through her school years, she battled alone with her thoughts. “I was invisible to my classmates. My family was strict. At home, I kept to myself. I didn’t want my family to know if I had any problems,” she said.

“But I have identity issues now, and can’t discuss it with my family. They won’t understand. I want to see a counsellor.”

Even after all these years, Jessica fears that if her extended relatives come to know of her problems, they will stop her from seeing a counsellor.

Resistance from parents

Maullika Sharma, a Bengaluru-based counsellor who works with adolescents, has seen a lot of resistance from parents to approach counsellors, even if the child asks for it.

Very often the need for counseling is expressed by the adolescent children, who find it difficult to convince their parents to get them the help. “Parents volunteer when the problem is around academic performance and related stress. But in other cases, it sometimes reaches the stage of self-harm before parents initiate action,” she said.

Moreover, children and parents drop out after a few sessions for various reasons, which range from financial constraints and societal pressure to plain denial of an issue, putting these youngsters at risk.

“They have difficulty in finding, choosing, or paying for the right help,” Bindu said. “There is also the denial. The thought that they can handle everything stops people from seeking help. Because of the taboo, the fear of being labelled and not getting proper support or information, they depend on social media and experiment with their life,” she said.

Rural challenge

In rural communities, primary health centres have a lot left to do. Rupa Hassan, who works with women in Hassan, said rural families see girls with mental health issues as a burden. “What can they do when there is no awareness and access to counselling centres?”

In the absence of empathy, the situation often aggravates and in some cases, the family either abandons them or they move out of the house. With no one to take care of, they end up as destitute, constantly enduring sexual assault. Some are rescued and sent to the few care centres that exist in the state.

The lack of access to mental health services in rural areas often aggravates the problems of the vulnerable sections of populations here.

Swatee Jog, a counsellor in Belagavi, said that schools and parents should work together towards preventive psychology to address the mental health issues of youngsters in rural areas.

“It is the responsibility of the government to provide proper health facilities. The government must safeguard the Right to Life of every person. With more funding, the government can provide free treatment to the poor through the public health system,” Bindu said. “It must act now to address both the short and long-term social, mental health, economic, and educational insecurity.”

Meanwhile, with the second wave here, Asha is worried. “If another lockdown happens, how am I going to cope?”

Jessica hopes someday her family would understand her identity crisis.

(*names changed)

(With inputs from Anitha Pailoor)