JOIN USMental health in an unequal world
The theme adopted for World Mental Health Day 2021, which was on October 10, was apt, and a poignant reminder of the existing multi-layered inequality all around, resulting in skewed access to something as basic as quality healthcare, much less mental healthcare. It is pertinent to ponder over certain basic issues that continue to plague mental health. Among all the health conditions in the world, mental health stands out as unique and paradoxical. It suffers from mixed baggage of being frequently discussed but little understood, widely prevalent but strongly stigmatised, often over-diagnosed but under-treated.
Living in an increasingly polarised world today, where large sections of the population continually struggle with discrimination, disparity, denial and despondency, where people repeatedly experience a volley of negative emotions like fear, anger, hatred and sorrow, mental health is undeniably the biggest casualty.
Adding fuel to fire is the pandemic that has taken millions of lives and left many more devastated and broken, exposing once again a wide chasm of inequality in every sphere of human life, and even death. The physical health crisis of Covid-19 is highly visible, its psycho-social impact on people’s mental health is less apparent, though it is as real and as acute. Considering a worldwide decline in mental health and wellbeing and the disconcerting likelihood of the trend lingering on for years, the World Health Organisation (WHO) sees it as nothing short of a “mass trauma.”
But even during normal times, WHO statistics indicate that neuropsychiatric disorders make up 13% of the global burden of disease, depression and anxiety, and almost eight lakh people die by suicide globally every year, of which India’s share is a whopping 36.6%, ranking highest in South-East Asia.
Yet, mental health receives unequal priority from all quarters, including policymakers, parents, teachers, work places, insurance companies, and even medical fraternity. While India’s budgetary allocation in 2021 increased appreciably by 137% for overall healthcare, strangely, mental health did not find even a mention in the budget speech or budgetary provision. The paltry sum allocated for it is only to the country’s three centrally-run mental health institutes, veritably ignoring the serious access and treatment gaps existing in rural and remote areas.
With educational institutions slowly limping back to normal, the uppermost priority is placed on making up for the lost learning, revising curriculum, altering examination mode, and implementing the New Education Policy. Amidst all this, Covid-related mental health challenges in students and teachers, which is as vital, if not more, remains least addressed. Returning to office, employees face similar disregard to their mental health conditions.
The neglect stems from approaching mental health almost always from the premise of a disease model rather than a health model, viewing a person as either sick or healthy. This either/or view discounts that the absence of disease does not necessarily spell health or wellbeing. Many suffering from mental disorders require psychiatric treatment and prolonged medication, but vast majorities who occasionally face milder emotional, psychological and behavioural issues either get totally ignored or get pigeonholed into mental illness categories and medicated without even trying the harmless and effective non-medical options.
Similarly, on the one hand, millions who are still shrouded in ignorance, stigma and myths continue to suffer severe mental illness that go under-recognised and under-treated. On the other hand, growing awareness, better education and higher access to mental health support systems in the higher income groups have eased as well as complicated the diagnosis process and perceptions of psychological disorders in equal measure. Uncritical web search, self-diagnosis, simple life problems deemed as illness, overzealous consultations and needless medication are becoming far more common among them. To a significant level, the growth in recent times of mental health disorders, especially among urban, high-income youth, can be attributed to over-diagnosis. This is as much a matter of disquiet as under-diagnosis and under-treatment. The pharmaceutical industry must share a large part of the blame for selling sickness and fuelling over-treatment and over-medicalisation.
Mental health and ensuing wellbeing are an inseparable part of a happy, healthy and productive life. It’s necessary to look more from a preventive and fostering perspective. Emulating countries like New Zealand and some European countries, emphasis should be placed on imparting mental health literacy and instilling mental hygiene from a tender age, starting from schools. This would act as a prophylactic measure, ensuring a healthier and more harmonious society.
(The writer is a psychologist, author and founder-director of Eudaimonic Centre for Positive Change & Wellbeing)
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