It is estimated that the world loses $1 trillion every year in economic output due to mental health disorders. While physical disorders such as diabetes, hypertension, cardiac disease and cancer are getting increasing attention and funding, it is not realised that mental health disorders account for an equally large proportion of ill health, chronic disability and mortality. Despite the fact that the 2013 Global Burden of Disease study estimated that neuropsychiatric disorders accounted for 31% of the global distribution of non-fatal disease burden, they are neglected. In India, these disorders were the number one cause of disability-adjusted life years (WHO defines this as one lost year of healthy life) in 2013. Suicide among youth is now one of the leading causes of death while many more suffer from depression and anxiety.
Surveys suggest that the incidence of serious mental illnesses like schizophrenia and bipolar disorders is fairly constant at about 1.5-3% of the world’s population. The incidence of milder forms of mental illness (depression, anxiety, post-traumatic stress disorder, attention-deficit disorder and many others) varies between and within countries but could affect up to 20% of the population.
India unveiled the National Mental Health Policy in 2014 but its implementation has been patchy. There is only one psychiatrist for 350,000 people, implying that delivery of care will necessarily have to be done by non-specialists, nurses, counsellors, community health workers and even layman. In fact, it is the family that provides care to most patients and the quality of this care can be improved by providing training and support to the care givers.
While severe mental illness is stigmatised in our society and there are many myths and misconceptions about it, the availability of effective treatment is the first step to reduce this stigma and encourage people to seek care. It is necessary that doctors and paramedical staff manning primary and secondary health centres should have a basic knowledge of mental illness and its treatment. Referral may be needed in severe cases, but many can be treated with counselling and medications.
For this, mental health care has to be integrated into ongoing programmes in the health care system.
Both quality of life and productivity of people with mental illnesses can be improved by simple interventions. There is enough evidence of the link between mental health and economic well-being of communities, so an investment in this area would reap dividends in the future. We need to give mental health the same priority as physical health and invest not only in diagnosis and treatment of disorders, but promotion of good mental health in schools, colleges, workplaces and communities. It is time to take mental health out of the shadows.
Soumya Swaminathan is director-general, Indian Council of Medical Research
The views expressed are personal