Mental illness is no longer what we once thought it to be. The complexities of modern living have been adding to the cornucopia of mental ailments. One of the most widespread mental disorders is depression, estimated to affect 350 million people globally. The World Health Organisation (WHO) estimates that depression will be the biggest cause of disability by 2020. Mental illnesses will catch up with, and possibly overshadow, heart disease as the world’s biggest health concern by 2025. Though depression can afflict anyone, young or old, it can be treated.
In India, around 130 million Indians — 7% of the population — are estimated to suffer from some form of mental ailments and more than 90% do not receive any treatment. Our psychiatrist-population ratio — one to a million — is abysmal. Recently, health minister Ghulam Nabi Azad acknowledged a nationwide shortfall of “about 8,000 psychiatrists, 17,000 clinical psychologists, 23,000 psychiatric social workers and 9,000 psychiatric nurses”. Furthermore, against 30,000 beds required for the mentally ill, barely 200 are available.
These statistics indicate societal neglect of a serious problem. It is important to recognise the signs and symptoms of mental ailments so that patients receive timely treatment. 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. A 2012 Lancet study says suicide is the second-highest cause of death among the youth, which could be triggered by multiple causes, including depression and substance abuse. The recent incident of singer Asha Bhosle’s daughter Varsha, who was reportedly suffering from depression, committing suicide is a case in point.
According to the WHO, almost 90% of the million annual suicides globally are associated with mental ailments. Suicide is among the top 20 leading causes of death for all ages worldwide. An estimated 11 attempted suicides take place for every suicide death — ample indication that suicides are a major preventable public health problem. 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% employers address issues such as the stigma of seeking help for mental health problems.
Fortunately, the government has taken cognisance of the problem: it has decided to offer free treatment at government or public super-specialty hospitals to people below the poverty line. This became possible after the health ministry included patients with mental disorders under the Rashtriya Arogya Nidhi (RAN) scheme, which till earlier provided financial assistance only to BPL families afflicted with cancer and cardiovascular ailments. Given this change, doctors now expect more patients to opt for treatment under RAN.
While treatments for many mental disorders are readily available, research is underway to find cures for certain other, curable mental illnesses. About 200 medicines are being developed by pharmaceutical companies and they cover diseases related to anxiety, depression and schizophrenia, as well as addictive disorders such as alcohol or drug dependency. All the drugs are either undergoing clinical trials or awaiting approval from the US Food and Drug Administration.
Over the past 50 years, innovative biopharmaceutical research has changed the perception of mental disorders as a subject of shame and apprehension. 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.
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.
On the 20th anniversary of World Mental Health Day today, let us remember that with the stress and strain of modern-day life, mental disorders could strike anybody. To prevent such an eventuality, it’s best to recognise the signs early and ensure that medical help is sought in the first instance.
BN Gangadhar is professor of Psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore
The views expressed by the author are personal