On short fuse, Delhi needs better mental healthcare
A disturbing CCTV footage of a Delhi mother punching and kicking her child surfaced last month. The one reported last week showed another mother flinging her son down the stairs. Police say that the women did not share a happy relationship with their in-laws and both incidents were preceded by family fights.
From postpartum psychosis to the Freudian defence of displacement, a range of theories was offered to explain why these mothers did what they did. But could their actions have been averted at any stage? Therapeutic intervention, psychologists say, could have helped. But neither the women nor their families felt it was necessary.
Anxiety, stress and grief are common life experiences. It is their unnatural intensity that becomes a cause for concern. However, even the most hypochondriac among us won’t acknowledge having mental distress because sharing it could cause social embarrassment.
So in most cases, medical help is sought only for serious mental conditions such as schizophrenia and bipolar disorder. But even milder forms of mental disorder — depression, anxiety, post-traumatic stress, etc. – make a case for treatment.
In 2008, NGO Manas interviewed 2,381 individuals in Delhi and found 180 of them suffered from psychiatric morbidity or a mental condition that leads to both physical and psychological deterioration. But only 5% of the afflicted sought professional help.
Almost every tenth person admitted to anxiety, palpitations, long depressive spells, severe mood swings and loss of sleep and appetite.
While the educated, working women shared their concerns with their doctors, the housewives did not enjoy this privilege. The husband decided if one was to be taken to a doctor or not. While some women found a sounding board in their grown up children, many who showed signs of mental disorder were sent to her parents’ homes.
Those who never sought medical help suffered from a mix of prejudice, ignorance and fear. Some approached tantriks, astrologers or religious gurus. While at least 12% of those suffering from psychiatric morbidity took to heavy smoking or mood-elevating drugs, another 9% drank to feel better.
Some of the younger respondents admitted to going shopping to release stress but most of them continued to feel angry, withdrawn, alienated and untrusting.
Nearly a decade after the study, things do not look any brighter.
If suicide rate is any measure to judge mental health conditions, Delhi is on the edge. In 2014, the capital accounted for nearly 10% of the total suicides recorded in 53 Indian cities. In absolute numbers, Delhi (1,847) was next only to Chennai (2,214) and Bengaluru (1,906).
Today, Delhi’s lifeline has become its biggest suicide magnet. Between January and November last year, 33 people jumped on the Metro rail tracks to kill themselves and 12 did not survive. It is estimated that, for each suicide, there are likely to have been more than 20 attempts.
While suicide is an extreme manifestation of depressive behaviour, Delhi residents demonstrate their mental stress in many other ways. Instances of road rage, for example, have become routine. Therapists call it the Intermittent Explosive Disorder, characterised by an extreme expression of anger.
The preventive mechanism remains weak. Few Delhi hospitals offer decent psychiatric treatment. The atmosphere at most of these facilities is not different from the stereotypical pagalkhana. There is a serious shortage of trained psychiatrists, support groups and toll-free help lines.
Experts say it does not require huge medical paraphernalia to treat mental illnesses. Liaison psychiatry or placing mental-health specialists in hospitals to work alongside doctors could help treating some disorders. The Centre for Mental Health found that one such initiative in Birmingham, UK, reduced the length of hospital stays and the number of readmissions, saving four times its running costs, The Economist reported in August 2014.
In another report, it was pointed out how France, where every third citizen was taking psychiatric drugs in the 1990s, reversed the trend by using short-talking therapy to break self-destructive patterns of thought and replace them with something positive.
Getting applauded for its Mohalla or neighbourhood clinics initiative by none other than former UN Secretary General Kofi Annan, the Delhi government could expand its primary care to include mental health. After all, what good is physical health if the mind is unclear and the spirit, broken.