World Health Day | The great depression: Understanding the cause of suicides in India
April 6: A 36-year-old DTC driver shared his very first video message with his father over WhatsApp at Bindapur in southwest Delhi. It was a dying declaration, blaming some relatives for driving him to suicide. Before his father could react, he heard a scream. It was too late already.
April 3: A 23-year-old man jumped off the 19th floor of a hotel in Bandra, Mumbai, after uploading a suicide tutorial on Facebook. The video has gone viral.
April 1: Ten days after his wife committed suicide, a 30-year-old man from Kailash Nagar in East Delhi decided to follow suit. He was found hanging from the same ceiling fan that claimed her life.
While a handful of suicides make it to the news, a majority is reduced to becoming mere statistics on the police department’s crime data sheet. On many occasions, nobody even bothers to scrutinise the psychiatric issues that may have driven the person to taking the extreme step.
Untreated depression is the leading cause of over 788,000 suicides that occur worldwide every year, roughly corresponding to one death in every 45 seconds. According to the Global Burden of Disease Study, it became India’s tenth-biggest cause of early death in 2015 – rising two positions from 12th in 2005. Most of the cases took root in undiagnosed and untreated depression.
This mental disorder affects nearly one in 20 people across India, the World Health Organisation (WHO) estimates . It has declared “Depression: Let’s talk” as the theme for World Health Day in an attempt to encourage people to come forward for treatment.
In conversation | Dr. Hank Bekedam, WHO India Head on World Health Day
“Depression is not a rare disease. It affects 4-5% people across the globe. In India, it is everywhere. Depression affects not only the patient, but also those close to them,” says Dr Henk Bekedam, WHO representative to India. “The number of people living with depression in India has increased by 18.4% between 2005 and 2015. Urbanisation is definitely a cause, as is minimal interpersonal interactions and the modern way of living (inactivity).”
Take, for instance, the case of a 42-year-old Delhi woman living behind locked doors with her daughter ever since her husband died in a road accident in 2013. When police finally rescued them on March 23, both weighed just 25 kg each.
Bekedam described depression as an ailment that few people like to talk about. “Those with depression find it difficult to come forward, and those around them find it difficult to recognise,” he said. It is more common among women (5.1%) than men (3.6%), and they are less likely to seek help or avail of treatment.
Many in India still don’t recognise depression as an ailment that can be treated and controlled. It is one of the leading causes of human rights abuse in the country, with affected people being locked up in rooms, tied to beds, kept isolated in hospitals or prisons or treated through traditional medical practices.
However, things are already taking a turn for the better. India’s new reformist mental healthcare bill decriminalises suicide and empowers the mentally ill to choose a mode of treatment, refuse institutionalisation, and nominate somebody to ensure that their wishes are carried out. It also bans the use of degrading treatments – including shock therapy – on children, and specifies that adults be subjected to them only after the administration of anaesthesia with the district medical board’s consent.
The government-run Institute of Human Behaviour and Allied Sciences (IHBAS) in northeast Delhi runs the world’s busiest psychiatric out-patients department with over 900 people being treated every day. Despite the rush, hospital authorities remain sensitive to the needs of their patients. Even more remarkable is the fact that less than 1% people referred to this tertiary hospital from places across northern India are hospitalised.
“Even though most of the people brought here are critically ill, 99% get treated at home. If any patient does get hospitalised, it’s for a maximum of two to three weeks. Very rarely are they admitted for several months or years,” said Dr Nimesh Desai, IHBAS director. “Most long-stay patients are here because they have been abandoned by their families, or have no idea where they come from.”
Bollywood celebrities and popular media channels have played a laudable part in spreading awareness on depression over the last two years, spurring more people to seek treatment.
Psychiatrists wrote over 9.4 million new prescriptions for antidepressants in 2016, up 12% from 8.4 million in 2015. Data provided by AIOCD Pharmasofttech AWACS, a pharmaceutical market research company, shows that the sale of these drugs has shot up by over 30% in the last four years – from Rs 760 crore in 2013 to Rs 1,093 crore in 2016.
Still, a majority of the affected people remain undiagnosed. “Mental illnesses are chronic ailments that affect patients and their families for life. Psychosocial stressors – social attitudes, discrimination and deprived opportunities – add to the challenge of managing the illness. So we actively counsel patients and their families on the nature of the illness, treatment and possible side effects,” says Dr Jahanara M Gajendragad, associate professor and head of psychiatric social work, IBHAS. “Treating mental health disorders is a lifelong commitment for the patient, his/her family and the community as a whole.”
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