Re-examining mental illness

An interview with Dr. R. Srinivasa Murthy, editor-in chief, World Health Report 2001, conducted by Usha Ramanathan. Excerpts:

What is the new understanding of mental health of which the Report speaks?

The Report is based on a new way of looking at mental health and mental disorders. It is a re-examination of the context of mental health in terms of new information that has emerged that tells us that mental disorder is understandable, treatable, and relevant to everyone. The finding that mental illness or mental disorder affects one in four persons is a reflection of this.

From the point of view of social costs, it makes sense to invest in taking care of mental illness. We are in a stronger position to deal with mental illness and mental disorder because we now have the technology to deal with the problem. We also have an improved capability to categorise people from what we had 20-30 years ago. We have specific treatments that are cost-effective. Institutional treatment was a response located in history; it was costly, and it has resulted in the violation of human rights almost universally. Now we know that the problem can be dealt with at the public health level, and it can be done by using the resources in the community.

Mental health care must be integrated with primary health care. The problem of course is acute in parts of the world where primary health care is itself non-existent. Care should be located in the community. And families and users have to be a part of the solution.

Why has mental health found a place of prominence now?

There is accumulating evidence of the high levels of disability that is imposed by mental illness. Forty-three per cent of the disability in developed countries is, for instance, due to mental illness. If it is lower in other parts of the world, that is because of the heavy burden that other illnesses, such as AIDS (in Africa) impose. Disability Adjusted Life Years (DALY) is an evolving index that helps to quantify the burden of disease. Of the 20 conditions identified as leading causes of disability adjusted life years, three are related to mental illness.

What does the Indian situation offer in the context of mental health?

In the Indian context, among the public issues relevant to mental health are: suicides among farmers, weavers and displaced factory workers; the needs of people affected by major disasters, for example, the Bhopal gas disaster, the Orissa cyclone, the Gujarat earthquake; and the deprivation of rights of mentally ill persons.

With regard to suicides, the association of loss of social support systems and poverty leading to experience of severe helplessness, even to 'family suicides', illustrates both the linkage of individual and community life as well as how distant events, like international economic policies, could reflect in the mental health of the population.

It is equally important to consider prevention at the level of society by appropriate social policies. Experience with disasters highlights both the vulnerability of the mental health of every one of us, where a single major event may bring about significant emotional disturbance for weeks and months, and reinforces the need to make mental health care an essential part of disaster care.

How would you suggest we approach the issue of mental health in our jurisdiction?

From my experience of working in India and other developing countries, and now on the WHR, I recognise that we need to work at many levels.

First, to assure rights of the mentally ill, the state should be responsible for providing essential services, maintaining standards and monitoring the mental health of the community. The last is especially important with globalisation, and massive changes in policy.

Secondly, it is essential that we initiate a massive public awareness campaign, on the reversibility of mental disorders, as well as on the rights of individuals to lead normal lives when they are suffering mental illness, and after recovery.

Thirdly, we will have to focus more research on the prevention of mental disorders and promotion of mental health in different communities. Currently the information available in this area is not adequate to develop universal solutions.

Are there special opportunities in India for mental health planning?

India is fortunate to be planning policies and programmes at a time when we have a new understanding of mental health. Specially, I want to recognise the available family support and community tolerance, which are vital for recovery. We need to build upon this community resource. Mental health is too important to be limited to mental health professionals.