Depressing scene

Print edition : April 10, 2009
in New Delhi

At the Institute of Mental Health, Chennai. Close to 7 per cent of the countrys population suffer from varying degrees of mental disorder.-K.V. SRINIVASAN

MENTAL ailments will overtake cardiovascular diseases to become the single largest health problem in the country by 2010, says a study done by the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, at the behest of the National Human Rights Commission (NHRC). It notes that close to 7 per cent of the countrys population suffer from varying degrees of mental disorder. And over 3 per cent of them need active treatment. Translated into numbers, this means that a staggering 30 to 35 lakh people in India are in urgent need of treatment, including hospitalisation, for mental ailments, but there are only 29,000 hospital beds and 3,300 psychiatrists available in all to treat them. Of these, over 3,000 psychiatrists are based in the four metros.

This woeful shortage of trained mental health care professionals in the country made Union Minister for Health and Family Welfare Dr. Anbumani Ramadoss to plead literally with NIMHANS graduates at their recent convocation ceremony to stay on in India and not migrate to Western countries.

However, there is some good news too. The Central government has finally woken up to this acute problem and is putting up a comprehensive plan of action on a war footing. Union Minister of State for Health P. Lakshmi told Frontline that the government planned to re-strategise the National Mental Health Programme (NMHP) and integrate it with the general health care programme. The NMHP has been in force since 1987 but has not delivered much. The government will now launch a nationwide programme to train general practitioners in mental ailments so that, even if they are not qualified enough to prescribe treatment, they can detect early signs and refer patients to psychiatrists. The problem with mental health is also one of awareness. Very often people do not realise that their weird behaviour could be the result of some mental disorder, and by the time they do it is too late. So, what we need is a system wherein the ailment can be detected at an early stage and treated properly, she said over phone from her constituency in Andhra Pradesh.

Another problem with the mental health care system, she said, was the social stigma attached to the disease, which prevented many people from disclosing their problem. This we plan to tackle through aggressive awareness campaigns on radio and television. Our advertisements are already on air. Besides, we need to sensitise the community at large because unlike several other diseases, mental health cannot have hospital-centric treatment alone. The family, the neighbourhood and society at large has to be involved, she said.

The Ministry has already finalised an ambitious plan of action to augment manpower and it has been approved by the Cabinet Committee on Economic Affairs. This plan seeks to establish at least 11 centres of excellence for mental health and neurosciences. A number of other institutions will be strengthened in terms of manpower. It is hoped that the plan, with an outlay of Rs.474 crore for the duration of the Eleventh Five-Year Plan, will churn out another 100 psychiatrists, 400 clinical psychologists, 400 psychiatric social workers and 800 psychiatric nurses every year. According to Lakshmi, the availability of more psychiatrists and other mental health care professionals will go a long way in dealing with the problem. The lack of timely access to a psychiatrist is at times as high as 50 to 80 per cent.

Another problem is the rehabilitation of cured patients. The stigma attached to the affliction is such that even after patients are cured, their relatives refuse to take them back. This increases the load on an already overburdened system. The Ministry of Social Justice has agreed to run houses for the rehabilitation of cured, abandoned patients, Lakshmi said. Professionals in the field of mental health care have greeted the governments campaign with some degree of scepticism but have approved it nonetheless. According to Dr. B.N. Gangadhar, head of psychiatry at NIMHANS, which is engaged in formulating a model mental health care programme along with the NHRC, it is in vogue to talk of mental health being in a shambles now but it has been so for years.

The situation has been quite bleak for years. In fact it has been so bleak that the Supreme Court was forced to take suo motu action and direct the NHRC to ensure that mental patients were given dignified and humane treatment, he said. The apex courts initiative resulted in the NHRC and NIMHANS coming together in the early 1990s to work on a project called Quality Assurance in Mental Health, he added.

According to Gangadhar, the programmes initiated by the United Progressive Alliance government are a step in the right direction, but there is a long way to go. We need to give training to general practitioners at the grassroots level to counsel mentally ill persons and to refer them to the right doctors. The present government has initiated a training programme for doctors at primary health care centres and at district hospitals. Over 200 district hospitals have already been covered; by 2012, all district hospitals will have trained doctors and adequate in-patient and outpatient departments for such patients. This is a major achievement because access to professional health care workers, especially in semi-urban and rural areas, remains the biggest problem today, he said.

Dr. Jitendra Nagpal, consultant psychiatrist at the Delhi-based Vidyasagar Institute of Mental Health and Neuro Sciences (VIMHANS), could not agree more. Nagpal, who has been involved in running community-based mental health care programmes for years now at his own initiative (he provides mental health counselling in over 500 schools in North India and runs various charitable mental health care centres in the Mathura-Vrindavan-Agra region), said availability of mental health professionals was a big challenge in rural and semi-urban areas.

For hundreds of miles outside Delhis periphery, there are no psychiatrists available and people are forced to go to faith healers, magicians and quacks to treat their mental disorders, thus compounding the problem. The only way this problem can be addressed is by public-private partnerships [PPP] because it is just not possible for the government to handle a problem of this magnitude alone, he said, describing the state of affairs in the field of mental health as pathetic.

The mental health care system would be put on the right track, he said, by creating a parallel secondary system of experts that is, by training general practitioners, paediatricians and gynaecologists in this area and by involving private players, who have success models to show, in the effort. But he said he was sceptical about the government initiative because his own experience showed that the governments obsession with control and authority had prevented it so far from involving private professionals. There was nothing to indicate that this was about to change now, he said.

The government action in this field has been marked by complacence, lethargy and red-tapism, which has so far played havoc with the system. We have had the NMHP for over 20 years now, but not even a single study has been done to check its impact. The sense of urgency with which this problem should be treated is also missing, said Nagpal with great anguish.

According to him, 10-15 crore people in India suffer from various mental disorders such as stress, insomnia, psychosomatic diseases and problems arising out of changing lifestyles following globalisation, urbanisation and breakdown of old family values. Nearly 1.5 crore people, he said, were known to be suffering from extreme schizophrenia.

It is reported that by 2020 depression will become the single largest killer in the world and India will lead the list. Sad to say, no one seems to realise the urgency of the situation. Unless the country has mentally sound people, how can we talk of being an economically strong nation? Nagpal said. The only way out, he said, was to have a multidisciplinary approach to the problem, involve society at large and adopt the PPP model, albeit under government control and supervision. Otherwise, he warned, all the talk of re-strategising the NMHP would remain on paper and, once again, thousands of crores of public money would get wasted.

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