Dr. Manik Inder Singh Sethi discusses some of the challenges facing mental health services in India, as well as some potential solutions.

I am a resident in the Department of Psychiatry that caters to one of the largest private universities in South India. India today boasts a population of 1.36 billion people, the second-highest in the world. There is less than one psychiatrist for every 100,000 individuals, which poses challenges for both mental health professionals and those seeking help.¹ India’s rich cultural diversity, hundreds of different languages, and varied religious beliefs that make it unique, sometimes becomes a hurdle. This happened in my case when I migrated from the northern part of the country. Learning a new language and the nuances of the culture that I was suddenly immersed in made the whole experience challenging for me.

From the beginning of my residency, I noticed there was a gross mismatch between the number of untoward mental health incidents and the utilization of services. My hospital is well equipped with a multidisciplinary team of psychiatrists, clinical psychologists, and psychiatric social workers (a luxury very few centers in India have). The ER was flocked with young adults escorted by the campus security either intoxicated, suicidal, psychotic, or in withdrawal from a substance. Despite this, there were hardly any students who were utilizing mental health services voluntarily. The problem with the current utilization of these services is that people wait till they hit rock bottom and can’t function without support, akin to not getting your motor vehicle serviced until it comes to a complete halt.

This prompted me to hold a focus group discussion with the stakeholders of the student community. It was pointed out that the prevailing notion is that walking on the corridor of the psychiatry department can make one the butt of ridicule and ostracization. An interesting observation was that all conditions were diagnosed by the psychiatrist under a single label i.e., “mental illness”. It was echoed that placing all mental health conditions under this one label, had far-reaching consequences and invited stigma, skepticism, and repulsion. Indian families are close-knit. Young adults depend on their parents for their emotional and monetary needs. This induces further inhibitions to seek help for their mental health problems: to avoid disappointing their parents, who in general don’t have a positive attitude about psychiatry and mental health services. Similar to apartheid, caste and faith-based discrimination are rampant in the Indian subcontinent, thus leaving these individuals vulnerable to increased mental health issues and in search of appropriate help. The students also suggested that they would be most comfortable with talking to someone close to their age, as they would be able to better open up about their problems. Another thing brought up was that young adults use smartphone applications for everything, right from buying groceries to finding themselves a date; an app for their mental health needs would be readily taken up by the students.

From this discussion, I realized that we Indians have the luxury of choosing from a wide variety of government-sanctioned treatment options including, but not limited to; Ayurveda, Siddha, Unani, Homeopathy, and other faith-based magico-religious practices depending on the prevailing explanatory model of illness in the community. The overemphasis on shelving distress into one of the Euro-American categories fails to account for the socio-cultural causes of their suffering, engendering the attitude of “pill for every ill”. This can result in seeking help from a medical doctor as a last resort. Secondly, there are a lot of myths and stigma surrounding mental illness, which may be partly because the concept of mind & mental health is not completely understood.

Equipped with all this new information, it was decided that change was incumbent. The working of the department was revamped according to “Professor Thirunavukarasu’s Utilitarian concept of Manas and Mental Health²”. Holistic evaluation of our clients is carried out and they are relabeled as ‘mentally not healthy, mentally unhealthy, mentally ill, or mentally healthy’ depending on their presentation. This discussion also laid the foundation for the development of ‘Here for You^®’ a mental health application that was developed with a dual purpose of screening Mental Health problems and connecting users anonymously with pro bono mental health services. An online peer support service ‘The Listening Space^TM’, was also created with the existing clients, who by the virtue of their lived experiences and consultations with mental health professionals, volunteered to get trained, lend support and empathy by the creation of a safe space for students suffering from a wide range of mental health issues. I believe difficult problems need innovative measures. These initiatives have helped decrease stigma and empower our tech-savvy young adults to seek help without fearing judgment or labels. We as a developing nation have a long journey ahead of us before this use of technology can be scalable, and help prepare us for the next pandemic of mental health problems.

References

1. Gururaj G, Verghese M, Benegal V, Rao GN NMHS Collaborators Group.  National Mental Health Survey of India, 2015-16: Summary.Bangalore: NIMHANS; 2016
2. Thirunavukarasu M. A utilitarian concept of manas and mental health. Indian J Psychiatry. 2011 Apr;53(2):99-110. doi: 10.4103/0019-5545.82532. PMID: 21772641; PMCID: PMC3136034.