Mental health issues are a problem that a large proportion of the population in India face today. The National Mental Health Survey estimates that 150 million individuals are currently living with mental illness in India. This staggering statistic demands a response of equal magnitude from the government, mental health professionals and individuals in the community. There is a dire need for reflection upon the trajectories that lead to mental ill health, effective treatment options and community-based solutions, for this is a serious public health concern that India is currently faced with.
September 17th marked the launch of The Banyan Academy of Leadership in Mental Health (BALM) – Sundram Fasteners Centre for Research and Social Action in Mental Health.
This centre is a collaborative effort between BALM and Sundram Fasteners Limited (SFL) that aims to develop comprehensive mental health services for vulnerable individuals, transform models of care and build strong practice-driven evidence through transdisciplinary research while educating individuals to work as professionals in the field.
Several noteworthy individuals were present at the centre’s launch last weekend, including Dr. Soumya Swaminathan, Director General of The Indian Council for Medical Research (ICMR), Dr. Nachiket Mor, Country Director of The Bill & Melinda Gates Foundation, India, Prof. Dr. Tom Burns (CBE) from the University of Oxford, Prof. Dr. Sanjeev Jain, from the Department of Psychiatry at NIMHANS, Dr. S. Parasuraman, Director of the Tata Institute of Social Sciences, Mr. Keshav Desiraju, the former Secretary of Health for the Government of India and Dr. J. Radhakrishnan, the current secretary of health and family welfare for the Government of India, Tamil Nadu.
These seven individuals participated in a panel discussion on transforming the state of mental health care in India that was moderated by Mr. N. Ram, the Chairman of Kasturi and Sons.
As with conversations that are engaging and productive, this panel discussion went on for two hours, an hour longer than originally planned for, touching upon numerous topics of interest.
Lack of qualified professionals
An issue that was brought up by almost all of the panel members was that of the paucity of qualified mental health professionals available in India.
Unlike other illnesses of the body, mental illness is something that always exists within a social situation, a point brought up by Prof. Burns. He maintained that because of this fact, our treatment of these issues must emphasize the whole systems that individuals live in.
Dr. Jain expressed that the psychiatric training conducted in India puts a lot of focus on western psychological theories, such as those of Freud and Jung, while ignoring contextual backdrop of India.
“Almost every woman that I’ve come across at NIMHANS has been a victim of abuse” he voiced.
Gender discrimination and sexual assault are glaringly obvious problems in India that have been linked to mental health issues (1, 2) so why aren’t they a focus of psychiatric training? These issues along with those of poverty and scarcity of human resources hand in hand with a rising population level are social factors that need to be addressed in the mental health framework.
Dr. Jain stated context-driven training is of utmost importance, as it would improve the quality of psychiatrists working in the mental health field, rather than just the quantity, thus taking into account the systems that individuals are living their daily lives in.
On top of psychiatrists, Dr. Gopikumar expressed that we need to look further into nurses, social workers and community lay-members for assistance. BALM in collaboration with TISS currently offers a diploma in community mental health programme that trains non-specialist members of the community to identify mental health issues within their communities and engaging with clients to navigate their daily lives while managing their illnesses.
Dr. Parasuraman declared that this programme would soon be available online, which will make its reach considerably more widespread.
Programmes like this have illustrated reductions in the prevalence of common mental health issues (1, 2) which in turn can reduce the burden of care in the long run.
Those who suffer from mental health issues have a life span that is 30 years less than the average, said Dr. Jain, expressing that professionals need to begin viewing these disorders as non-communicable diseases in order to treat them promptly and effectively.
Inspiration can also be drawn from The Echo Model, which links specialist teams with primary care clinicians through electronic devices in order to spread valuable knowledge to those who need it in an efficient manner.
Dr. Sarin highlighted the importance of the identification of effective treatment models, as well as the need to be open, flexible and responsive to users when developing new interventions.
Thus far, there have been no audits investigating the outcomes of the District Mental Health Programmes (DMHP) in India, even though they have supposedly been in place for years.
The role of government vs. the role of community
The Government of India recently implemented the National Mental Health Policy, a policy that members of The Banyan played an integral role in writing.
It was brought up during this panel, however, that with total healthcare expenditure at a dismal 1.9% of the total budget, the responsibility of improving mental health care in India cannot be shouldered solely on the government.
Mr. Desiraju expressed concerns that the government would not show the leadership required to change the current course of mental health care in India.
In fact, Tamil Nadu is the only state in India that has the DMHP running in all 32 of its districts. As articulated by Dr. Radhakrishnan, South India’s health care and mental health care programmes have been consistently more stable and widespread than those in other parts of the country and thus it is integral to find out why that is, and perhaps replicate the success of the South in the rest of the country.
A robust study of DMHP outcomes across the country will be invaluable in aiding the government in figuring out what parts of the programme they need to alter and what parts they need to build upon.
Dr. Swaminathan, the director of the ICMR, called attention to the fact that there are several “islands of excellence” across India, however they are unable to scale up to governmental or centeralised levels,
Why is this the case? Possibly, lack of published research and documented protocols make replication efforts stagnant. She affirmed that the only way to move rapidly forward is through implementation research that results in well-documented and published studies.
A collaborative effort
The main take away from this panel was the absolute need for multiple stakeholders, including government officials, mental health care professionals, academics and community members to work together to solve these problems.After all, mental health care starts with attitude and goes up to treatment and therefore addressing issues of stigma are also paramount in tackling these issues at their root.
Current practices need to be viewed with a critical and reflective lens, and different groups and stakeholders need to come together – like they did during the launch of this centre – to brainstorm and innovate creative solutions for complex problems.
The collaboration with Sundram Fasteners Limited for this centre is a great one, for at SFL they are an organization that are highly committed to social justice and responsibility.
This centre, the first of its kind, is a prime example of how a multi-organisational, multi- stakeholder strategy aimed to tackle these mental health issues can work and we’re very excited to see what this collaboration will do for the future of mental health in India.