Suicide where people ‘harm themselves with the goal of ending their life and die as a result’ has been making news in India. It is a tragic and preventable way of dying. People from all strata and ages are being driven to this act of desperation. Students, industrialists, farmers, succumb to the mental trauma and take their lives. Depression caused by a whole range of possible reasons- mounting financial burden, mental disorder, chronic pain, social pressures, can drive persons to this extreme act of hopelessness.
As the National Crime Record Bureau’s (NCRB) latest report succinctly puts it, ‘every suicide is a personal tragedy that prematurely takes a life of an individual and has a continuing ripple effect’. As per the latest report of NCRB, every year more than 1,00,000 people commit suicide in our country. The latest data as available for the year 2021 shows a 7.2 percent increase over 2020.
All this background is to put in context the recent report of the Parliamentary Standing Committee on Health & Family Welfare submitted on August 4, 2023. The report on ‘Mental Health Care and Its Management in Contemporary Times’ could not have come at more appropriate time when mental health-related issues are rising.
Mental health has been defined as a state of wellbeing that enables people to cope with the stresses of life. The Committee’s report covers the whole gamut of issues-status of infrastructure, regulatory structure and causes behind the increased prevalence of mental health problems. The last mental health survey commissioned by the Ministry of Health & Family Welfare was conducted in 2015-16. As per this survey, India’s mental morbidity rate for those above the age of 18, was estimated to be 10.6 percent.
The Committee noted that there has been little change from the issues highlighted in the 2015-16 survey —the treatment gap defined as the difference between requirement and access to treatment having, and the overall numbers would have only increased due to lack of mental health professionals, stigma, and weak infrastructure.
The Committee noted the adverse impact of COVID-19 on the psycho-social well-being of all groups. It recommended one more survey be conducted expeditiously to assess and address the present situation. The Committee highlighted the prevalence of mental health issues among children and adolescents. This, the Report suggests, is more in urban areas.
The lack of awareness, access to essential mental health services also adds to the problem. Educational hubs like Kota are prime examples of the pressure cooker environment in which adolescents are put into with no facilities for counselling.
The Committee took note of the rising incidence of suicides in the country and the urgent need to identify and help the vulnerable persons. The lack of mental health professionals has specifically been observed in the Report. Currently it is estimated that there are 0.75 psychiatrists per lakh people. Ideally it was noted that there should be at least three psychiatrists per lakh people, which would mean an additional 27,000 psychiatrists. The Report highlights the lack of mental health services at the primary and secondary level.
We have a Mental Healthcare Act 2017 which while incorporating very many of the recommendations of the National Mental Health Policy, has been implemented haphazardly. Thus, as noted by the Committee, the Mental Health Review Board mandated by the Act have not been set up in several States. While a Central Mental Health Authority has been established, the Committee noted its inconspicuous presence-and its absence in very many States.
The Committee appreciated the steps taken by the Insurance Regulatory Development Authority of India (IRDA) making it mandatory for insurance companies to cover mental illness also. It stressed the need for the Ministry to work closely with IRDA to ensure that insurance providers act on the IRDA’s mandate so that mental health issues do not get neglected. The Committee directed that the data be collected from the insurance providers on this aspect.
There is unfortunately too much stigma attached to mental health issues. There is a desperate need to identify early, persons going through depression. Family and friends can play a critical role in identifying and assisting such persons. It is good that celebrities are acknowledging publicly that despite all the luxuries they enjoy, they too do go through severe bouts of depression and need professional help.
Mental health issues are only going to increase with the increasing high stress of modern life. As per the World Health Organisation (WHO) the burden of mental health problems in India is 2443 disability-adjusted years ( DALY’s) — the measure of overall disease burden expressed as the number of years lost due to ill-health, disability or early death per 100 00 population; the age adjusted suicide rate per 100 000 is 21.1. The WHO estimates the economic loss due to mental health conditions to be USD 1.03 trillion.
A publicity campaign is required to reduce and remove the stigma attached to mental health problems; awareness drives need to be launched. Having mental health problems does not mean you are insane-it only means that you need professional help.
As the WHO puts it, it calls for a comprehensive strategy for prevention, treatment, and recovery through a whole-of-government approach. We cannot afford to have otherwise physically healthy individuals become a burden on society due to mental health problems. Their ailments can with proper care be treated and these individuals can become useful, productive members of society. The Government should act on the recommendations of the Standing Committee.
—The author, Najib Shah, is former Chairman, Central Board of Indirect Taxes & Customs. The views expressed are personal.
(Edited by : C H Unnikrishnan)