Mental health yet to get the attention it deserves

Despite large number of suicide cases getting repoted there is shortage of proper treatment options

By   |  Published: 9th Jul 2018  12:03 amUpdated: 8th Jul 2018  11:40 pm
According to a WHO study, the age group of 15 years and 29 years account for the highest suicide rate.

Hyderabad: Almost on a daily basis, we come across instances of persons committing suicides in the face of personal tragedies, professional setbacks or for that matter even for obscure reasons.

In fact, according to a WHO study, the age group of 15 years and 29 years account for the highest suicide rate for a lakh of population i.e. close to 35 suicides occur in this age group (for one lakh) every year in India.

With changing lifestyle such as long work hours and distressed family situations, large number of mental, behavioural diseases and cases of substance abuse are getting reported. And yet, including Telangana, there are not many State-run health institutions that provide proper support to persons struggling with mental health issues.

Then there is the issue of stigma due to which mental health disorders are seldom reported, as a result persons with such issues lead a poor quality of life. Although it’s quite hard to measure, the socio-economic impact of such conditions is also huge and always unacknowledged.

There are enough studies including the National Mental Health Study (NMHS) taken up across India by NIMHANS, Bengaluru in 2016 that highlight the imbalance or shortage of proper treatment options.

According to NMHS, countrywide ‘mental health programmes and services need significant strengthening or scaling up to deliver appropriate and comprehensive services for millions across the Country who are in need of care’.

A whopping 150 million (15 crore) persons in India are in need of mental health interventions and care for short and long term. Considering far reaching impact social and economic impact, they need urgent interventions, according to NMHS.

The irony is that despite the high incidence of the ailment, in Telangana and elsewhere in the country, 85 per cent to 90 per cent of medical care to such persons is provided at private mental healthcare facilities.

There is a a huge treatment gap of 85 per cent for providing support to persons suffering from common mental health issues. This means, that 85 per cent of people struggling with anxiety and depression do not get treatment for their condition. The NMHS also said that 73.6 per cent of persons struggling with severe mental health disorders do not get treatment at any stage in their lives in India.

Then there is the issue of severe shortage of mental health professionals to provide quality healthcare. According to various sources, the overall requirement of psychiatrists for India is anywhere between 60,000 and 65,000 psychiatrists.


Depression can be treated with medication: expert

Depression is just like any other medical disorder that can be treated by proper medication with very good results, says Head, Department of Psychiatry, Kakatiya Medical College, Warangal, Dr SRR Y Srinivas. The senior mental health expert told ‘Telangana Today’ that family members or significant others must play an important role in identifying patients’ symptoms and seek help quickly.

Treatment for depression

Thanks largely to development of modern medicine, with proper guidance, medications and counselling, depressed persons can be treated properly. Such persons think negatively all the time, even if their lives are normal. They feel worthlessness, hopeless and suffer from delusion that they are sad despite lot of positive things happening in their lives.

What are the causes

A lot of research is going in this field. However, many attribute depression to chemical imbalances in the brain. When the internal milieu is unstable and gets exacerbated due to outside factors such as a major tragedy, they trigger depression and suicidal tendencies. Some also attribute depression to polygenic inheritance or single gene inheritance. In common terms, there are theories that depression has its roots in genetics too.

Link between genes and depression

For example, if two persons face a major tragedy in their lives. The one with genetic proclivity towards depression will think of ending life, despite many positive things in their lives. The other person, even if he is poor and struggling, will find ways to deal with the tragedy and keep fighting.

On symptoms

Some common symptoms include sad and irritable mood, spells of crying, decreased interest in any kind of activity, lack of socialising, not taking personal care and talking negatively all the time despite positive things happening in life.

Medical procedure

Depression can be treated through medication and Electro Convulsive Therapy (ECT), which is also known as electroshock therapy. There are very well developed modern medicines that give good results in treating depression. In fact, one of three depressive patients react positively to drugs.

How effective is ECT?

Unfortunately, due to various reasons, ECT has earned a bad reputation. However, it is the best option for persons who are highly suicidal and severely depressive. It is one of the fastest and best treatment methods to relieve persons from suicidal tendencies. In just three sittings, we have seen patients completely getting rid of suicidal feelings. However, ECT should be done only by trained hands because anaesthesia is involved.

Telangana lacks focussed plan

While a lot has been done to improve clinical health services and medical infrastructure in Telangana, health authorities are yet to rollout a focussed plan to build an ecosystem that would provide holistic support to persons struggling with mental health ailments.

The Centre of Excellence status to Institute of Mental Health, Erragadda was accorded way back in 2009-10 when the Ministry of Health and Family Welfare had decided to upgrade the services in about 20 mental health institutions across the country.

Last year June, a foundation stone was laid out for construction of a new building with Rs 18 crore at IMH, Erragadda. It was planned to construct an auditorium, special wards for patients and teaching aids such as a hi-tech library for PG students pursuing specialisation of mental healthcare.

While senior doctors here have said that the project when completed would provide top quality treatment, the pace works of the new facility has remained sluggish. As a result, senior doctors at IMH, which receives anywhere between 350 and 400 patients on a daily basis in the outpatient wings, have been struggling to provide quality patient-care.

The administration and patient care at IMH also struggles due to manpower shortage. The hospital has six units of psychiatry for which it requires nearly 12 Assistant Professors while there are only two remaining. The mental health institute also needs nearly 12 senior residents for providing care to patients.

Due to stigma associated with mental health illness, a majority of patients hesitate to even enter a standalone mental health facility. To enable patients to overcome hesitation, Ministry had suggested that General Hospitals should have dedicated mental health wards and departments. Experts here suggested that such measures should be taken up in TS to improve mental healthcare services.

No State-run rehab services

Providing adequate rehabilitation facilities in State-run hospitals has remained a big issue, even as private sector has continued to play a dominant role. There is only one rehab facility at National Institute for Empowerment of Persons with Intellectual Disabilities (DIVYANGJAN) formerly NIMH at Bowenpally which is funded by the Centre.

A rehab facility will require recruiting occupational therapists, psychological counsellors and other ancillary staff, who along with senior doctors, enable patients to get back to their normal life.

Attempting suicide is no longer a crime

Blurb: Mental Healthcare Act also prohibits use of electric shock for children and has made use of anaesthesia and muscle relaxants mandatory for giving this treatment to adults

The Mental Healthcare Act-2017, which was notified a few months ago by Ministry of Health, Medical and Family Welfare (MOHFW) will have far reaching implications on the way patients with mental health issues are treated by doctors and other government departments.

To begin with, attempting suicide is no longer a crime in India because the Mental Healthcare Act has decriminalised it.

“Notwithstanding anything contained in section 309 of the Indian Penal code any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said the Code,” the Mental Healthcare Act said.

Section 309 of Indian Penal Code says, “Whoever attempts suicide and does any act towards commission of such offense, shall be punished with simple imprisonment for a term which may extend to one year.”

Instead of prosecuting persons who have unsuccessfully tried to commit suicide, the State governments has the duty to provide care, treatment and rehabilitation to them. Helping such persons will reduce the risk of recurrence of attempt to commit suicide.

The Mental Healthcare Act has also prohibited the use of electric shock for children and has made it mandatory for use of anaesthesia and muscle relaxants for giving this treatment to adults.

Another very interesting rule in the Mental Healthcare Act 2017 is Advanced Directive in which people can give directions in advance regarding their preferred mode of treatment in case of mental illness in the future.

“Every person, who is not a minor, shall have a right to make an advance directive in writing, specifying the way the person wishes to be cared for and treated for a mental illness; the way the person wishes not to be cared for and treated for a mental illness; Capacity to make mental health care and treatment decisions.”