No, none of us understand Mental Health
‘A little knowledge is a dangerous thing’ - Jithin at every debate at high school when the opposing speaker made a ridiculous point with half baked information
A lot of us believe that we understand mental health and would be considerate to those around us who suffer from issues. How true is this? For starters, ask yourself this question: do you know the difference between a psychiatrist and a psychologist? If you can’t answer that but you can tell the difference between a cardiologist and a gynaecologist, your mental health awareness is quite possibly a bubble.
Image Courtesy: Harvard Business Review
J: For most of us, mental issues fall in binaries, it could either be mild depression or advanced schizophrenia. We fail to acknowledge that like every other physical health problem, this too could have various degrees of gravity, needing different types of responses. While being fully cognizant of a person's state, lack of enough knowledge could drive us to extremes - on one end, telling a schizophrenic person to ‘stop being delusional’, and on the other, pushing someone with mild depression into antipsychotic medications or stimulants. The National Institute of Mental Health & Neurosciences (NIMHANS) is the foremost authority on mental health issues in India, and a nationwide survey conducted by them revealed that nearly 150 million Indians need support on battling mental health issues, while less than 30 million amongst us had access to it. If there’s one thing you already know about mental health in India - it would be that not many of us, including educated, erudite folks, are aware of its implications.
F: The price we pay for negligence to symptoms of physical ailments is known well. It makes us visibly incapable of being productive in daily tasks. But mental ailments are different, it leaves patients incapable of making judgements for themselves. Prioritising one above the other would tantamount to comparing whether a mobile phone with a broken screen is better than one with a software malfunction. How do we convince people to take actions to address the mental health crisis?
J: In an old episode of the Podcast ‘Solvable’, writer Malcolm Gladwell speaks to Rosanne Haggerty about how the actual cost of not addressing homelessness in cities is unseen, as nobody accounts for the additional spend on increased crime patrol and public healthcare needed to tend neighbourhoods with higher number of homeless people. In the same way, the cost of not addressing mental health issues is unknown, for the drain in productivity of an individual who is mentally unwell is ignored. WHO estimates that the Indian economy would suffer a productivity loss amounting to $1.03 Trillion between 2012 and 2030! ($1T == Rs. 73 lakh crores).
F: Between most of our colleagues and friends, there is no open stigma against mental health issues. One could attribute it to the abundant references in the Netflix titles.. A question to ask, would you be ashamed to reach out to a therapist when you are under stress? To have the same level of seriousness as a physical health issue, one should be comfortable addressing it, even if it is for stress and anxiety.
J: The stigma around mental health in India is deep-rooted. For most of our documented history, the lens of criminality was used to address this issue. The first law in this regard was The Lunatic Removal Act of 1852, meant to send mentally unwell British officers back from their Indian service duties to avoid them indulging in criminal activity. This law set the context for the Indian Lunacy Act of 1912. Naturally, we looked at mentally unwell persons as threats to society at large rather than as sick individuals who needed help. Thus, the stigma that surrounds patients and their relatives were only natural. As long as we associate shock treatments with mental health, we will observe hush-hushing of illness into the background. Nobody wanted to declare themselves as a ‘lunatic’. After independence, India took 35 years to put down its first Mental Health Act, in 1987. Outdated and inconsiderate as birth, the Act, by criminalising attempted suicide and legalising isolation of severely ill patients. This Act stayed for three decades until it was overturned by our present government through the Mental Healthcare Act of 2017, finally granting mentally ill individuals the right to live with dignity. Suicides by ill patients are no longer criminal offences, and every mentally unwell patient has a right to seek treatment for the illness. Electroconvulsive Theory, ECT, or ‘shock treatments’ is a medical practice just like any physical surgery, involving sending electrical currents to our neural system. While it was practised in a wayward manner earlier, ever since the new Mental Healthcare Act 2017, ECT requires sedation or anaesthesia like normal surgeries. That said, despite having its heart at the right place, the Act hasn’t improved the state of mental health in India even after three years into its existence. India allocates only ~0.05% of its overall healthcare budget to mental health, amounting to Rs. 40 crores, and spent only 12% of the allocated value last year, which is a mere ~ Rs. 5 crores. As with any Indian policy, there’s an ocean between fine print and implementation.
F: Over years of conditioning, we’ve now learnt to watch our daily diet, add workouts to our routines and monitor our blood sugar, pressure and cholesterol levels to ensure that our body runs well. But for our mind, we tend to pay attention only when there’s an impending crisis or when we get to the brink of a breakdown or a mental illness. Is there a compelling reason why we should track our mental well-being or have a preventive approach to it?
J: A study by a UK based charitable society concluded that 42.5% of Indian corporate employees suffered from at least one form of mental illness, the most common being depression and anxiety. This shouldn’t be surprising for a country so prone to discrimination on the basis of everything from caste, colour, ethnicity or even languages known, but what is alarming is that this proportion is from India’s most elite - the top 5% of the population who have formal jobs. Indian corporates are known for their toxic work culture, from indecent communication to frequent threats of job insecurity. Add gender issues into the mix, and toxic turns terrible - 38% of working women in India show signs of psychiatric morbidity compared to only 26% of the women who don’t work. Taking stock of our daily mental well-being is not a luxury, it is an inevitable part of keeping us at our productive best. Just the way employers engage staff to get a medical checkup once a while, ensuring that individuals are always at their best mental state should be normalised.
Bubble Break
That said, our responses as individuals to mental health too have followed a pattern similar to our government. We’re aware, we acknowledge, but we haven’t done anything about it. There isn’t a threshold that we need to cross before seeking help. Like one figures out a good doctor early, a trusted therapist is one you should identify before you are at the brink.
Not all fevers require hospitalisation, and not all kinds of depression need stimulants. All you need is a trusted doctor who can tell you what you need.
Next Week: We continue to delve into the misunderstood bubble around mental health, exploring how corporates try to find easy fixes, insurance companies feign ignorance and most importantly, how startups are employing tech to build solutions that make mental healthcare affordable and accessible to everyone.
Till then, here’s some homework for you: google the difference between a psychologist and a psychiatrist.
References:
National Mental Health Survey by NIMHANS: http://indianmhs.nimhans.ac.in/Docs/Report2.pdf
Lancet Global Health Study: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30138-5/fulltext?fbclid=IwAR0tpajs4v5Bh3WOmnelbJ3aWJHrZLw-4bvJEnW_-Qj2toHn83d7edUUCfE
ET Report on Mental Health among India’s Working Class; https://m.economictimes.com/magazines/panache/world-mental-health-day-nearly-half-of-india-inc-employees-suffer-from-depression/articleshow/66119215.cms
India’s unacknowledged productivity loss; https://economictimes.indiatimes.com/magazines/panache/mental-health-may-hurt-india-to-tune-of-1-03-trillion-heres-a-dose-for-cos/articleshow/71045027.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
Episode 1, Series 1 of the podcast: Solvable from Pushkin Industries