The Hindu Editorial Analysis- 10th October 2024 | Current Affairs & Hindu Analysis: Daily, Weekly & Monthly - UPSC PDF Download

Mental Health in India’s Material World 

Why in News?

In July this year, the case of a 26-year-old woman executive working for a multinational consulting firm, ending her life due to immense work pressures moved the spotlight to an important issue that concerns millions of working Indians. In September, a 38-year-old software engineer with 15 years of experience in a Chennai-based firm, ended his life. He was on medication for depression caused by work stress. Despite their “successful” careers, the loss of these lives underscores a growing mental health crisis in India, where success is often equated with relentless productivity and material wealth. These events reveal the struggles many face such as battling depression, anxiety, and a lack of purpose even as they put up a facade of success and contentment.

Mental Health in India: Statistics

• Mental health issues significantly affect India, leading to 2,443 disability-adjusted life years for every 100,000 people.
• The age-adjusted suicide rate stands at 21.1 per 100,000 individuals.
• For every 100,000 people, the overall suicide rate is 10.9.
• Between 2012 and 2030, the economic impact of mental health problems is projected to reach USD 1.03 trillion.
• The occurrence of mental health issues is notably higher in urban metro areas at 13.5%, compared to rural regions at 6.9% and urban non-metro areas at 4.3%.

Determinants of Mental Health

Impacts of mental health issues

• Diminish individual quality of life
• Constrain overall productivity through absenteeism, reduced efficiency, disability.
• Increased healthcare costs

Challenges in addressing the issue of mental health

• Stigmatisation of mental illness leading to delay in seeking treatment and social exclusion and isolation for the ones affected.

• Financial barriers to accessing mental health treatment. 
•  There is a significant lack of infrastructure: Globally, there are only 0.04 mental hospitals for every 100,000 people, and in India, this number is even lower at just 0.004. 
•  India does not have enough qualified mental health professionals and services: According to the WHO, there are only 0.3 psychiatrists available for every 100,000 individuals. 
•  The treatment gap for mental health issues is quite large, ranging from 70% to 92% for various disorders. 
•  There is also a limited availability of education and awareness regarding mental health. 

Mental Healthcare Act, 2017

Definition of Mental Health

According to section 2 of the Act, mental illness refers to a significant disorder in thinking, mood, perception, orientation, or thought. This disorder can greatly affect a person's behavior, their ability to understand what is real, and their capacity to handle everyday tasks.

Rights Under the Act

• Right to access mental healthcare - Everyone has the right to receive mental health services.
• Right to protection from cruel, inhuman, and degrading treatment - Individuals must be treated with respect and dignity.
• Right to equality and non-discrimination - No one should face discrimination because of their mental health condition.
• Right to information - Individuals have the right to be informed about their treatment and care.
• Right to confidentiality - Personal information regarding mental health must be kept private.
• Right to legal aid - People can seek legal help regarding their mental health rights.
• Right to make complaints - Individuals can report any shortcomings in the mental health services they receive. (This means no one should be told to leave the country if they express dissatisfaction with the services.)
• Right to make an advance directive - Individuals can specify how they wish to be treated for their illness and who they choose to represent them.

Mental Health Review Commission and Board

• The Mental Health Review Commission will act as a special group that will regularly check how advance directives are made and offer advice to the government regarding individuals with mental health issues.
• The Commission will work together with state governments to set up Mental Health Review Boards in each district of a state.

Decriminalising suicide

• A person who tries to commit suicide is considered to be experiencing mental illness at that time.
• Such individuals will not face punishment under the Indian Penal Code.

Prohibiting electro-convulsive therapy

• Electro-convulsive therapy can only be performed when using muscle relaxants and anesthesia.
• This therapy is not allowed for minors.

Penalties and offences

• Any violation of a rule can lead to a punishment of a six-month prison term and/or a fine of Rs. 10,000.
• For those who commit the same offense again, they may face an additional two years in prison and/or fines ranging from Rs. 50,000 to Rs. 5 lakh.

Government initiatives to address issues of mental health

Tele-MANAS

The Tele Mental Health Programme is designed to enhance mental health services across the country.

Structure of Tele-MANAS

• Tier 1: State Tele-MANAS cells with trained mental health experts available for teleconsultation via a special Interactive Voice Response system (IVRS).
• Tier 2: District Mental Health Programme (DMHP) and Medical College resources offer in-person consultations or audio-visual consultations through eSanjeevani.

Tele-MANAS aims to bring together various mental health services and professionals, which include:

• National teleconsultation service
• e-Sanjeevani
• Ayushman Bharat Digital Mission

Common mental health issues addressed through Tele-MANAS include:

• Sadness
• Insomnia
• Stress
• Anxiety

Features of Tele-MANAS

• It is a free service with a toll-free number 14416.
• Available 24/7 in 20 languages with more than 1,900 trained counselors.
• Connects users to suitable services and nearby healthcare facilities.
• Nodal Centre: National Institute of Mental Health and Neuro Sciences (NIMHANS).
• International Institute of Information Technology-Bangalore (IIITB) offers technological support.

eSanjeevani

eSanjeevani was introduced by the Ministry of Health and Family Welfare in 2019.

This is a web-based teleconsultation platform that provides two types of telemedicine services:

• Doctor-to-Doctor (eSanjeevani) teleconsultation.
• Doctor-to-Patient (eSanjeevani OPD) teleconsultation.

The Doctor-to-Patient eSanjeevani OPD service was launched during the COVID pandemic to offer healthcare to patients at home.

National Institute of Mental Health & Neuro Sciences (NIMHANS)

• This institute is recognized as an institute of national importance under the Ministry of Health and Family Welfare.
• NIMHANS provides psychological support and training through the (iGOT)-Diksha platform.

National Mental Health Programme

As part of the District Mental Health Programme, over 1.73 lakh healthcare centers, including Sub-Health Centres, Primary Health Centres, urban PHCs, and wellness centers, have been upgraded to Ayushman Arogya Mandirs to offer mental health services.

Ayushman Bharat – HWC Scheme

Mental health services are now included in the package of services under the Comprehensive Primary Health Care offered by the Ayushman Bharat – HWC Scheme.

Operational guidelines on Mental, Neurological, and Substance Use Disorders (MNS) have been issued for Health and Wellness Centres (HWC) under the Ayushman Bharat initiative.

Kiran Helpline

This is a 24/7 toll-free helpline designed to support individuals dealing with anxiety, stress, depression, suicidal thoughts, and other mental health issues.

Policy Recommendations on Mental Health

• Increase the number of psychiatrists from 0.75 per lakh population in 2021 to the WHO standard of 3 per lakh population.
• Evaluate the effectiveness of programs by collecting feedback from users, professionals, and stakeholders to make necessary adjustments.
• Support peer networks, self-help groups, and community rehabilitation programs to reduce the stigma surrounding mental health disorders.
• Collaborate with NGOs to improve efforts, share knowledge, and utilize resources to enhance future policies.
• Include individuals with personal mental health experiences in decision-making and service planning to improve person-centered care.
• Standardize mental health service guidelines across both government and private sectors.
• Incorporate mental health interventions in schools, including a suitable curriculum for teachers and students that focuses on early intervention and positive communication.
• Adopt a community-wide approach to address mental health issues and combat stigma.