Mental Healthcare

12 Dec 2018
16 min read

Last Updated: October 2022

For Prelims: World Mental Health Day, Mental HealthCare Act 2017, Kiran Helpline, Manodarpan Initiatives, MANAS

For Mains: Mental Health as a basic human right, Challenges associated to promoting mental health in India

What is Mental Health?

According to the World Health Organisation (WHO), mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Mental health is a basic human right and it is crucial to personal, community and socio-economic development.

What are the Determinants of Mental Health?

Multiple individual, social and structural determinants combine to protect/undermine our mental health and shift our position on the mental health continuum.

Individual psychological and biological factors such as emotional skills, substance use and genetics can make people more vulnerable to mental health problems.
Exposure to unfavourable social, economic, geopolitical and environmental circumstances – including poverty, violence, inequality and environmental deprivation – also increases people’s risk of experiencing mental health conditions.
Risks can manifest themselves at all stages of life, but those that occur during developmentally sensitive periods, especially early childhood, are particularly detrimental.
- For example, harsh parenting and physical punishment is known to undermine child health and bullying is a leading risk factor for mental health conditions.
Protective factors similarly occur throughout our lives and serve to strengthen resilience. They include our individual social and emotional skills and attributes as well as positive social interactions, quality education, decent work, safe neighbourhoods and community cohesion, among others.

What Steps have been Taken to Promote Mental Health?

Global Initiatives:
- World Mental Health Day is observed on 10th October every year, with the overall objective of raising awareness of mental health issues around the world and mobilising efforts in support of mental health.
- WHO’s Comprehensive Mental Action Plan 2013-2020 was also adopted by the 66^th World Health Assembly.
- The Mental Health Atlas was launched by WHO in 2017 and is released triennially.
  - It is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. It serves as a guide for countries for the development and planning of mental health services.
- Suicide prevention is a global priority and included in the Sustainable Development Goals (SDG 3.4).
Initiatives by Government of India:
- National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the National Mental Health Program (NMHP) since 1982.
  - The Program was re-strategize in 2003 to include two schemes, viz. Modernization of State Mental Hospitals and Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals.
  - District Mental Health Programme (DMHP), 1996 was also launched to provide community mental health services at the primary health care level.
- Mental Health Act: The Mental HealthCare Act 2017 guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
  - It has significantly reduced the scope for the use of Section 309 IPC and made the attempt to commit suicide punishable only as an exception.
- Kiran Helpline: In 2020, the Ministry of Social Justice and Empowerment launched a 24/7 toll-free helpline ‘Kiran’ to provide support to people facing anxiety, stress, depression, suicidal thoughts and other mental health concerns.
- Manodarpan Initiative: It is an initiative of the Ministry of Education aimed to provide psychosocial support to students, family members and teachers for their mental health and well-being during the times of Covid-19 pandemic.
- MANAS Mobile App: In 2021, the Government of India launched the MANAS (Mental Health and Normalcy Augmentation System) Mobile App to promote mental wellbeing across age groups.
  - MANAS was endorsed as a national program by the Prime Minister’s Science, Technology, and Innovation Advisory Council (PM-STIAC).

What are the Important Points about Mental HealthCare Act 2017?

Right to Make an Advance Directive
- Patient can state on how to be treated or not to be treated for the illness during a mental health situation.
Right to Appoint a Nominated Representative
- A person shall have the right to appoint a nominated representative to take on his/her behalf, all health-related decisions
  - Right to access mental health care
  - Right to free & quality services
  - Right to get free medicines
  - Right to community living
  - Right to protection from cruel, inhuman and degrading treatment
  - Right to live in an environment, safe and hygienic, having basic amenities
  - Right to legal aid
  - No Electroconvulsive Therapy (ECT) without anaesthesia
Attempt to Commit Suicide not an Offence
- This act brought changes in Section 309 of the Indian Penal Code (which criminalized attempted suicide).
- Now, a person who attempts to commit suicide will be presumed to be “suffering from severe stress’’ and shall not be subjected to any investigation or prosecution.
- The act envisages the establishment of Central Mental Health Authority and State Mental Health Authority.

What are the Challenges in Promoting Mental Health?

High Public Health Burden: An estimated 150 million people across India are in need of mental health care interventions, according to India’s latest National Mental Health Survey 2015-16.
Lack of Resources: Low proportion of mental health workforce in India (per 100,000 population) include psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07).
- Low financial resource allocation of just over a percent of GDP on healthcare has created impediments in public access to affordable mental healthcare.
Loss to Economy: due to delayed or non treatment of mentally ill persons there is loss in terms of human capital and an overall loss to the economy in the form of lost man-days, plus the poor is stressed as most of mental healthcare is in urban areas and are unavailable in primary healthcare centres in rural areas, this increases out of pocket expenditure.
Demographic Dividend: According to WHO, the burden of mental disorders is maximal in young adults. As most of the population is young (India has more than 50% of its population below the age of 25) so it requires a special focus in mental health of youth by the government to reap the benefits arising out of the demographic dividend in India.
Post-Treatment Gap: There is need for proper rehabilitation of the mentally ill persons post his/her treatment which is currently not present.
Lack of Awareness: Poor awareness about the symptoms of mental illness, social stigma and abandonment of mentally ill especially old and destitute leads to social isolation.
- Reluctance on part of family members to seek treatment for the patient has resulted in a massive treatment gap, which further worsens the present mental illness of a person.
Rise in Severity: Mental health problems, tend to increase during economic downturns, therefore special attention is needed during times of economic distress.
Prone to Abuse: Mentally ill patients are vulnerable to and usually suffer from physical abuse, sexual abuse, wrongful confinement, even at homes and mental healthcare facilities which is a cause of concern and a gross human right violation.

What Should be the Way Forward?

Increase Resources
- Increasing mental healthcare facilities and related infrastructure through more resource allocation in the budget.
- Adequate Mental healthcare professional availability.
Increasing Awareness:
- For patients to undertake timely treatment
- To breakdown societal prejudices/ stigma
- To discourage questionable treatment from faith healers.
- For eg. “The Live Love Laugh Foundation” which aims to reduce the stigma, spread awareness and change the way we look at Mental Health.
More Investment in Public Healthcare:
- There is only one primary healthcare centre for more than 51,000 people in India.
- The World Bank estimates that 90% of all health needs can be met at the primary healthcare level thus more investments are needed in order for patients to get easier, cheaper and faster access to services, plus, training at grass root level for ASHA, ANM, AWW centre workers on how to recognize common to severe mental health problems like schizophrenia, anxiety, depression, and alcohol abuse.
Community Partnership:
- By forming their self-help groups of carers families along with NGO’s which brings community participation and helps reduction in social stigma associated with mental illness.
Empathetic Service Delivery:
- Delivery of services should be sensitive, compassionate and free from stigma and discrimination in public healthcare institutions plus there is need for police sensitization and training regarding recognition of acute mental disorders and undertaking of necessary action to protect the human rights of the mentally ill, his family and his fellow citizens.

Generating Awareness:
- India needs a constant stream of funds for educating and creating awareness about mental health and chronic issues around it.
- If individuals continue to view mental illness with apprehension and resistance, it will remain difficult for people with mental health concerns to seek the support they require due to the fear of being labelled or judged.

UPSC Civil Services Examination, Previous Year Questions (PYQs)

Mains

Q. Pawan is working as an officer in the State Government for the last ten years. As a part of routine transfer, he was posted to another department. He joined in a new office along with five other colleagues. The head of the office was a senior officer conversant with the functioning of the office. As a part of general inquiry, Pawan gathered that his senior officer carries the reputation of being difficult and insensitive person having his own disturbed family life. Initially, all seemed to go well. However, after some time Pawan felt that the senior officer was belittling him and at times unreasonable. Whatever suggestions given or views expressed by Pawan in the meetings were summarily rejected and the senior officer would express displeasure in the presence of others. It became a pattern of boss’ style of functioning to show him in bad light highlighting his shortcomings and humiliating publicly. It became apparent that though there were no serious work-related problems/shortcomings, the senior officer was always on one pretext or the other and would scold and shout at him. The continuous harassment and public criticism of Pawan resulted in loss of confidence, self-esteem and equanimity. Pawan realised that his relation with his senior officer was becoming more toxic and due to this, he felt perpetually tensed, anxious and stressed. His mind was occupied with negativity and caused him mental torture, anguish and agony. Eventually, it badly affected his personal and family life. He was no longer joyous, happy and contented even at home. Rather without any reason he would lose his temper with his wife and other family members. The family environment was no longer pleasant and congenial. His wife who was always supportive to him also became a victim of his negativity and hostile behaviour. Due to harassment and humiliation suffered by him in the office, comfort and happiness virtually vanished from his life. Thus, it damaged his physical and mental health. (2021)

(a) What are the options available with Pawan to cope with the situation?

(b) What approach Pawan should adopt for bringing peace,tranquility and congenial environment in the office and home?

(c) As an outsider, what are your suggestions for both boss and subordinate to overcome this situation and for improving the work performance, mental and emotional hygiene?

(d) In the above scenario, what type of training would you suggest for officers at various level sin the government offices?