For every 100 000 people in India, there are 0.3 psychiatrists. That number is even lower when it comes to nurses (0.12), psychologists (0.07) and social workers (0.07); and even still, of the services available, only 12% of mental health services are actually accessed. In rural and tribal areas (or geographically distant areas), this treatment gap is further heightened.
In my final week at the Society for Participatory Research in Asia (PRIA), I had the opportunity to attend a National Mental Health Conference in Delhi presented by FICCI Aditya Birla CSR Centre for Excellence and MPower called “Speak Up”. The event marked one of the first of its kind and brought together interdisciplinary academics, delegates, service providers, government officials, and all other general stakeholders with the aim of starting a national mental health movement- breaking the stigma surrounding a topic that has, for years all around the world, remained predominantly “taboo”.
As a foreigner undergraduate student, I hold a deep passion for Global Mental Health, but acknowledge that, as former CAPI Intern Rachel Barr noted: “it is not my job or right, to form conclusions” (something perhaps most relevant within the context of the research I conducted with PRIA on accessible psychological support systems for mothers within the postpartum period in rural Rajasthan), but here I hope to share an overly-simplified summary of what I learned on October 30th, 2018.
India is home to the second largest population of the world and comprises almost 18% (1.36 billion as of December, 2018) of all human beings on earth. According to a study published by the World Health organization in 2015, over 1 in every 5 people in India suffer from depression in their lifetime and almost 20% of youth are directly affected by some form of mental illness.
The wide-ranging agenda of Speak Up saw discussions in various sectors of Mental Health with even more diverse panel members. One of which focused on the role of policy within Mental Health- specifically referring to the Mental Health Care Act (MHCA) implementation in India (July 7, 2018), which was passed on April 7th, 2017 and replaced the former existing 1987 Mental Health Act.
The enactment of the 2017 Mental Health Care Act held a lot of progressive theoretical promise and made big leaps from its 1987 form. However, its subsequent actions and practical application have led to strong dissonance between health care service providers, stakeholders, and policy-makers, which was made clear by the Indian Psychiatry Society. The act has been praised as revolutionary (said to have rehumanized mental healthcare as an example), as well as served as a barrier to necessary patient care. This panel revealed the importance of collaboration within these decision-making processes; mental health has fought for far too long through an “us vs them” narrative. Having a small glimpse at the complexities which bridge policy and mental health services- which can either connect or disconnect people to vital access and to networks of support- within India was extremely fascinating and a privilege to learn about.
Here are a few other reports, perspectives, and information about the act, if you are interested in learning more:
https://www.thehindu.com/news/national/all-you-need-to-know-about-the-mental-healthcare-bill/article17662163.ece (Information about the Mental Health Care Bill)
https://caravanmagazine.in/perspectives/mental-healthcare-act-premature-celebration (Featuring some thoughts shared by one of the organizations which sat on the MHCA discussion panel (Indian Psychiatry Society, IPS)
As the day progressed, the conversation on mental health continued. Sessions on “Sharing of best practices and Challenges”, “Capacity Building for the Mental Health and Workplace” and “The Next Generation: It’s okay to talk” were conducted. While the discussion collaboratively spanned many areas of mental health, one theme remained constant throughout: that even with all the areas of disconnect; the varied, at times opposing, lenses and approaches to mental health strategies; and the issues that still remain, hope remains. Our awareness is growing and each lens- no matter how different- is incredibly valuable; none are mutually exclusive. Rather, like puzzle pieces, each view composes a bigger and more complete fluid picture that we can only hope to continue to better understand.
Change begins from the bottom-up. It starts with awareness, an expanding understanding, and a willingness to reach out and to listen. It comes from a realization that it really is, not only okay but, actually important to talk and that this accompanied vulnerability and trust comes from deep strength. Change starts with coming together, caring for one another, and a desire to walk with and alongside one another. It is sustained by changes in structures and policy and treatment gaps and support; it is rooted in relearning connection and humanity, relearning vulnerability and co-operation and unlearning stigmas and “othering”.
In a single day, my eyes were opened to so many things surrounding Mental Health in both the Indian and the global context. Individuals from all over the world participated and contributed. It was a true honour to witness such passion, as well as hunger for knowledge, interaction and change, ignite the room from individuals and organizations of different backgrounds, disciplines, and areas of work. I was deeply intrigued by the complexities of the new MHCA and healthcare provider challenges presented in parallel with new methodologies and ways of thinking. These were introduced by organizations rooted in context-specific alternative approaches, to include people at many levels (of course, there are still more to be included) of the equation and at every generation. Each organization willingly shared their ideas, wanting to promote knowledge translation, rather than hoarding innovative strategies and thoughts in order to seek individualistic gain- a theme all too common within our engrained system rooted in neo-liberalism. I was encouraged to see once disconnected micro and macro level approaches begin to shake hands and merge together synergistically.
The #SpeakUp National Mental Health Movement marked the beginning of something very special: a conversation that will not stop and is not afraid to disagree, to confront, or to change for the betterment of our society.
Certainly, many questions remain. Having the honour of observing and learning more about the Mental Health situation in India has also caused me to ask more about the state of mental healthcare back at home. How have our own policies turned into action? While our days devoted to mental health have hailed a lot of media attention, the reality is that even within our own school and the privilege that those attending, myself included, hold, individuals still face large barriers to support. #Clicktivism can be a powerful tool, but how far does/can it extend? Service and treatment gaps remain large, and even when services are available, are they accessible? If yes, to whom?
I do not have all (if any) of the answers, nor the solutions, but I will continue to ask questions and to continue finding out. #SpeakUp has encouraged me with an opportunity to learn, to discuss, to grow, to engage, and most importantly, to ask: how can we, how can I, do more?
Patel, V., and Saxena, S. (2014). Transforming lives, enhancing communities – Innovations in global mental health. N Engl J Med. 370:498–501.
World Health Organization. World Health Statistics (2016). Geneva 27, Switzerland: World Health Organization.