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Editorials/Opinions Analyses for UPSC – 8 June 2021

Contents

  1. Towards a stronger mental health strategy

Towards a stronger mental health strategy

Context:

Mental health issues are emerging as a major health challenge in the world, especially due to the havoc wrecked by the second wave of the Covid-19 pandemic.

Relevance:

GS-II: Social Justice (Health related issues, Government Interventions and Policies, Issues arising out of the design and implementation of Government Policies)

Mains Questions:

More needs to be done in India in the context of exacerbated mental illnesses, especially after the Covid-19 Pandemic. Discuss. (15 Marks)

Dimensions of the Article:

  1. Understanding Mental illnesses
  2. About the current situation of exacerbated mental illness
  3. Initiatives in India
  4. Way Forward: Additional measures for India

Understanding Mental illnesses

  • Mental illnesses include anxiety disorders, psychotic disorders, mood disorders, substance use disorders, personality disorders and eating disorders.
  • The majority of suicides in the world are related to psychiatric problems or to the illnesses listed above. Death by suicide is a complex phenomenon and not fully reported.
  • Mental health may not be the primary concern in developing economies like India as there may be other communicable and non-communicable diseases which may be more prevalent.

Importance of mental health:

  • Emotional and mental health is important because it’s a vital part of your life and impacts your thoughts, behaviors and emotions.
  • Being healthy emotionally can promote productivity and effectiveness in activities like work, school or caregiving.
  • It plays an important part in the health of your relationships, and allows you to adapt to changes in your life and cope with adversity.
  • Our mental health encompasses our psychological, emotional and social well-being. This means it impacts how we feel, think and behave each day.
  • Our mental health also contributes to our decision making process, how we cope with stress and how we relate to others in our lives.
  • Global burden of mental health will be well beyond the treatment capacities of developed and developing countries.
  • The social and economic costs associated with growing burden of mental ill health focused the possibilities for promoting mental health as well as preventing and treating mental illness.

About the current situation of exacerbated mental illness

  • According to the World Health Organization (WHO), there is a 10-25-year life expectancy reduction in patients with severe mental disorders.
  • About 72% of member states had a standalone policy or plan for mental health in 2017.
  • Studies in The Lancet Public Health (2019) revealed that median mental health spending across the world was around 2% of the total government health expenditure in 2015. There was higher allocation in developed countries than in developing countries.
  • Residential mental health services, particularly community ones, are an important component for good quality mental health care. In most industrialised economies, there has been a growth of community healthcare facilities in line with the increase in patients with mental health issues.

Situation In India

  • Recent reports published in Lancet revealed that one in seven people in India had a mental disorder ranging from mild to severe in 2017. Also, the proportional contribution of mental disorders to the total disease burden had doubled between 1990 and 2017.
  • Government expenditure on hospitals dealing with mental health issues as a percentage of total government expenditure on mental health is 1.3% in India; in developed countries, it ranges from 3% to 15%.
  • In India, the share of mental hospitals per 1,00,000 population is as low as 0.01 in line with developing countries, according to the WHO. This may possibly be due to the lack of focussed attention given to mental health compared to other major diseases in India.
  • In the distribution of mental health units in general hospitals globally, in 2016, India was ranked 114 with just 0.03 units per 1,00,000 population.
  • India was at the 99th position in the distribution of mental health outpatient facilities
  • India was ranked 107 when it came to people working in the mental health sector with just less than 0.3 per 1,00,000 population.
  • Globally, the suicide rate was 10.6 per 1,00,000 population whereas in India, it was 16.3 per 1,00,000 in 2016. The suicide rate was higher among males compared to females.
  • Depressive disorders were more prevalent among females than males which could be due to sexual abuse, gender discrimination, stress due to antenatal and postnatal issues and other reasons.

Initiatives in India

Mental Health Care Act, 2017

  • The Mental Health Care Act (MHCA) 2017 came into force in 2018 to meet the requirements of the United Nations Convention on the Rights of Persons with Disabilities which India ratified in 2007.
  • The Act provides for a right to make an Advance Directive, wherein patients can state on how to be treated or not to be treated for the illness during a mental health situation.
  • This act brought changes in Section 309 of the Indian Penal Code (which criminalized attempted suicide). The attempt to commit suicide is punishable only as an exception. 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 also provides for 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 like:
    • 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, and
    • No Electroconvulsive Therapy (ECT) without anesthesia.

National Mental Health Programme

  • National Mental Health Programme (NMHP) was started in 1982 with the objectives to ensure availability and accessibility of minimum mental health care for all, to encourage mental health knowledge and skills and to promote community participate in mental health service development and to stimulate self-help in the community.
  • Objectives of National Mental Health Programme
    • Minimum mental heathcare for all – To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population;
    • Application of Mental Health Knowledge –  To encourage the application of mental health knowledge in general healthcare and in social development; and
    • Community Participation – To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.

District Mental Health Programme

  • During IX five-year plan, District Mental Health Programme was initiated (1986) based on Bellary Model developed by NIMHANS, Bengaluru.
  • Components of District Mental Health Programme
    • Early detection and treatment
    • Training
    • Public Awareness Generation
    • Monitoring

Way Forward: Additional measures for India

  • In order to further address mental health issues, India could reduce the treatment gap for mental disorders, increase the number of personnel in the mental health sector, work towards reducing discriminatory attitudes, and devise an integrated approach for detecting, treating, and managing patient needs.
  • More counselling facilities, especially in rural areas, with special support for women through the provision of women doctors are needed.
  • More telemedicine, telephone-based helpline numbers, and mental health apps could help.
  • Communities and families have an important role in this regard and so do community-based programmes.
  • School-based programmes on mental health can improve the mental health of children.
  • More fund allocation for treatment of mental health, especially to those States in need of funds, could do wonders.
  • There needs to be a road map for mental health awareness. This should include the traditional media, government programmes, the education system, industry, and social media.
  • Media awareness and government involvement is already happening in India but both can improve.
  • It is high time that industry and private sector companies set up counselling facilities.
  • The application of big data and crowd sourcing ideas may help us in informed decision-making.

-Source: The Hindu

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