Mental Health in India: A Problematic Discourse Can Only Lead to Inadequate Laws
Effective legislation on mental health needs to address both the social and economic dimensions of deprivation that persons without access to mental healthcare face.
In 2017, a World Health Organization (WHO) report estimated that 20% of Indians are likely to suffer from depression. A 2016 study published by the National Institute of Mental Health and Neuroscience (Nimhans) also found that around 14% of Indians have mental disorders, and at least 10% of them require immediate medical intervention. Lack of awareness, combined with stigmatisation and a paucity of accessible professional resources, has meant that only about 10%-12% are able to seek help.
Despite these problems, only 0.06% of India’s health budget is devoted to mental health. Available data suggests that state spending in this regard is abysmal. The Minister of State for Health and Family Welfare, Anupriya Patel, declared in the Lok Sabha, that India had only 3,827 registered psychiatrists when it needs at least 13,500.
This reading list discusses the problems within the mental health discourse, in India.
1) Mental Health: Past and Present
The first legislation related to mental health in India, the Lunacy Act, was introduced by the British in 1858. Authors A Kiranmayi, U Vindhya, V Vijayalakshmi give us some insight into why it took so long for the British to introduce mental health related legislations. They believed that mental health in India in the past was also viewed from an orientalist perspective.
“It was commonly believed that the prevalence of mental illness in India was much less than in the western countries, citing the ‘oriental philosophy of life’, the limited urbanisation and industrialisation, the strong family ties as factors responsible for this ‘low prevalence’ of mental illness. Much of the work in the area of mental health continues to be directed at treatment of illness rather than towards preventive or promotive efforts.”
Prateeksha Sharma believes, there exists a disparity between developed and developing countries in the way that mental health is perceived and treated. From a comparative study of peer support systems in aiding mental healthcare in the United States and in India, Sharma surmises that developing countries seem to be lagging behind in terms of formulating adequate legislation, and in creating a more inclusive community which is more accepting of people with mental health problems. Building such a community ensures that the rights of those with mental health problems are better protected.
“Notwithstanding the gains that expatients, activists or consumers of mental health services have made in the developed, Western world in rallying for their rights, inclusion and dignity, their replicas duplicated, adopted or developed in the developing or underdeveloped parts of the world are vastly different—in terms of their social bargaining ability, wage negotiating capacity and acceptability within their own communities. The latter have developed mostly due to stimulus provided by the socially dominant, educated, professional groups who create versions best suited for the dissemination of their own goals and professional practices. In the West, psychiatry has reoriented itself to focus on “recovery,” whereas in India the goal of psychiatry is to fill what is identified as the “treatment gap in mental healthcare”
2) Women Are at a Greater Disadvantage
In 2011, a WHO study reported that nearly 36% of Indians suffer from major depressive episodes (MDEs). Research shows that women are more vulnerable to depression, with a 50% higher burden of cases. Teertha Arora and Nandita Bhan have argued that this is owing to the stigma attached with mental health disorders.
“Depression among women in India often goes undiagnosed or untreated due to lack of public understanding of the condition, the disadvantaged position of women in multiple facets of life, stigma attached to mental disorders and paucity of mental health professionals. Women’s risk of developing depression are greatest during their child-bearing years, manifesting in postpartum depression.”
Women have been particularly susceptible to common mental health disorders, where higher rates have been observed as compared to men. Differences between genders in areas such as the age of onset of symptoms, the course of the disorder, frequency of psychotic symptoms, social adjustment, and long-term outcome of severe mental disorders among others have been marked. Yet, as A Kiranmayi, U Vindhya, V Vijayalakshmi point out, the women’s movement in India did not prioritse mental health as an issue. In their article, they have also highlighted the fact that the discourses on mental health do not recognise the unequal status of women as a cause for mental disorders.
“First, the women’s movement in our country, over the past two decades or so has had to deal with an enormously wide range of issues and problems that are largely consequences and effects of societal oppression of women. Issues of survival – for land, for work and wages, issues like sexual and family violence, harassment and discrimination in places of work and working conditions, inequities in services like education and health care are a few examples of the interventions and initiatives of the women’s movement. Mental distress has not figured on the agenda, perhaps because it is viewed as a manifestation of an individual problem, not directly related to societal oppression, and not common to all women. It is necessary to consider the socio-cultural context of women since it is being increasingly recognised that the stresses that differentially affect women because of their unequal social status have led to pervasive mental health problems”
3) The Mental Health Discourse Needs Autonomy
Bhargavi Davar believes that while it is certainly true that public health related policies must be holistic in nature encompassing as many issues as possible, a “holistic” conception of mental health is not about treating mental disorders as just another type of public health issue. Mental health must be linked with the public health discourse but the differences must be also recognised, articulated and debated.
“We need – and probably have – a holistic and people based conception of health. We need – and at this point in time, certainly do not have – a holistic and people based conception of mental health. We cannot assume that since we have a holistic conception of health, therefore, we always and already have a holistic conception of mental health. The mental health discourse needs to be treated differently and a little autonomously – the core disciplines are different, the questions are different, the socio-political histories and practices, movements and mobilisations, policies and laws, around mental health are different.”
4) The Inadequate Mental Health Care Bill
The government’s attempt to tackle the problem of mental health in India resulted in the culmination of the Mental Health Act, 2016. It replaced the Indian Lunacy Act, 1912 in 1993 when it came into force. However, it has severe shortcomings. K S Jacob points this out while terming the bill as a work in progress.
“The inclusion of mental retardation under mental illness was problematic. The grouping together of different types of treatment and rehabilitation settings, and the demand for uniform standards made this legislation difficult to implement in practice. The setting of, as yet, unachievable minimum standards (for example, one psychiatrist for every 10 beds) was criticised. The exclusion of government hospitals from its licensing procedures was a weakness. The act also did not cover other facilities where people with mental illness were involuntarily admitted. Limited budget and resources also meant poor functioning of national and state mental health authorities, which hampered its implementation.”
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