India’s Headache on Mental Health

Even though depression is estimated to be the leading cause of disability worldwide and schizophrenia is estimated to affect 33 million people in developing countries, mental illnesses are still not acknowledged as major diseases in many developing countries. Since these diseases often cause long term disability rather than death and often have an early age of onset, studies focusing on prevalence or mortality rates largely underestimate the devastating effects. The Institute of Medicine (IOM) estimated in 2001 that brain disorders are responsible for at least 27 percent of all ‘years lived with disability’ in developing countries.  When combining both death and disability from brain disorders it comprise nearly 15 percent of the developing countries burden of disease

In many developing communities diagnoses of mental disorders have no conceptual equivalent, and where they do the illnesses are stereotyped in pejorative language (‘imbecile’, ‘idiot’, ‘stupid’ and ‘mentally-invalid person’, is used to refer to the mentally challenged).

While 7% of the Indian population (around 8,000,000 people) is estimated to suffer from a mental disorder, there is a critical shortage of mental health professionals and facilities to care for the population. The country only has a fourth of the psychiatrists and psychiatric nurses needed to take sufficient care of its massive population. That adds up to 8,000 psychiatrists, 17,000 clinical psychologists, 23,000 psychiatric social workers and 9,000 psychiatric nurses missing from the health care sector. The logistic situation is even worse as there are only 200 beds in psychiatric hospitals against the 30,000 required for the mentally ill. As of now there is one psychiatrist for every 400,000 people in India.

India must also address  the embedded social stigma that accompanies mental illnesses. Even in the urban areas of India, cases of mental illness are passed off by family members as the sick being possessed by evil spirits, thus religious healers are called in, rather than medical professionals.

The Indian government in December 2011 proposed the forming of 11 teaching hospitals and called for more post-graduate seats in psychiatry and clinical psychology. They hope this will add 1,700 new qualified mental health professionals each year to try and stem the tide.

The lack of trained personnel is not a problem limited to India, in fact, half of all countries in the world have no more than one psychiatrist per 100,000 people and a third of all countries have no mental health programs at all, leaving a vast population without access to even basic mental health care. According to IMO there is a misconception that mental health disorders are exclusive to the developed world, that they do not cause mortality, they are not amenable to treatment, and they are too expensive to manage.

Mental health has so far not been considered relevant to global health. While infectious diseases like TB, AIDS, and Malaria receive lot of resources and publicity, there is a void of attention and resources spent on the just as debilitating mental illnesses. In spite of evidence suggesting otherwise – investments in mental health have not yet been considered cost-effective and worthy. This is particularly puzzling considering that these assessments often are performed by  countries that invest substantially in domestic mental health care.

Three-quarters of people living with mental health problems now live in the developing world, so the need for action is clear.  Some organizations have already recognized this, One Canadian fund in 2011 – donated $20 million in funding for proposals to improve mental health treatment, expand access to care, and reduce the stigma in developing countries with an objective to support the development of solutions that are effective, low-cost, and accessible to those that need them most. Donor countries and developing countries alike need to focus their efforts in combating both the stigma and the illness associated with mental health disorders.


3 thoughts on “India’s Headache on Mental Health

  1. Dr Milan Balakrishnan October 5, 2012 / 1:45 am

    I completely agree a major reason for this is that mental health prof are concentrated in Indian metros while in the smaller cities there are very few…Maybe telepsychiatry and online help can reduce this gap…

    • Mikkel Guldberg October 5, 2012 / 10:03 am

      Thanks for your reply Dr. Balakrishnan
      It would be fantastic if modern technology could help close the gap, but I would be afraid that these technologies would have a hard time being utilized outside the metro areas.

      Other initiatives that have been proposed include educating some doctors in the rural areas with basic knowledge so they’d be able to do a basic diagnosis and then have them report back to actual psychiatric clinics in the metro areas for exact treatment prescriptions.

      Also studies have shown that for some diseases a lower dose approach could yield better results as well make treatment more cost effective. (Emsley, Oosthuizen, Joubert, Hawkridge
      & Stein 1999)

  2. Dr. Milan Balakrishnan October 6, 2012 / 2:50 am

    Thanks for starting up a very interesting coversation which would lead to an exchange of ideas…Surprisingly internet penetration is growing rapidly even outside the metros…We have been getting calls from smaller towns like trichy,raipur,etc…Capacity building off course is as important because of the growing population…We are also working on an E-module for training primary care physicians to make a diagnosis and start basic treatment..

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