Appalling infrastructure deepens India’s mental health crisis

India, with the rest of the world, celebrates World Mental Health Day on October 10, but it has earmarked just a miniscule 0.83 per cent of the total health budget for mental health. The WHO estimates of 2001 indicate that on an average there is a 22 per cent probability of an individual developing one or more mental or behavioral disorders in their lifetime in India.

According to WHO data, the total number of psychiatrists per 100,000 people is 0.4, total number of psychiatric nurses per 100,000 people is 0.04 and total number of psychologists per 100,000 people is 0.02 in India. “For every 1 million people, there are just 3 psychiatrists, and even fewer psychologists.”

Mental illness constitutes nearly one-sixth of all health-related disorders. The study by the National Commission on Macroeconomics and Health (NCMH) shows that at least 6.5 per cent of the Indian population has some form of mental disorders, with no discernible rural–urban differences. The WHO predicts that about 20 per cent of India’s population would suffer from some form of mental illness by the year 2020.

There are a total of 43 mental hospitals across the country with a combined bed capacity of 20,000. The first mental hospital was established in Calcutta in 1786, later another mental hospital was established in Munger (Bihar) in 1795, primarily for mentally disturbed soldiers. In 1858, the British colonialist enacted the Lunacy Act, containing guidelines on admissions and treatment of “criminal lunatics”, which later became the Indian Lunacy Act of 1918.

In 1982, the Centre launched a national mental health programme to improve services by upgrading facilities and staff training, and providing care at the community level. But it was never been implemented properly, especially at district and rural levels. Prior to 1993, Indian Lunacy Act, 1912 was governing the mental health in India. In 1947, the Indian Psychiatric Society came into existence, which later drafted a Mental Health Bill that was approved in 1987.

Although it was a seen as a breakthrough from the obsolete Indian Lunacy Act, experts argue that the 1987 bill excludes WHO guidelines, and that it failed to remove the power of the criminal court to exert its control over the patients, there were no provisions for punishing the relatives and officers requesting unnecessary detention of a person to such hospitals, neither was there any provision for transportation of an unwilling patient except by police. To make matters complicated, definition of a “mentally-ill person” does not specify the types of mental illness to be included in the Bill.

A study by Human Rights Watch exposes the state of mental hospitals in our country, it documents involuntary admissions and arbitrary detentions of women in these facilities; overcrowding and a lack of hygiene; inadequate access to healthcare; forced treatment, including electro-convulsive therapy, as well as physical, verbal and sexual violence.

With the lack of mental institutions and proper fa-cilities, families are laden with the responsibility of taking care of the mentally unfit. Social stigma, lack of professional know-ledge, financial and physical burdens forces people to mistreat the mentally ill. This is also one of the major reasons why many families end up abandoning the mentally ill by shoving them into shoddy government hospitals.

Amid these appalling conditions, women are seen to be more victimised at the hands of unregulated mental health laws and stigmas. A documentary called India’s Mental Health Crisis marks out examples of men misusing mental health laws to gain divorce and women being forcefully admitted to mental hospitals by their families for as long as a lifetime.

“Stigma and common beliefs restrain people from approaching professionals. Often people would rather consult a general physician over recurring insomnia and depression, rather than a psychiatrist. Mental disorders are seen as a sign of weakness and abnormalcy, hence no one wants to openly accept and recognise the need for psychiatric consultations,” says Dr Naveen Kumar of the Manas foundation. n Tomorrow: A phenomenon called madnessTo use LTE, Project Loon partners with telecommunications companies to share cellular spectrum so that people will be able to access the Internet everywhere directly from their phones and other LTE-enabled devices. Google uses solar panel and wind to power electronic equipment in the balloon throughout the day.

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