World mental health day is celebrated all over the world on 10th October. Mental health is now recognized as a major cause of morbidity worldwide and the awareness regarding its proper and timely management is increasing. As per World Health Organization, Depression will be second only to cardiac diseases by 2020 as the leading cause of morbidity and disability worldwide. One in four families have one member with a mental health issue and adolescent and childhood mental health issues are on the rise along with old age mental health problems.
In India the scenario is worse with almost 5-7 % of population suffering from mental health problems leading to considerable morbidity and burden. More than 100,000 people commit suicide every year and India is the capital of adolescent and young age suicides. The condition is made worse by poor socioeconomic conditions, substance abuse, gender inequality and poor health infrastructure to deal with mental health issues. India has only around 4000 psychiatrist for a billion plus population compare it with USA which has around 50,000 psychiatrists for a much lesser population, yet they call it a shortage. Overall expenditure on mental health by government is meagre, as less than 1 percent of the total 0.9 percent of GDP allocated for health comes to mental health. Due to lack of financial returns the private sector is reluctant to invest in mental health.
Mental health issues are not only a huge problem themselves but they even coexist with physical health conditions and make them worse for example diabetes is worsened by coexisting depression and anxiety, the same goes for asthma and other lung conditions, cardiac problems, neurological issues, skin conditions and so on. So for proper treatment of these physical conditions the mental health issue needs to be addressed as well, which is often neglected in our country leading to poor treatment outcomes.
In India, being a mentally ill patient still carries a huge stigma and this is perhaps the biggest of all barriers for mental health. Because of the stigma people don’t prefer going to a mental health professional for an evaluation and they keep on suffering or seek solace in drugs and alcohol which actually make it worse and furthermore many times they prefer going to faith healers considering it as a curse from the deities or the result of witchcraft or black magic delaying treatment which actually increases the suffering manifold and also increases the stigma attached.
Various studies have reported an average gap spanning few years to more than 14 years in starting of symptoms of schizophrenia and treatment seeking in our country, the major damage has already taken place by that time.
The effects of stigma deeply affect an individual at all levels right from treatment seeking to social and financial opportunities and caregiver and family stress. Moreover, there is evidence that despite the significant scientific advances in our understanding of the cause and treatment of psychiatricdisorders, stigma is growing says a report from a Global Programme of the World Psychiatric Association.
The scenario is not much better amongst the medical fraternity too as evident by the lack of awareness and hence failure in recognition of mental illnesses co-morbid with physical conditions consequently reflecting in poor consultation liaison between psychiatry and other specialities in our country as compared to western countries says a study published in Indian Journal of Social Psychiatry regarding consultation liaison patterns in a tertiary care centre in which I was one of the chief investigators.