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Let’s talk about Depression - Mann Ki Baat on World Health Day

Photo: Siddharth Kankaria/Research Matters

When Prime Minister Mr. Narendra Modi spoke about depression on his latest ‘Mann ki baat’, he stressed on the need for spreading awareness about this mental illness. He urged parents to watch out for signs of depression among children and added how yoga, volunteering and a positive peer support can help one to come out of depression successfully. But, what made the Prime Minister of a country talk about depression?

According to a recent report by the World Health Organization, about 300 million people around the world suffer from depression – a whopping 18% surge since the last decade. Yet another study ranks India as the most ‘depressed’ country, followed by the Netherlands, France and USA. At its worst, depression leads to suicide and around 800,000 people give up on life every year around the world. Of these, 135,000 are Indians – the largest for any country. The numbers are increasing at an alarming rate urging an immediate solution to heal the disturbed minds.

Realizing this, the World Health Organization (WHO) has announced that the theme for this year’s World Health Day, celebrated on April 7th, is ‘Depression’. The day marks the founding of WHO in 1948 and aims at drawing attention of the global community towards major health issues affecting people across the world each year.

WHO defines depression as an illness characterized by persistent sadness and a loss of interest in activities that one would normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. In addition, people with depression normally have several of the following symptoms - loss of energy, change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt, or hopelessness, and thoughts of self-harm or suicide.

Depression and Mental Health Disorders

Multiple social, psychological, and biological factors determine the level of mental health of a person at any point in time. Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence, physical ill-health and human rights violations. Situations like war and conflict definitely aggravate mental disorders, but so do simple yet largely ignored road traffic in urban settings and drought in rural areas.

Depression is the most common mental health disorder and one of the main causes of disability worldwide. It affects people of all ages, from all walks of life, in all countries. It causes mental anguish and devastating consequences for relationships with family and friends, and impacts the ability to earn a living. Recent statistics suggests that depression affects more women than men. 

There are other kinds of disorders affecting our mental health - depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism. Most of them are characterized by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others. Statistics say bipolar disorder affects about 60 million people worldwide, while schizophrenia affects about 21 million. In low- and middle-income countries, between 76% and 85% of people with mental disorders receive no treatment for their disorder, while 35%-50% of such people in high-income countries, are in the same situation. Access to health care and social services capable of providing treatment and social support is key.

Mental illness is strongly attached to stigma and discrimination in the society because of stereotyping people with mental illness as lunatics or crazy. Many believe that such people are violent and dangerous, when, in fact they are more at risk of being attacked or harming themselves than harming others. Stigma and discrimination can also worsen one’s mental health problems, and cause massive delays in getting the help and treatment they need for their recovery. 

India and Mental Health

A report on Depression and other Common Mental Disorders by WHO pegs the number of people suffering from depression in India at five crores. Numerous mental health activists, academicians and researchers in India have been working on mental health for many decades. Government measures to tackle this unseen social disorder dates back to the British rule when the Lunatics Removal Act of 1851 and other archaic laws were passed, branding people with mental illness as lunatics and confined them to what was called ‘mad houses’ or asylums.

Though India has come a long way since those times, there are still miles to go. Lack of qualified professionals in providing care to the mentally disturbed plaques our healthcare system. “Nearly 2 crore people with mental illness in India need acute care in institutions, but we have only 20,000 beds in both public and private sector. There are roughly around 4500 psychiatrists in India, but 10% of Indians suffer from common mental illness. There is a dearth of manpower to tackle mental illness”, says Dr Nilesh Mohite, a resident doctor in the department of Psychiatry at the Tezpur Medical College in Assam. 

Community based mental health care programs involving self-help groups, social workers and grass root organisations, has shown successful results in the past but they need to be scaled up. The National Mental Health Programme, launched in 1982, has evolved over the years and is strategically working towards integrating treatment of mental disorders at primary health care outlets. A recent breakthrough in regulating mental health issues and bringing it to the forefront is the passing of the historic Mental Healthcare Bill in the Lok Sabha on March 27th, 2017.

The Mental Healthcare Bill, 2016, aims to provide better healthcare services to those with mental illness and ensure they have the right to live a life with dignity by not being discriminated against or harassed. The bill, if passed as an act, decriminalises the attempt to commit suicide, bans use of electric shock therapy for treating children with mental illness and permits conditional use of shock therapy on adults after being given anaesthesia and muscle relaxants. “This bill is a right based, patient centric progressive bill with a community focus”, said a statement from the government.

“This is the first time that the government ensures to preserve the dignity of the affected person by replacing term ‘mentally ill’ to ‘person with mental illness’ as a non-stigmatising measure”, says Dr. S K Chaturvedi, Dean of the Behavioural Sciences at NIMHANS. The pitfall in the mental health is that people are in constant denial of their mental illness and do not accept to get treated because of the fear of stigma of being called mentally ill. “In India, infectious diseases like TB, Malaria and non-communicable diseases like cancers, cardiac diseases, diabetes, etc. get more attention. But, there is an increasing awareness among the policy makers and public about psychiatric illness”, adds Dr. Chaturvedi. With increased political priority on mental disorders, there is hope for easy access to mental health care and reduced stigma attached to it.

Mental illness along with many other non-communicable diseases are on the rise across the world. A range of factors from global trade policies to healthy neighbourhoods has a profound impact on the health of the people. Hence, health is a by-product of all the actions- good and bad. A healthy society can be achieved when all the forces working towards physical, mental and social well-being of all the individuals come together in unison. World Health Day reiterates the commitment made by all countries to their people to protect their health and thereby, contributing to the overall development in harmony with nature.