Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources
Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
World Mental Health day is observed every 10th October to raise awareness about mental health. People have now begun to understand that suicide is not crime but a kind of mental disorder. Similarly, depression and other mental health issues need to be understood.
The mental health day is being observed for few decades. Stigma of mental illness around world still remains though it is less in developed countries due to awareness programmes and presence of science. But in Africa and Asia, stigma continues to be present and mental disorder is still misunderstood.
Hence, there is a need to reduce the stigma of meatal illness. Mental health problem as mental disease or lunacy like schizophrenia and bipolar disorder.
150 years ago people were not much concerned about people with mental awareness and they were put in mental asylum. But now various methods are available for diagnosing mental health disorders in 21st century. Treatment has become available just in past 20 years. So, the problem that mental illness can’t be treated has gone. Here, the most important need is to reduce stigma, respect human rights and identify and accept depression.
Frequency of schizophrenia is not large as such diseases are generally genetically and biologically caused with frequency of 2-3%.
Depression, anxiety, obsessive disorder, phobia are more common mental disorders and it depends on culture, development stage of society, social values, family system.
India has 6-8% prevalence of mental disorder and Europe has 20-25%. Though India has less common prevalence of mental illness, there is a need for treatment.
Depression is a condition where person loses confidence and the common behaviour is attempted suicide and in unfortunate cases, successful suicide. Specific characteristics of suicide is that it doesn’t occur much in high income countries.
As per WHO, more than 8 lakh people die every year due to suicide. Hence, as it is a state of mind, it is possible to bring it back to normal state and prevent such unfortunate deaths.
Till date, suicide in India was a criminal offence under Section 309 of IPC. Now, the government is planning to delete the section which is largely hailed as a positive action in correct direction. In 1990s, one judgement almost annulled section 309of IPC but then it was said that decriminalisation of suicide should be not by judicial order but by Parliament. Unfortunately, even that took 20 years to shape up. This makes India one of the few societies to implement it last. When the person thinks of suicide, he/she is in a deceased state. Thus, instead of providing a cure, the person was either prosecuted or punished by the state to take life. This made him pursue it without any other positive alternate.
The idea behind decriminalisation of suicide is that the person should be seen as person in need of help because of psychiatric disorder. But because 309 was applicable, family members, friends, doctors and hospitals rarely reported the case as attempted suicide. Instead, it was presented as accident. Thus, decriminalisation should happen and mental Health Care Bill 2016 is progressive step and accurate data will be available now. It may seem temporarily that the rates will increase because there will higher reporting but that should not be read in a misleading way.
Another common known word in society is depression. Depression is not day to day work related stress or low feeling or feeling of sadness. It is a clinical disease which has a significant impairment to one’s life in various aspect because of sustained more than two or four weeks of low mood, negative thoughts and decreased activity.
Once there is visibility of classical symptom of these feelings, then only it be seen as clinical depression. Depression is a significant public health problem which is as common as road injuries or traffic accidents, cancer etc. It is easily treatable and preventable. If the depression is identified, it is very easy to treat effectively with low cost medicines.
WHO has said that depression is the leading cause of disability worldwide and it is a major contributor of overall burden of disease. At the same time, more women are affected than men due to depression.
By end of 1990s, the entire public health structure across the globe shifted from old incorrect approach of calculating public health problems according to number of deaths. Earlier, the public health model was only based on mortality statistics. This is the reason that WHO and other health institutions are explaining that public health should not be calculated in terms of death statistics but by how much individual, family and society is suffering.
Acknowledging the existence
There are other diseases also which are rarely talked about- dementia, developmental disorder including autism, headache disorder etc.
In old age beyond 60-65 years, a lot of problems of body and mind increase. With the longer life expectancy, people are living longer lives even in Asia and south Asian countries. Thus, the existence of such diseased was not seen much before or was not a major public health concern.
The natural system of decay and degeneration does happen with body and mind. So, recent memory loss or decrease in physical abilities of vision and hearing are normal. It is called the ageing process. But when the brain decay happens because of certain diseases process, like Alzheimer’s, dementia or because of vascular reasons- BP being uncontrolled, at the age of 65 years, people may have intellectual and memory defect as if in age of 85 years. So the early onset of intellectual decay and memory deficit is what predominantly occurs in dementia.
Dementia with increasing life expectancy is becoming a major problem. It requires care in this era as joint families are breaking up and there are no one to look after the elderly in family or in society. As a result, many people end up living a troubled life.
The other end of spectrum is equally important to recognise. In childhood and adolescence leading to adulthood, there are major set of problems other than mental illness and mental retardation.
Mental retardation is now called intellectual impairment. It is when a child, generally at birth, because of genetic reasons has limited intellectual capacity. So the intellectual compromises start with birth. Rarely may it happen because of some brain disease after birth in first few years. Thus, intellectual impairment means that someone has three-fourth or half the intellectual potential than the average person has. So, it may end up in understanding that the person is not able to look after oneself or may not be capable of self-care or holding a job. Although, a lot of people with intellectual impairment can be trained and rehabilitated!
There is no treatment for intellectual impairment as of now. There is only rehabilitation, repetitive training and education to bring out the best potential.
Symptoms of medical disorder
The person might be in good physical health and may not have any problem in the family or social sphere but such person can also have symptoms of depression like sadness of mood, low mood, negative thoughts, lack of energy, problems in sleep and appetite. The depression may happen for biological reasons and may also happen because of external reasons in real world.
With a lot of long term medical conditions like kidney, heart problems, bronchial asthma, there is associated depression. Because the physical health is not well, there may exist depression. So the overlap between mental and physical care is to be recognised.
The positive part is that if depression is treated with physical illness well enough, then the physical illness performs much better to recover. The data has suggested that people with diabetes or heart attack will fare much better if the associated depression is identified and treated. The old adage of “healthy mind and healthy body” is actually very crucial and practically applicable.
Government of India is also running lot of mental health programme. India had one of the first programmes on mental health care. Unfortunately due to funding and social attitude and basic lack of human resource in mental health, it got delayed by 20-25 years. But it has picked up again in last few years. National mental health program is already available in most states although not in all districts. It is difficult to reach all corners in such huge geographical area. But the New Mental Healthcare Bill 2016 does provide mental health as a basic right. Thus, it will begin the obligation of every state to be able to provide minimum mental health care to people who require it which is going to be a huge task. Hence, for this state managed institutions, general hospital psychiatrists units, private practitioners, NGOs, and society together can possibly help achieve the dream of mental health care for all.
Connecting the dots:
What is depression? Why is it considered a stigma? What are the possible steps to address it?