By-Lisha Kalra
Among the prime contributors to disability-adjusted life years (DALYs) in mankind worldwide are psychiatric or psychological disorders and abnormalities related to mental health (Global Burden of Disease Study [GBD], 2019, as cited in Lancet, 2020). Recent empirical publications concerning psychopathology have converged focus on its increasing prevalence at any point in time among different population segments. For instance, in their meta-analysis, Charlson et al. (2019) found approximately one in five people living with severe mental disorders (e.g., depressive and anxiety disorders, post-traumatic stress disorder, bipolar disorder, schizophrenia, etc.) in areas affected by humanitarian emergencies with point prevalence higher than the previous WHO estimates (World Health Organization [WHO], 2005, as cited in Charlson et al., 2019). Noting a deficit in epidemiological studies for psychological issues in children below 7 years of age, Vasileva et al. (2020) conducted a systematic review revealing a significant number of young children living with mental disorders – the most common being oppositional defiant disorder and attention-deficit hyperactivity disorder, besides depressive and anxiety disorders. Similarly, psychiatric disorders also affect a considerable proportion of adolescents aged between 10 to 19 years, with the global prevalence being 58.1, 51.4, and 31.0 for in-patients, the general adolescent population, and high-risk adolescents, respectively (Ghafari et al., 2022).
Such figures become even more critical in a country like India where the population is diverse and its size has been known to comprise a large chunk of the global burden of psychological disorders despite an under-reporting of the actual number of occurring cases and an absence of a nationwide psychiatric epidemiology (Charlson et al., 2016; Singh et al., 2023).
Although there have been progressive attempts to develop mental health practices in India, their current status still remains underwhelming. A not-so-recent but sufficiently relevant meta-analytic review conducted by Misra & Rizvi (2012), for instance, analyzed the trends restraining the growth of clinical psychology in India. Delineating issues at two levels, namely, systemic and practice-based, Misra & Rizvi (2012) provide an evidence-based framework to examine the various challenges entrenched in the basic constitution and application of clinical psychology in India. At the systemic level, issues pertaining to the credentials of clinicians, the neglect of ethical guidelines and codes of conduct, and inadequate indigenization attempts by scholars, and at the practice level, poor collection of empirical clinical data due to stigmatization and prepotent faith in mythological and religious principles – all contribute towards limiting its scientific applicability in India. Combined with these are the questionable credentials of many practicing clinical psychologists and the neglect of academic guidelines (e.g., references and citations) by some scholars, further housing doubts regarding the legitimacy of the work done in the field (Misra & Rizvi, 2012). Despite these challenges, progressive developments such as supervised training in national institutes for clinical psychologists (e.g., National Institute of Mental Health and Neurosciences [NIMHANS]), an increasing number of trained professionals and publications, and increased awareness of mental health in recent years – all point towards a brighter future for clinical psychology in years to come.
I have been fortunate enough to be given the opportunity to visit the Institute of Human Behavior and Allied Sciences (IHBAS) during my degree in Bachelor’s. The experience was rather enlightening and captured my zeal for mental health. If I had previously indulged in visualizing cases while reading them in theory, this exposure helped me observe patients in actual time and space, and experience the various underlying complexities and issues that occur in practical setups. There is a thin line demarcating theory and practical, and this entails the spontaneity to use the theoretical paradigm in a manner that is contingent on the context of the individual concerned. Reverting to Stokols’s (1996) socio-ecological framework, it is imperative that the idiosyncrasy of contexts while interacting with, diagnosing, and treating patients matters the most.
In addition, I realized how important it is to let patients know that one cares for their well-being. Within its vicinity, for instance, IHBAS has two long-stay homes that harbor chronically ill or abandoned patients and ensure that they are assisted, engaged, and not neglected. Saksham, as they call it, made me realize that such individuals needed something to hold back on. And I soon cognized that we might be their something – or someone – they are waiting timelessly for, perhaps…? Perhaps, they were just happy to see some new faces, or perhaps, they were happy to realize that we cared about them. Whatever the case, seeing their pretty faces smile at us with all their heart made me feel more grounded and grateful for what I have been privileged with in life. Such an experience on top made me clearer regarding what I wish to pursue. I envision my life as being able to help others to the best of my capacities, and perhaps, trying to make the world a place a bit better to live in if not much – because each step counts.
Just like IHBAS, various other Indian mental health institutions are working towards mending the treatment gaps that exist with respect to the stigma associated with mental health and related issues. Patients were generally willing to approach psychiatrists to identify their problems and improve the quality of their lives. While the set of patients entering IHBAS, for instance, constituted probably just a third of the whole Indian population, the fact that it was diverse and that patients approached a psychiatric/behavioral setup may be a positive indicator of the improving conditions of mental health in India. Moreover, the Government of India (GOI) has been focusing on and formulating schemes for ensuring public mental health and well-being with the latest ones being the National Mental Health Program (NMHP), Rashtriya Kishor Swasthya Karyakram (RKSK), Manas, Pradhan Mantri Atmanirbhar Swast Bharat Yojana, and Helplines and Counseling services (e.g., Roshni Helpline [91-22-25706000], Vandrevala Foundation’s 24×7 Helpline [1860-2662345 or 1800-2333330]). Combined, such attempts are manifestations of progress, thereby justifying that mental health is truly a fundamental human right.
I would like to end my article by sharing an excerpt from my write-up – Healed. “I shall not give up on myself for I have such a beautifully resilient spirit. Yesterday was a melancholic season, with autumn leaves littered all over the heartless face of the earth – crying helplessly yet hopeful for a happy ending, ironically. I felt sad indeed – uncertain of my being, and truly tired. Overtly, I seemed so strong; Covertly, I was breaking down. I didn’t talk about it much, because my feelings flunked to figure a trail out to the language of the human species. ‘I am such a worthless being’, I’d say such things – unaware of the weeds they attached to my beautiful bonsai every day, piece by piece, breath by breath. Yet, I harbored them. I watered them and learned something from them. The lesson, like the first ray of shine at dawn, made the fall gone. I realized that yesterday was truly just a season born to end, and how I shaped today depended on what I wanted from me this season. I craved happiness. That is what I eagerly wished for. Happiness for self and others in a garden that grew flowers than insecurities, embracing everyone’s being.
But it wasn’t me. It wasn’t me alone. Help. Help was there. A kind person. A loving being who passed through the depths of language to see me…see the wavery sea that had me in…Help. Help. I said. Save me. Save me. I cried…And that is how my darling sweetheart, I healed.” – ha.ra
References:
Charlson, F., Van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. The Lancet, 394(1), 240–248. https://doi.org/10.1016/s0140-6736(19)30934-1
Ghafari, M., Nadi, T., Bahadivand-Chegini, S., & Doosti-Irani, A. (2022). Global prevalence of unmet need for mental health care among adolescents: A systematic review and meta-analysis. Archives of Psychiatric Nursing, 36, 1–6. https://doi.org/10.1016/j.apnu.2021.10.008
Misra, R. K., & Rizvi, S. H. (2012). Clinical Psychology in India: A Meta-analytic Review. International Journal of Psychological Studies, 4(4). https://doi.org/10.5539/ijps.v4n4p18
Singh, L. K., Giri, A. K., Chhalotre, V., Sharma, R. K., Rao, G. N., Gopalkrishna, G., Varghese, M., Chand, P., Satyanarayana, V. A., Muralidhar, D., & Somani, A. (2023). Prevalence of Psychiatric Disorders in Chhattisgarh: Findings from National Mental Health Survey. Indian Journal of Psychological Medicine, 025371762211416.
Vasileva, M., Graf, R. K., Reinelt, T., Petermann, U., & Petermann, F. (2020). Research review: A meta‐analysis of the international prevalence and comorbidity of mental disorders in children between 1 and 7 years. Journal of Child Psychology and Psychiatry, 62(4), 372–381. https://doi.org/10.1111/jcpp.13261