By-Anushka Singh
Merriam-Webster dictionary reported “gaslighting” as the word of the year 2022. A term used in psychology to imply manipulation of a victim to the point that they start to question their thoughts and beliefs. This word alone showed a 1740% increase in search history. More and more people are becoming interested in understanding various mental health concepts. A quick social media search would show thousands of people talking about their experiences with therapy, mental health, and its impact on their lives. In fact, a survey by Suicide Prevention Foundation India (2020) reported that 68 percent of Mental Health Practitioners (MHP) saw a rise in people seeking therapy.
Mental Health, now more than ever, finds its relevance in our lives. However, its accessibility does not. In 2016, the National Mental Health Survey of India found that over 150 million Indians needed some form of mental health service yet only 30 million had access to them. From this lens, the need for mental health to be considered a fundamental human right becomes dire. This article tries to tackle the hurdles in the way for mental health to be considered a fundamental human right through 3As- Awareness, Advocacy, and Action.
Awareness- The first step to making mental health more accessible to people is through awareness. Here, Education and de-stigmatisation play major roles. Education, in itself, is a tool for de-stigmatisation.
Students should be introduced to mental health as a part of the curriculum. Just like physical health should not only be seen as a means to prevent disease but also lead a more enriched socio-emotional life, Mental health education should not be limited to mental health disorders but expand more on a holistic idea of healthy mental health. Students can be taught mental health vocabulary to introduce them to disorders and identify signs and symptoms. They can also be taught basic stress management techniques like breathing exercises from a young age. However, to look beyond the disorders, the curriculum can also include teaching young children the emotional vocabulary to better express themselves.
An interesting approach utilized by the Delhi govt is that of the Happiness Curriculum. According to the State Council of Educational Research and Training (SCERT) website, the objectives of this curriculum focus on developing self-awareness, mindfulness, critical thinking, building empathy, healthy relationships with social groups, and life skills for better conflict resolution and deeper human values. Even though this is a recent act, this leaves an opportunity for children to learn and explore mental health in educational settings.
At a community level, ASHA workers can be taught mental health awareness as a means to utilize community education through people who are part of the community. Even in work settings, mental health vocabulary can be taught to employees. Better HR policies along with open and concise communication networks should be established for employees to feel comfortable discussing their troubles with their HR. More workshops with trained professionals can be introduced at both the community level and work setting to educate people on the necessity of mental health.
Lastly, mental health awareness can only be achieved through open communication, creating a safe space for learning and unlearning, and comprehensive mental health education in schools and community settings to reduce stigma, increase understanding, and promote help-seeking behaviors.
Advocacy- Advocacy for mental health focuses on legislative means to ensure accessibility to mental health services. The Indian government has introduced a few acts over the years to address the mental health of its situations.
The history of these laws can be traced back to the ‘Lunacy Act of 1912’ which focused on patients within asylum care. This law was repealed by the ‘Mental Health Act 1987’which replaced the word lunacy with more appropriate verbiage and focused on psychological support for the mentally ill. However, this act put a lot of focus on the institutionalization of the patients, regardless of the effectiveness of the treatment. The Mental Health Act of 2017 which came into effect in May 2018 made a landmark judgement and decriminalised suicide which was punishable under Section 309 of the Indian Penal Code. The law also focused on the definition of mental illness as, “a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, especially characterized by sub normality of intelligence” (Chadda, 2019). Owing to this definition many disorders such as depression and anxiety were also recognized as mental illnesses and the rights of such persons were ensured in terms of access to mental healthcare and treatment, the right to dignity, the right to confidentiality, and the right to community-based rehabilitation. The act also made it necessary for insurance policies to include mental health illnesses and their treatment in the insurance plan. The Insurance Regulatory and Development Authority of India (IRDAI), hence, made it necessary for insurance companies to recognize the MHCA. Certain government insurance policies like the Ayushman Bharat healthcare program now, include the costs for screening and diagnostic procedures, pre and post-hospitalization charges, therapeutic counseling, and regular follow-ups for patients with severe psychiatric disorders.
The Mental Health Care Act (2018) was considered a footstep in the direction of mental health accessibility. However, like our understanding of mental health, the act in itself needs to keep evolving with time, at par with the research developments. For eg, the act continues to not account for the caregiver toll, some of the people directly affected by the patients. These people spend their time, energy, and other resources to help their loved ones, often missing work and their personal life events, yet no provisions have been made to ensure their well-being. An article published in The Wire titled “How India Continues To Punish Those Who Attempt Suicide” (2023) shed light on how section 309 of IPC is yet to be repealed by the parliament. Even though, the MHC Act, suggests that attempts of death by suicide should not be punished, the ambiguous nature of section 309 allows the police to investigate and unintentionally further harass the victim. Thus, the decriminalization proposed by MHCA continues to be only an intermediate solution for the victims of attempted suicide.
Other than the MHCA, the Prevention of Children’s Sexual Offences Act (2012), and the Persons with Disability Act (2016) also recognize the the importance of mental well-being of those included.
It is only through advocacy, that mental health rights and accessibility can be ensured for all irrespective of their background.
Action- Action focuses on the effective implementation of the policies and laws included in the awareness and advocacy sections. However, I see the action part as an inclusive space for every individual to do their part for accessible mental health resources. This could mean simply being there for a person in need to helping an NGO working towards mental health advocacy and awareness through financial and in-person support. The action also sees us, people who are active members of the mental health community take initiative and educate and empower as many people about mental health. Forming college support groups, advocating for better mental health policies, using the right vocabulary and not casually using mental health terminology out of context, and educating friends and family on the importance of mental health awareness are some of how we can work towards mental health awareness.
Lastly, people who aspire to be future mental health practitioners should recognize and adhere to the therapeutic standards and appropriate educational qualifications. There seems to be a rise of “quacks” or people with an inappropriate understanding of mental health promoting toxic ideology surrounding mental health. Such people seem to do more harm than good. It becomes important for us to identify and report such individuals.
Conclusion:
India is among the unhappiest countries in the world, ranking 126 out of 136 countries included in the World Happiness Report (2023). It reports among the highest recorded deaths by suicide rates (Vijayakumar et al., 2022). A study conducted at the National Institute of Mental Health and Neuro Sciences (2016) found that at least 13.7% of Indian adults suffer from mental illness, and 10.6% of them require immediate treatment and intervention. These are just some of the stats that show the ground reality of where mental health stands in India. These stats also reflect the need and urgency to accept mental health as a fundamental human right for all. The Universal Declaration of Human Rights, adopted by the United Nations, recognizes the right to health as a fundamental human right. Acts such as the Mental Health Care Act (2017) aim to work towards reaching the goals of accessible mental health for all. However, the journey to accessible mental health is long and strenuous and can only be achieved through mental health awareness, higher standards for mental health advocacy and actively working towards a better and brighter tomorrow.
By looking at mental health as a fundamental human right, we recognize the importance of mental health, we destigmatize its negative notion, and leave room for more and more people to educate themselves about the importance of healthy mental health and seek necessary help.
References:
Chadda, R. K. (2019a). Influence of the new mental health legislation in India. BJPsych International, 17(1), 20–22. https://doi.org/10.1192/bji.2019.18
Happiness Curriculum (CHVTL) | State Council of Educational Research and Training (SCERT). (n.d.). Scert.delhi.gov.in. Retrieved September 30, 2023, from https://scert.delhi.gov.in/scert/happiness-curriculum-chvtl
More than 68% of therapists register hike in people seeking therapy with more people doing so for first time since COVID-19 pandemic hit: SPIF survey. (2020, September 16). Www.pharmabiz.com. http://www.pharmabiz.com/NewsDetails.aspx?aid=131141&sid=2
Murthy, R. S. (2017). National mental health survey of India 2015–2016. Indian journal of psychiatry, 59(1), 21. Nelson, V. M. (2020). Suicide prevention India foundation. Retrieved from Pharmabizz: http://www.pharmabiz.com/NewsDetails.aspx?aid=131141&sid=2
Accessed September 30, 2023 Vettorino, M., & 2022. (2022, December 6). This Is Merriam-Webster’s 2022 Word of the Year. Reader’s Digest. https://www.rd.com/article/merriam-webster-word-of-the-year/
Vijayakumar, L., Chandra, P. S., Kumar, M. S., Pathare, S., Banerjee, D., Goswami, T., & Dandona, R. (2022a). The national suicide prevention strategy in India: context and considerations for urgent action. The Lancet Psychiatry, 9(2), 160–168. https://doi.org/10.1016/s2215-0366(21)00152-8