Mental Health: A Fundamental Human Right

WHO states that health is a state of complete physical, mental and social well-being and not merely the absence of disease. Mental health, a state of serenity and feeling of well-being, is essential for us to lead a meaningful life. It directly influences individual well-being, productivity, relationships, and economic stability. Although it is an essential component of quality of life, mental health remains largely neglected. Ted Kaczynski quoted, “The concept of mental health in our society is defined largely by the extent to which an individual behaves in accord with the needs of the system and does so without showing signs of stress” in his infamous manifesto; which still holds true.

Mental health is a fundamental right and every individual has the inherent entitlement to mental well-being. One in eight people in the world lives with a mental disorder (WHO, 2022) but self-reporting of mental illnesses remains low. (Ranjan et al. 2023) Mental illnesses cause significant morbidity and mortality, thereby violating fundamental human rights. Stigma, seclusion, and discrimination continue to plague our society. Involuntary placement, involuntary treatment and long durations of inpatient stay for people with mental disorders impact on some of their most fundamental rights, including the right to liberty, equality and the right to exercise legal capacity. People with mental disorders are deprived of their right to be treated with dignity. The problem is compounded by a persistent lack of access of mental healthcare to select population groups. (Payne et al. 2023) Higher socioeconomic status is more likely to be associated with easier access and higher self-reporting. Due to a lack of robust social healthcare service, private sector shoulders the majority of responsibility for mental health services. (Ranjan et al. 2023) Money matters when it comes to availability of these services. Young, successful patients are more appealing to a therapist as clients versus old, poor, or patients of different culture.

Strategies for promoting mental health awareness should target different populations with different media platforms and native languages. Cross cultural interventions like direct education channels should be setup with regular community-based interactions. A holistic strategy including social, religious, demographic and economic factors is a necessity. The incorporation of diverse technological innovations, including teletherapy, virtual healthcare platforms, mental health applications, and wearable devices, presents significant potential for enhancing access to mental health services and improving overall care. Mobile applications for mental health enable individuals to track their emotional wellness, engage in mindfulness exercises, and conveniently access self-help materials while on the go. Additionally, wearable gadgets equipped with biometric data capabilities offer valuable information regarding stress levels and sleep patterns, potentially serving as significant indicators of one’s mental health condition. There is ongoing research to assess the effectiveness and safety of digital interventions, encouraging collaboration among researchers, mental health experts, and technology innovators. Adequate training in the ethical use of technology is vital for mental health professionals to ensure the maintenance of therapeutic boundaries while responsibly harnessing technological advancements. Improving e-health literacy reduced the negative effects of coronaphobia on loneliness, irritability, depression, and stigma. (Xu et al. 2023). Following the rapid digitisation of India, e-health initiatives should aim to reach and educate people even in remote areas.

Governments and organizations need to take cognizance of lacunae in mental healthcare services. Global mental healthcare services remain underfunded and underserviced. Newer policies based on evidence and population directed interventions should be the focus of political will. Organisations can continue to highlight these issues with advertising campaigns, marathons, gatherings, posters, social media and sensitising people towards the importance of mental health. Understanding and dictums of international organisations for human rights and mental health should align with the domestic policies implemented by the governments, Creating policies, plans, and laws for mental health is the important for good governance and service development.

The Government of India introduced the National Mental Health Programme (NMHP) in 1982, aiming to address mental health conditions, promote positive mental health, and facilitate rehabilitation. Additionally, the District Mental Health Program was launched to offer basic mental healthcare services at the grassroots level. The NHRC has undertaken assessments of mental health institutions and proposed changes to the government. The Indian Psychiatry Society (IPS) has made significant contributions through ongoing research in the field of mental health. Collaborative models between government bodies and NGOs, such as the Medico Pastoral Association and the Institute of Human Behaviour and Allied Sciences (IHBAS), have been established to aid the rehabilitation and reintegration of individuals with mental health conditions. NGOs have also initiated community programs to enhance mental health awareness through research, university training, and mental health boot camps in both rural and urban areas. (Thara et al., 2010) The new Mental Healthcare Act, 2017 has shifted the focus to a rights-based approach to provide treatment, care, and protection of a person with mental illness compared to previous Mental Health Act 1987. This dynamic shift is to align, harmonize, and fulfil the requirements of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

JEEVANI is the first structured state-wide college mental health service in India. Directorate of Collegiate Education, Government of Kerala, implemented the program in 2019 in 66 colleges for approximately 60,000 students. Describing the framework, technical material, and providing an overview of its functioning from a resource-constrained setting in India may encourage higher education institutions to consider similar projects. (Jaisoorya et al., 2023) Being a doctor with a mental disorder has given me a unique insight into these challenges. Anticipating stigma, possible ridicule and seclusion, negative impact in social interactions delayed my approach to mental healthcare services by many years. Contrary to intuition, medical fraternity still lacks insight into its fallacies when mental health is concerned. Financial constraints and dependence, poor emotional expression, an unhealthy positive reinforcement of stoicism considerably hindered me in seeking medical care. An institutional student welfare initiative provided me access without barriers, and use of multiple online peer communities, messaging groups, art and creativity, sports within the institute have fostered a feeling of inclusion. I have benefitted from a robust mental health program with a holistic approach, and strongly advocate for aggressive implementation of such interventions on a larger scale. Recognising the need for mental health is the need of the hour.

References:

1. Ranjan A, Crasta JE. Progress towards universal health coverage in the context of mental disorders in India: evidence from national sample survey data. Int J Ment Health Syst. 2023;17(1):27. Published 2023 Sep 19. doi:10.1186/s13033-023-00595-6
2. Lowther-Payne, H.J., Ushakova, A., Beckwith, A. et al. Understanding inequalities in access to adult mental health services in the UK: a systematic mapping review. BMC Health Serv Res 23, 1042 (2023).
3. Xu RH, Chan HH, Shi L, Li T, Wang D. Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study. JMIR Public Health Surveill. 2023;9:e47556. Published 2023 Sep 29. doi:10.2196/47556
4. Thara R, Patel V. Role of non-governmental organizations in mental health in India. Indian J Psychiatry. 2010 Jan;52(Suppl 1):S389-95. doi: 10.4103/0019-5545.69276. PMID: 21836712; PMCID: PMC3146177.
5. Jaisoorya T S, Joseph S, Kalarani K S, et al. Framework and Overview of a State-Wide College Mental Health Program in Kerala, India. Indian J Psychol Med. 2023;45(5):526- 532. doi:10.1177/02537176221122407