By-Shailija Tripathi
“The privilege of a lifetime is to become who you truly are.” said the Swiss psychiatrist and philosopher Carl Jung. In today’s times, anyone coming across these words would indeed meditate upon them for a split second. However, I believe that what catches our attention is the phrase ‘to become who you truly are’ and we indulge in fantasies of our ideal self and the hypothetical path to achieve this self. What seduces me about this quote is how Jung selected the word ‘privilege’ to describe the experience of self-actualisation. In a world where the Global Hunger Crisis impacts a sizeable 10% of the total population (Action Against Hunger, 2023), access to affordable healthcare, let alone mental health care, remains a luxury available only to small socioeconomic strata, which has both the awareness and the resources to act on it.
What Does the Data Say?
As of October 2021, Indian women had the highest share of the nation’s mental health disorders, amounting to 39 and 30 per cent for stress and anxiety disorders respectively. Comparatively, 33 per cent of men had depression as compared to women with 31 per cent during the same period (Minhas, 2023). According to the latest report of the National Crime Records Bureau 2019-21, 4.7 crore, including more than 17.56 lakh women ended their lives in the 54 years of available records (The New Indian Express, 2022). The numbers hit a peak in 2021 when 1,65,033 suicides were reported, as compared to 1,53,052 and 1,39,123 in 2020 and 2019, respectively. Between 2014 and 2021, 310 transgenders were recorded to have committed suicide. As many as 28 transgenders took their lives in 2021. The worst year for suicides was 2021 when 131 cases of mass and family suicides were reported from across the country, 33 cases of mass and family suicides were reported from Tamil Nadu in 2021, followed by 25 in Rajasthan, 22 in Andhra Pradesh, 12 in Kerala and 10 in Karnataka (The New Indian Express, 2022). What is even grimmer is the fact that this data only considers reported cases and not the stories that remain invisible to us.
While these numbers melt into each other and appear to us as mere statistics, they reflect a calamity that superficial conversations cannot hack. Consumerism-fueled ‘self-care’ talks may help some, but they cannot be generalised to a greater marginalised section, as they treat mental disorders as a personal failure. Wrapped in a positive tone, sprinkled with therapy-speak, they regard mental illnesses as a result of what we haven’t been doing. Rarely do we talk about this crisis being a product of the structural failure of our society. We may treat a sick child with jaundice in an infirmary, but if we send him back to live by an open sewer, he will revert to his original symptoms. This allegory can be applied to how we cannot expect mental wellness in a society whose very composition works against it.
In a pluralistic society such as India, which comprises various overlapping caste-class-gender-based communities, a single solution cannot target all populations. According to the Union Budget for Mental Health (2023-24), the total mental health budget is 1,199 Crore, with special emphasis laid on the National Mental Health Programme’s digital arm T-MANAS, which will improve access to tele-mental health in remote areas of the country. While it is an essential service, especially since the COVID-19 pandemic, there are limited pieces of evidence of how effectively it is implemented and what is the efficacy of these services. Moreover, in the absence of sturdy data privacy regulations in our country, it is difficult to ensure the privacy and rights of citizens would be protected. This poses a threat to the dignity of the citizens availing these services and also robs them of their agency over their own stories and struggles.
While T-MANAS has received a much-required sizeable budget, the National Suicide Prevention Strategy (NSPS), which was introduced by the Ministry of Health & Family Welfare to reduce the number of suicides per year by 10% by 2030, has neither received increased funding nor a mention in the budget speech. Without allocating ample resources to NSPS, delivering emergency mental health services to those who suffering, especially on such a large scale, will be next to impossible. India’s mental health sector is overworked, underpaid and a victim of stigmatisation, which gives rise to not only malpractice and exploitation but also an efflux of professionals to foreign countries in search of a better quality of life.
Some Plausible Solutions
There are two ways through which we can tackle the aforementioned issues: intersectional action research ( a paradigm that focuses on bringing about social change through science) and using its findings as a basis for future policies. Indian academics, social workers, sociologists and the government need to function harmoniously and work with marginalised communities. This nation needs honesty and integrity in action-based academia, where sampling and data collection must be done in a way that truly represents the Indian population. It is only through a combination of multiple perspectives and fields that we can generate a comprehensive knowledge of people’s struggles (especially the communities that are often underrepresented), barriers to mental wellness and how these communities can be empowered and made to realise that mental wellness is not mythology, but a state of being they have every right to enjoy.
The very core of Indian society is built upon the ethos of ‘Vasudhaiv Kutumbakam’ (the world is a single abode). The value we hold for communities is our strength and policies need to be devised to tap into this strength. Ample investments should be made into strengthening community-based healthcare services (such as the District Mental Health Programme mandated by the Mental Healthcare Act, 2017) that can be tailored according to the cultural strengths and requirements of specific communities. For a multicultural society such as ours, it is essential to treat people not in a vacuum but as a part of a larger socio-political-economic system and be sensitive towards social privileges and lack thereof. According to NCRB, in 2021, 26% of people who died by suicide were daily wage earners. Climate change, which leads to extreme temperature turbulence and unexpected rains forces small farmers and landless labourers to secure personal loans with hefty interest rates. Upon inability to pay them off, they often resort to suicide to escape the crushing pressure of debt. Along with mental health services, annual expenditure on schemes aimed at providing food security, affordable education, livelihood and employment (such as the Mid-Day Meal Scheme, Samagra Shiksha and MNREGA) must also be invested in. An improvement in quality of life will heavily contribute to the better mental health of the masses.
Conclusion:
As romantic as it sounds, striving for a society where everyone can access the help they need without guilt, shame, stigma and economic limitations may be the antidote to tackling this ongoing mental health crisis. Realising our solemn duty as citizens, academics, practitioners and activists in spreading awareness and demanding mental health as a fundamental right is the only way to ensure that every Indian will live a life of dignity and vitality, both in the body and the mind
References:
Keshav Desiraju India Mental Health Observatory. Union Budget for Mental Health 2022-23. Published online 2022. Accessed May 23, 2022. https://cmhlp.org/wp-content/uploads/2022/02/IMHO-Union-Budget-for-Mental-Health-2022-23 .pdf
Minhas, A. (2023, July 12). Mental health disorders among Indians in India in 2021, by gender. Statista. Retrieved from. https://www.statista.com/statistics/1315256/india-mental-health-disorders-among-indians-by-gen der/
Mahasur, S., & Nicole Fernandes, T. (2022, September). Impact of Poverty Reduction Programmes on Suicide, Mental Health and Wellbeing. Retrieved from. https://cmhlp.org/wp-content/uploads/2022/09/Poverty-Reduction-as-a-Tool-to-Improve-MH-Ou tco mes-1.pdf
National Suicide Prevention Strategy. (Accessed 2023, September 27) Ministry of Health & Family Welfare. Retrieved from. https://main.mohfw.gov.in/sites/default/files/National%20Suicide%20Prevention%20Strategy.pdf
Accidental Deaths & Suicides in India 2021. (2021) National Crimes Records Bureau.
NHRC says all the 46 Government Mental Healthcare Institutions across the country depict a very pathetic and inhuman handling by different stakeholders; issues notices. (2023, January 25) National Human Rights Commission India. Retrieved from. https://nhrc.nic.in/media/press-release/nhrc-says-all-46-government-mental-healthcare-institution sacross-country-depict
NIMHANS Annual Report 2020-21. (Accessed 2023, September 27). National Institute of Mental Health and Neuro Sciences (NIMHANS). Retrieved from. https://nimhans.ac.in/wp-content/uploads/2022/09/NIMHANS_AR_2020-21_English.pdf
Ranade, K., Kapoor, A., & Fernandes, TN. (2022). Mental health law, policy & program in India – A fragmented narrative of change, contradictions and possibilities. SSM – Mental Health. 2022;2:100174. doi:10.1016/j.ssmmh.2022.100174
Shastri, M.(2021, June). Deconstructing the DMHP: Part 1 – Introduction to India’s District Mental Health Programme. India Mental Health Observatory, Centre for Mental Law & Policy, ILS. Retrieved from. https://cmhlp.org/wp-content/uploads/2021/11/Issue-Brief-DMHP-I.pdf