Last week, two comprehensive studies, one by The Lancet Psychiatry and the other by humanitarian aid organisation Médecins Sans Frontières (MSF), underlined the staggering burden of untreated mental health disorders in India. The MSF study found that due to exposure to traumatic events, over 1.8 million adults in the Kashmir Valley — or 45 per cent of the population — suffered from mental illnesses. The Lancet Psychiatry established in three new papers that a third of the global burden of disease for mental, neurological and substance use disorders occurs in India and China, more than in all high-income countries combined.
The Hindu spoke to Professor Vikram Patel , co-author of one of the Lancet papers and co-founder of a community-based mental health centre, Sangath. Excerpts:
In the Lancet paper, you mention that we are at a “remarkable stage of epidemiological and demographic transition”. Could you elaborate on this?
The numbers are staggering but it is important to note that these include the full range of severity of a very wide variety of mental health problems, a significant proportion of which will benefit from psychosocial interventions, including self-care, rather than clinical interventions. The remarkable transitions in India are related to the ageing of the population as result of the falling birth rate and increasing life expectancy, and thus a shift in the pattern of diseases from those associated with childbirth and childhood to those associated with youth and ageing. As mental disorders often have their onset in youth, this explains in part the increase in the contribution of these disorders to the burden of disease in India.
How do we use these numbers to translate into an effective policy intervention? The answer is already well captured in India’s national mental health policy released by the current government in 2014. The challenge lies in the implementation of this policy. We need a public mental health professional in charge of the mental health programme at Central and State levels, working in close coordination with each other and districts; we need to engage community health workers to carry out front-line tasks related to prevention and treatment; and we need all our district hospitals to have fully resourced psychiatric units.
What are the challenges in putting mental health at the heart of the national health agenda?
In fact, mental health is getting a lot more attention in national policy: the problem is that this is not necessarily translated down to all States, and even more pertinently, down to the districts. Thus, there is a huge gap between state policy and actual practice on the ground.
You’ve spoken about task-sharing in the past. Given the enormous lack of financial and human resources, what sort of collaborations are feasible?
Task-sharing is the foundation of India’s public health-care system, epitomised by the ASHA [Accredited Social Health Activist] worker who I consider the soul of the National Health Mission. The immediate imperative is to expand the role of this worker, obviously accompanied by appropriate additional resources, to address mental health problems using the many evidence-based psychosocial intervention packages that now exist.
Are there any quick fixes, low-hanging fruits — especially in conflict zones — that the government can experiment with in trying to expand the access to care?
I think the government must recognise that the wounds of conflict are even more grievous on the mind than the body, and indeed may even serve to fuel further conflict. Where conflict cannot be avoided, provision of adequate psychosocial services to prevent the adverse mental health consequences should take priority.
vidya.krishnan@thehindu.co.in
