The incidence of mental illness is predicted to rise. Its economic burden would be the single largest burden among all disease categories in times to come.
The reasons are many. First, mental illness strikes people in adolescence or early youth. This is the time a person is still acquiring skills and training through education to become employable. Secondly, when one becomes mentally troubled enough to be called ‘ill’, they are frequently incapacitated enough to not be able to either continue such education for significant periods of time, or at all.
Managing a member who is ‘ill’ requires a lot of adjustment by the family. More often than not, one person becoming ill puts others through care-giving stress and emotional burden, in addition to facing the economic consequences of a person facing ‘disability’. More often than not, another person is required to look after the person, in worst-case scenarios on a full-time basis, which may rob the carer of employment opportunities. Managing a mentally ill member in the family also involves people themselves becoming ill!
Mental illness is not ‘traditionally’ seen as a form of disability, for no mentally ill person has any outward signs, unless they are severely disturbed and behaviourally completely maladjusted. Yet they invite scope for social exclusion. This means they do not even get the support that perhaps other disabled people with more ‘visible’ disabilities would get in society. Since for families too, the person suddenly becomes mentally ‘ill’ or their behaviour becomes unexplainable, not having been born with any visible retardation or neurological problems, adjustment to the appearance of mental illness itself is a setback.
Though professionals time and again attempt to give psychological support to families and individuals in order to help people rehabilitate, few people know that complete recovery is possible — even in serious illnesses.
If there is a way out of mental illness and some have successfully recovered, why do we not hear such success stories in the public sphere? The reason is the stigma: the fear does not leave people even after they recover completely. Not many want to admit they lived with schizophrenia or bipolar disorder in their past, for they do not want to invite any speculation about themselves, their current abilities for work, their reliability or their marriage prospects.
In many developed countries it is considered important that those with mental illnesses be supported to rehabilitate and find employment, while also being enabled to live independently and as regular and socially adjusted individuals. Even when someone is classified as mentally ill, his or her right to happiness is still considered a valid requirement. Consequently many allied health professionals and therapists with newer orientations create outcomes of wellness in those countries. Increasingly there is also a shift towards bringing recovery in the domain of psychiatric concerns, rather than mere rehabilitation. This is particularly so in Canada, Sweden, Finland and Australia. Meanwhile, in low-income countries such as India the talk is around increasing the infrastructure for psychiatry, training more personnel, having more specialists who can deal with the increasing incidence of disturbed behaviour.
Bringing in more professionals to ‘manage’ the mentally ill does not really reduce the incidence of illness; it only shifts the focus from the fact that people who are suffering can be healed if offered other support systems such as enabling environments which are not just productivity driven but also humane, families that do not saddle individuals with their own aspirations and careers but let young people decide what they want to do with their lives. Of course these are the simpler things one is alluding to, and not the complexity of reasons that coalesce to create mental illnesses, when they do.
On the other hand, owing to the stigma, though many recover, few ever hear about them outside of academic and research contexts, whereas a whole world out there could benefit from their triumphs. This is simply because a lot of times the ones who recover do not go back to their doctors to tell them they have recovered, or that they have gone off medication. The doctors simply do not know.
In accordance with the shift that is happening in some of the above-mentioned countries, the low-income countries can easily move their policy focus more towards rehabilitation support and guidance, providing nutrition and employment to people rather than training more professionals to deal with problems that have no solutions coming that way. Shifting the focus will also mean the government will enable more people and families to be saved from permanent poverty, rather than becoming caught in a flux of illness that progressively enfeebles the whole family, and society itself, in the long run.
Countries such as India have a natural advantage in the scope of rehabilitation and recovery that we can offer, for our social fabric is not entirely fragmented and most people can still count on the family for support. This advantage has been reported in psychiatric research. Consolidating these structures with more training and knowledge, millions in this country who face insecure lives, future and prospects could be empowered.
(Prateeksha Sharma is a musician who works in the field of mental health. prateeksha_sharma@yahoo.co.uk)
