Health

Addressing mental health in rural India

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India is home to an estimated 56 million people suffering from depression and 38 million more from anxiety disorders, according to the World Health Organisation (WHO). But while 20 percent of the country’s population suffer from mental illness, only 12 percent at most seek aid for their mental health concerns. Those who do are more likely to be located in urban areas, perched on top of the socioeconomic ladder, and have access to qualified psychologists, psychiatrists, appropriate medicines and both online and offline social networks that greatly destigmatise mental health disorders. These privileges aren’t readily accessible in India’s rural villages. 

"In many of the villages we work in, people consult faith healers for epileptic attacks," said Amul Joshi, Country Director of the MINDS Foundation, an international organisation based in the United States that works primarily in the western Indian state of Gujarat. Since 2016, it has taken its operations to 92 villages in the state to conduct mental health awareness and educational workshops. Nearly 19,000 villagers have participated in these workshops and 193 patients requiring mental health treatment have been taken to city hospitals in Vadodara and Bhavnagar. 

Much of the foundation’s work consists of conducting primary research in these villages. One of its recent studies surveyed awareness about mental health and well-being among families from the Navrachana International School community in rural Vadodara, via standardised questionnaires. Another one focused on gender bias against women regarding access to mental health treatment. 

In rural India, the challenges of addressing mental illness are particularly significant. The country lacks resources in the field, and most of the available resources are located in major cities or highly urbanised states. According to the 2015-16 National Mental Health Survey, the number of psychiatrists in the country varied from 0.05 for every 100,000 persons in Madhya Pradesh (central India) to 1.2 in southeastern Kerala.  

Except for Kerala, all other states fell short of the WHO’s requirement of at least 1 psychiatrist for every 100,000 persons. The survey notes that the prevalence of mental issues – ranging from depression to epileptic disorders – seems to be higher in urban areas, because there are better reporting standards and a lower threshold for active interventions in cities. 

"People are mostly unaware about the mental disorders they are suffering. They take it as their fate: go to quacks or religious healers. That’s why there’s stigma attached to the word ‘psychiatrist’ and ‘psychiatric disorders,’" said Dr Rajiv Mehta, Consultant Psychiatrist at the Sir Ganga Ram Hospital of New Delhi. These disorders also include drug dependence, which is rampant in villages, especially among men.  

Dr Samir Parikh, a highly reputed psychiatrist and the director of the Department of Mental Health and Behavioural Sciences at Fortis Healthcare, said mental health awareness is necessary across the country, in both urban and rural settings. "The issue is critical in villages because of the high concentration of mental health specialists in urban areas. We need constructive public-private partnerships, where access to mental health prevention and treatment is given to the rural population at minimal cost," he said. 

The scarcity of medical professionals and healthcare infrastructure deepens the stigma surrounding mental illness in villages. However, villages also present opportunities to apply community-based approaches to mental disorders. A bottom-up, grassroots approach such as the one developed by the MINDS Foundation could very well be the answer to unite local communities and health workers, and to end prejudices and misconceptions about mental disease. 

Thanks to a strong sense of community, many socio-psychological issues can now be addressed at a village level. "The community takes care of the homeless living with mental illness, or people with developmental delay. Without sophistication, the rural folk have their own ways of promoting education and healthy living by being close to nature. In contrast, in urban settings, this is largely absent due to the growing trend of nuclear families and independent living," wrote Pragya Lodha, associate programme developer of the MINDS Foundation, in an article for the Better India website.

In other words, a close-knit, family-like community, properly educated in mental health, is better equipped to take care of its own, providing prevention, treatment and well-being.   

Addressing mental health in rural India
 

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Printable version | Jan 24, 2020 1:13:25 PM | https://www.thehindu.com/sci-tech/health/addressing-mental-health-in-rural-india/article25352154.ece

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