It is a known fact that the mental health situation was very bad in the country even before COVID struck. The first two waves worsened the mental health condition of people. “In the first wave, most important external factor was sudden loss of livelihood for a huge number of people in the country. In the second wave the reason for mental health situation was the loss of loved ones and falling ill with COVID. Bereavement or falling seriously ill, both take a serious toll on mental health,” says veteran psychiatrist Dr Vikram Patel. Co-founder of Goa-based mental health research and intervention centre Sangath and Pershing Square Professor of Global Health at Harvard Medical School, USA, Dr Patel has also pointed out these issues in his article titled ‘Transforming Mental Health in India’ in the recently published white paper titled -‘Breaking the barriers: pathways to addressing mental health and long COVID impact’.
GAP BETWEEN POLICY AND EXECUTION: “There is a huge gap between government policies and its execution on ground. There is a National Mental Health Policy and a Mental Health Care Act which are aspirational and visionary. But the problem lies in their implementation; most parts of the country still follow a much older model of mental health care that precedes the Policy and Act,” Dr Patel says. According to him, the Mental Health Policy and the Mental Health Care Act are yet to change the way in which mental health care programmes are implemented. “By that I especially refer to the very narrow medical approach that is being used in the mental health care in the public healthcare system, which considers mental illness purely as a psychiatric problem that needs a psychiatrist, prescribing medicines. But in fact, the reality is a majority of mental health problems do not need a psychiatrist or medication,” he says. What they need is psychosocial interventions delivered by counsellors, community health workers or just ordinary members of the community to support people who are experiencing a mental health problem. For most people, this is sufficient for recovering from their mental health problems.
PRIMARY PREVENTION: Dr Patel argues in his article for the white paper there has to be a renewed focus on primary prevention to reduce the occurrence of mental health problems. “We know that most mental health problems begin before the age of 24. This clearly shows that the experiences in first two decades of life are most critical to understand why mental health problems occur in the first place. “The most important targets for prevention are adverse experiences, neglect and maltreatment experienced by children and adolescents at home and educational institutions. So, with regards to primary intervention we know that providing a nurturing environment at home for young children and at school for school-going children and adolescents and protect and promote mental health”.
NEED FOR TRIBUNALS: Dr Patel also pointed out the need for safeguarding the rights of persons suffering from severe mental health problem to determine whether they need to be admitted to a hospital without their consent. “The old rules said that a magistrate or a complaint by a parent or a guardian or the police could forcibly confine a mental health patient in a hospital without their consent. It is well known that abuses of human rights were rampant in such hospitals. The new Mental Health Act gives the right of self-determination regarding in-patient care, rather than someone else like a magistrate or a police officer taking that decision,” he says. If the person refuses care and people are concerned that the refusal of treatment can cause harm to the patient, then the Act calls for independent tribunals to assess the situation and then make a recommendation on whether the individual has to be involuntarily admitted in an institution. “The problem is there are hardly any such tribunals even though we need one in each of the more than 700 districts of the country,” Dr Patel informs.
THE WAY FORWARD:
“Screening for common mental health problems like depression in primary care and providing brief psychosocial interventions through counsellors is an immediate priority. In the spirit of the Sustainable Development Goals, no one in our country should be left behind by implementing evidence-informed community and primary care delivered programmes, embedded in a universal health coverage and empowerment framework. Collectively, it can help build stronger communities, improving their capacities to confront the pandemic and the crises that loom in our post-pandemic future,” he concludes.