Psychiatry has had, in my opinion, three major revolutions. The first one was way back in the 18th century with the unchaining and moral treatment of those in asylums; something that showed the world that even those with severe psychiatric illnesses were deserving of care and respect, and were not innately dangerous or violent as it was erroneously believed. The second one was in the mid-20th century with the discovery of effective treatments for previously untreatable illnesses like schizophrenia, bipolar disorder and severe depression; a discovery that allowed lakhs of patients housed in institutions and asylums to return to the community, with many able to resume normal and independent lives. The third has been even more recent- the demonstration that psychiatric symptoms are related to chemical and functional changes in specific parts and specific pathways in the brain. This evidence has helped dispel the previous explanations for mental illnesses- curses from Gods, possession by demons, witchcraft, magic- to the shadows among the scientific community.
But as with most revolutions, the translation of the ideas and ideals and achievements to long-term societal change takes time, effort, persistence and patience and the field of psychiatry finds itself in this transition phase right now. We now have the evidence base as well as safe and effective treatment options for pretty much every psychiatric illness, yet only one in every four individuals with a psychiatric illness in India receives adequate and appropriate treatment (as per the National Mental Health Survey of India 2015-16), largely attributable to lack of awareness, stigma and accessibility issues.
The World Health Organization estimates that one in eight people globally live with a mental disorder. In India itself, there are over one crore individuals with severe mental illnesses like schizophrenia or bipolar disorder, and multitudes more with substance use disorders, dementia, depression and anxiety. The Covid-19 pandemic has only added to the mental health crisis. And last year, India reached an all-time high in terms of deaths due to suicide; with 1.64 lakh individuals losing their life due to the same. This significant burden of mental illness, the massive treatment gap, growing social and economic inequalities, the climate crisis, prolonged conflicts and the associated trauma and displacement make this year’s World Mental Health Day theme ‘Making Mental Health & Well-Being for All a Global Priority’, very pertinent.
This theme, however, puts forth numerous challenges and questions. But perhaps the most relevant one to each of us is what can we do to reach those around us, especially the most vulnerable, at a time when the mental health awareness is low and stigma and discrimination are widespread.
I reckon the first step would be to recognize and acknowledge the apprehension and disapproval attached to mental illness and all that it touches-psychiatric institutions, personnel, patient’s families and most aspects of the patient’s life too, and then try to move beyond that towards genuine, non-judgemental and empathetic conversations on mental health. Stigma and prejudice not only influence the behaviour of society towards patients and their families, it also makes people reluctant to come forward and seek treatment (which leads to worse clinical outcomes) and prevents patients from regaining respect from themselves in their own eyes.
I often remember the succinct Star Trek quote, “We often fear what we do not understand; our best defence is knowledge.” In this digital era, information is always at our fingertips and improving our understanding of mental health is always a worthy endeavour. Also, some of the knowledge we gain might astonish us. For example, studies suggest that people with psychiatric illnesses are more likely to be victims of violence than perpetrators!It certainly made me question my prejudice when I first read a research article stating that some years ago,as a young resident doctor.
Of course, enhancing awareness, decreasing stigma and increasing the conversation around mental health must go hand-in-hand with improving access to mental healthcare (by strengthening community programmes, investing in capacity building and integrating mental health with general health care), making essential medicines and psychological and social interventions easily available, long-term political commitment and greater rights-based advocacy; and the governments and bureaucracy definitely seem to be taking steps in the right direction. Goa seems to be doing pretty well, with many good mental health professionals, free treatment for all psychiatric illnesses in many government setups and the notification and implementation of laws to help safeguard the rights and autonomy of those living with mental illness like the Mental Health Care Act 2017. Initiatives like e-Manas which are in the pipeline will further reduce the treatment gap and make mental healthcare more accessible. That being said, there is still a very long way to go, many barriers to break, many hurdles to jump over in the quest to achieve mental health for all; and we all have a role to play and the surest way to eventually succeed is by being partners in this revolutionary journey.
(Dr Colin Braganza, MD Psychiatry, is a psychiatrist who believes that increasing the conversation around mental health is a key step towards creating a better world for us all)
