Mental health: Action should match awareness

To address the global mental health crisis effectively, immediate societal and policy interventions are necessary

The slogan ‘no health without mental health’, mostly used by mental health professionals in times past, has now become a global refrain. This is in part because of the enormous impact of Covid-19 upon already fragile mental health treatment services, particularly in low and middle-income countries. During Covid-19, depressive and anxiety disorders have jumped by 28% and 26% respectively.

Pre-pandemic, there were 970 million persons, or 13% of the world population, living with mental disorders. Anxiety and depression constitute nearly 60% of mental disorders. Nearly one in 10 of those with mental disorders have serious illnesses like schizophrenia and bipolar mood disorder.

Mental health conditions are now recognised as an important part of public health. People with severe mental illness die 10 to 20 years earlier than the general population. Globally, one of every hundred deaths is a suicide. This is more common among younger populations.

At different developmental phases of one’s life, a person may be vulnerable to different mental disorders. Gender as well as other social determinants also account for variability in mental disorders.

Read | Socially isolated people have differently-wired brains and poorer cognition, research shows

Apart from premature mortality, mental disorders are associated with a high burden in terms of years lost to disability (YLDs) in healthy years. Depression and anxiety rank among the top 10 causes of YLDs. Additionally, there is a significant economic burden from death, disability and lost productivity.

The use of psychoactive substances is a global problem, growing not just among younger people across the world, but also among women and the elderly.

Despite rising awareness, mental healthcare for the public has remained ‘business as usual’. This is why the World Mental Health Report 2022, released earlier in June, calls for transforming mental health for all.

We seldom think that factors like economic downturn, social polarisation, humanitarian emergencies, forced displacement and climate change can have lasting effects on our psyche, but they do.

The spectrum from wellness to illness can sometimes make it difficult to differentiate a departure from wellness.

Mental and physical well-being are also highly interrelated. While chronic depression can reduce immunity and increase chances of contracting serious infections, a person with epilepsy, heart disease, diabetes or cancer is more likely to be at risk of mental health problems.

There is still a huge stigma around acknowledging mental health problems and around seeking help at all levels of society. Stigma, discrimination and abuse are major barriers to timely mental healthcare.

One way to address this barrier is by assigning a greater value to mental health, improving knowledge about disorders and improving access to mental healthcare. It is equally critical to ensure the human rights of persons with mental illness and to minimise any kind of coercion.

Need for change

If we are to thrive as a society, we need to focus on building individuals as social capital. Individuals can make a big difference by better understanding and valuing mental health and taking action to promote and protect it in daily life.

Physical, emotional, cognitive skills and behaviours buffer stress and contribute to individual resilience, capability and control.

Norms, networks and institutions that enhance family relations, create opportunities to work and learn, and build community trust are vital. We need to develop human rights-based, person-centric and recovery-oriented care through a balanced biopsychosocial approach that is gender-sensitive. We need to embed mental health services in general healthcare. We need a network of community-based mental health services.

Community providers need to be strengthened to support people living with mental health conditions. Early interventions can prevent mortality as well as disability.

Community care involves diverse stakeholders. Primary healthcare providers trained in providing mental health support and those with lived experience can provide support with the help of helplines, technology and online services. This particularly applies in the case of people who have no direct contact with healthcare professionals.

Having a network of mental healthcare services is vital. Those in crisis also need to be quickly identified and referred to specialised mental healthcare.

Specialised mental healthcare is still wanting due to a lack of professionals.
We also need to focus on the environments we provide at home, in schools, at work and in our communities. Protective measures include positive parenting, quality education and employment, safe neighbourhoods and community cohesion.

The emotional, cognitive and social development of children and adolescents requires attention. Child and adolescent mental health can be achieved through policies and legislation, good maternal mental health, caregiver support, school-based programmes and changes to community and online environments.

Workplaces, where adults spend most of their waking time, also need to foster healthy lifestyle habits among employees. Apart from diet, exercise and healthy sleep, the focus should also be on psychosocial health, including stress mitigation, improving relationships at work and outside work and maintaining a healthy work-life balance.

The SOLVE model developed by the International Labour Organisation looks at the interconnectedness of psychosocial stressors and how they can be effectively addressed to develop a healthy and happy workforce. Such interventions are also vital in correctional settings like prisons, which have high rates of mental distress.

Carers of persons also face tremendous hardships. Thus, social benefits for maternity, work injury, disability, and old-age pensions can be a lifeline for people with mental health conditions in times of hardship.

As the WHO emphasises, the need of the hour is to improve mental health literacy, close governance gaps, shift focus to community care, make essential medicines available, improve access to digital resources, reduce the digital divide and include persons with mental illness in various benefit and insurance schemes.

All of us — individuals, governments, non-governmental organisations, carers, mental healthcare providers, employers, academia, media and civil society stakeholders, need to play a part in transforming mental healthcare.

Our country has a progressive Mental Healthcare Act and a community-based Mental Healthcare Policy. The recently announced Tele-Mental Health programme holds promise to reach out to lakhs of people in need of services.

The District Mental Health Programme has been expanded to most districts. Health and wellness centres will focus on positive mental health. There are many notable examples of effective mental health promotion and community care which need to be expanded across the country.

We need to see the realisation of these measures, focus on mental health literacy, enhance human resources for mental healthcare, and ensure a multi-sectoral approach that enables us to take mental health services to the people.

(Pratima Murthy is Director and Senior Professor of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore)