[op-ed snap] India’s ignored mental health challenge

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Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: National Mental Health Policy 2014 and how it has proved ineffective in containing mental health issues in India


Context

Mental health situation in India

  1. India is facing a possible “mental health epidemic”
  2. India’s contribution to global suicide deaths increased from 25·3% in 1990 to 36·6% in 2016 among women, and from 18·7% to 24·3% among men
  3. The jump far outstrips the approximately 1.4 percentage point increase in India’s share of global population in that period
  4. Suicide is the largest killer of India’s 15-29 and 15-39 age cohorts

Demography of suicides

  1. Suicide makes up a higher percentage of deaths in the more developed states of the south and western and central states have mid-level SDRs
  2. The northwest and less developed north have low SDRs, while the east and northeast have mixed rates
  3. The variations across states are due to the different levels of urbanization, the proportion of the literate population, and the difference in literacy attainment

The gender gap in suicides

  1. Indian women’s SDRs are almost three times higher than the rates expected globally for countries at similar levels of sociodemographic development
  2. This is because women are struggling with disproportionate socio-economic burdens
  3. Their high SDRs relative to men are rooted in factors as varied as the difference in socially acceptable methods of dealing with stress and conflict for women and men, domestic violence and the different ways in which poverty affects the genders
  4. A particularly important detail is that married women form the biggest victim group of suicide deaths among women in general
  5. This group becomes more vulnerable due to arranged and early marriage, young motherhood and economic dependence

Migration also a factor

  1. The past few decades have witnessed economic, labour and social changes on a scale rarely seen before
  2. Such rapid change with the economic dislocation and change in social and community links it brings can be destabilizing
  3. There is a cost to the loss of social links for the men who migrate, as well as for their families that stay behind
  4. The parlous state of agriculture doesn’t help

The social stigma 

  1. The social stigma attached to mental health disorders in India is a major hurdle in addressing them
  2. Until last year, suicide was a criminal offence in India, which was a major cause of under-reporting of suicide deaths in the National Crime Records Bureau of India
  3. Suicide is often preceded by a history of depression, stress, or anxiety
  4. The stigma and general lack of knowledge and understanding when it comes to mental health disorders prevent timely intervention

Fewer facilities and doctors

  1. The state capabilities for addressing mental health issues are close to non-existent
  2. The expenditure on mental health accounts for a tiny fraction of total public health spending
  3. The country has about 5,000 psychiatrists and less than 2,000 clinical psychologists
  4. This is minuscule, given population size

Way Forward

  1. The National Mental Health Policy 2014 shows how wide the gap between good intentions and effectiveness can be
  2. The decriminalization of suicide last year was long overdue and welcome
  3. The Insurance Regulatory and Development Authority of India has mandated that insurance companies are to make provisions to cover mental illnesses in their policies along with physical illnesses
  4. India’s mental health landscape should be improved in order to bring down suicide rates
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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