Mental Health and Awareness

 Mental health is a major concern worldwide and India is not far behind in sharing this. If we evaluate developments in the field of mental health, the pace appears to be slow. Dr Brock Chisholm, the first Director-General of the World Health Organization (WHO), in 1954, had presciently declared that “without mental health, there can be no true physical health.” More than 60 years later, the scenario has not altered substantially. About 14% of the global burden of disease is attributed to neuropsychiatric disorders. The burden of mental disorders is likely to have been underestimated because of an inadequate appreciation of the interplay between mental illness and other health disorders. There remain considerable issues of priority-setting based on the burden of health problems and of addressing inequalities about determinants and solutions for health problems.

Progress in mental health service delivery has been slow in most low- and middle-income countries. Barriers include the existing public-health priorities and their influence on funding; challenges to the delivery of mental health care in primary-care settings; the low numbers of those trained in mental health care; and the lack of mental health perspective in public health leadership. There have been numerous calls for invoking political will, enhancing advocacy and galvanizing community participation; all with scant improvement in outcomes.

Thus, it becomes now opportune to explore the paradigm of mental health awareness as a means of combating stigma, enhancing prevention, ensuring early recognition, and also stimulating simple and practical interventions within the community. Today there are opportunities in terms of growing acknowledgement of mental disorders as key targets of global health action, as well as of leveraging new technologies, particularly the internet, big data and cell phones in amplifying simple field interventions found successful in primary care and other echelons.

WHAT EXACTLY IS A MENTAL ILLNESS?

A mental illness is a physical illness of the brain that causes disturbances in thinking, behaviour, energy or emotion that make it difficult to cope with the ordinary demands of life. Research is starting to uncover the complicated causes of these diseases which can include genetics, brain chemistry, brain structure, experiencing trauma and/or having another medical condition, like heart disease.

The two most common mental health conditions are:

Anxiety Disorders – More than 18% of adults each year struggle with some type of anxiety disorder, including post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder (panic attacks), generalized anxiety disorder and specific phobias.

Mood Disorders – Mood disorders, such as depression and bipolar depression, affect nearly 10% of adults each year and are characterized by difficulties in regulating one’s mood.

MENTAL HEALTH AWARENESS

Mental health awareness campaigns have yielded positive outcomes. Some of the strategies undertaken to target awareness and address stigma around mental illness include participation by family members, sensitization to treatment and social inclusion. Lack of knowledge about mental illnesses poses a challenge to the mental health care delivery system. Research has highlighted the role of community-based systems in low-income countries and has also yielded positive results in creating awareness, thereby impacting participation.

Awareness and health literacy are two sides of the same coin. Stigma and discrimination are negative consequences of ignorance and misinformation. There are a few studies which have measured mental health literacy in the Indian context. One study found mental health literacy among adolescents to be very low, i.e. depression was identified by 29.04% and schizophrenia/psychosis was recognized only by 1.31%. Stigma was noted to be present in help-seeking.

These findings reinforce the need to increase awareness of mental health. Mental health literacy is a related concept which is increasingly seen as an important measure of the awareness and knowledge of mental health disorders. Health literacy has been described as the “ability to access, understand, and use the information to promote and maintain good health.” Mental health literacy encompasses recognition, causes, self-help, facilitation of professional intervention, and navigating the information highway Image shown below. Attitudes which hinder recognition and appropriate help-seeking can be counter-acted by information which is already readily available in the public domain. There are plenty of examples of awareness positively impacting mental health outcomes like the Norwegian campaign to reduce the duration of untreated psychosis.

The impact of stigma has led to the institution of various programs worldwide to challenge the stereotypes and discrimination that generate social disability. Mental health awareness programs have had a favorable impact and can produce positive change in people's views of mental illnesses. However, more robust evaluations are needed to assess the long-term impact of approaches to increasing mental health literacy worldwide.

INDIAN SCENARIO

The WHO has defined sustainable development goals and elaborated on the impact of mental illnesses and suicide on them. The suicide rate in India in 2015 at 15.7/100,000 is higher than the regional average of 12.9 and the global average of 10.6. Suicide is the leading cause of death among those aged 15–29 in India. There remains a massive unaddressed need within the population.

The treatment gap, as measured by the absolute difference between the prevalence of mental illnesses and the treated proportion, is 76%–85% in less-developed countries. One of the major reasons attributed to such a wide treatment gap is the problem of inadequate resources. In India, inadequacy exists in infrastructure as well as in human resources. Despite improvements in various health indicators, India contributes disproportionately to the global burden of disease. Our health indicators compare unfavourably with other middle-income countries and India's regional neighbours. A large proportion of the population ends up impoverished because of high out-of-pocket healthcare expenditures and suffers the adverse consequences of poor quality of care. Task-shifting to nonspecialist community health workers has been recommended as an effective strategy for the delivery of efficacious treatments in low-resource settings. Given the dire shortage in numbers of psychiatrists, psychologists, psychiatric nurses, and social workers; piggybacking on primary care systems and employing innovative force multipliers are future courses of action.

CONVENTIONAL MEDIA 

Media has been the cornerstone of the previous action in the field of mental health awareness. Celebrity endorsements, like the recent one by actress Deepika Padukone who shared her experience of depression, together with succinct taglines of advertisements and content-rich narrations and documentaries; have been the mainstay of media drives so far.

Making evidence-based mental health information easily available to journalists and other content providers like internet portals from trusted and reliable sources like the Indian Psychiatry Society, research organizations, medical colleges, etc., through their websites is a relatively simple step. Accessibility of simply translated jargon-free content in various regional languages in written and spoken forms will go a long way. It also behoves professionals in the mental health domain to take the lead in engaging and partnering with the media. Encouraging recovered patients to make their success stories accessible to all shall make good the paucity of authentic narratives.

GOVERNMENT PROGRAMS

Despite some cavilling about the quantum, the government remains the biggest single spender in the mental health sector. While most new interventions remain isolated and confined to urban areas, it is only the public health system through large programs which can reach the rural masses. Apart from the National and District Mental Health Programs, the National Rural Health Mission is on its way to becoming the vehicle for delivering mental health as a part of integrated primary care at the cutting edge of the public healthcare system. Seeing that it partners with existing private and alternative care providers in a non-threatening manner, shall help such large interventions synergize and succeed.

EDUCATION SYSTEM

Most chronic and debilitating mental illnesses have their onset before 24 years of age when most are a part of the educational system. From including mental health narratives in curricula toward, de-stigmatization, removing discrimination and early detection, to empowering stakeholders for early detection and simple interventions; the educational system yields myriad opportunities for enhancing mental health awareness.

INTERNET, SOCIAL MEDIA AND CELLPHONES

Hand-held devices and social media can truly be game-changers in the propagation of effective mental health interventions through focussed amplification, and not just in increasing information. With the greater utilization of big data, the understanding of subtle and distributed patterns over large volumes shall inform decision-making. 

HOW CAN YOU OVERCOME IT?

Although the general perception of mental illness has improved over the past decades, studies show that stigma against mental illness is still powerful, largely due to media stereotypes and lack of education, and that people tend to attach negative stigmas to mental health conditions at a far higher rate than to other diseases and disabilities, such as cancer, diabetes or heart disease.

Stigma affects not only the number of seeking treatment but also the number of resources available for proper treatment. Stigma and misinformation can feel like overwhelming obstacles for someone who is struggling with a mental health condition. Here are a few powerful things you can do to help:

• Showing individuals respect and acceptance removes a significant barrier to successfully coping with their illness. Having people see you as an individual and not as your illness can make the biggest difference for someone who is struggling with their mental health.
• Advocating within our circles of influence helps ensure these individuals have the same rights and opportunities as other members of your church, school and community.
• Learning more about mental health allows us to provide helpful support to those affected in our families and communities.