Investing in mental health for the future

Mental Health Day is observed all over the World on October 10  every year under the auspices of the  World Federation for Mental Health (WFMH) and supported by the World Psychiatric Association (WPA) and World Association for Social Psychiatry (WASP).  The theme for this year is  ‘The Great Push: Investing in Mental Health.’  The call is for governments and authorities to invest in promoting  and supporting mental health for the future of our generation.  This call has been endorsed by the Movement for Global Mental Health and encompasses Unity (unified efforts of all involved in mental health),Visibility (making mental health a focus of attention), Rights (preserving the rights of persons with mental illness) and Recovery (highlighting the need for rehabilitative measures). Mental health has always remained neglected by governments, health administrators and policy makers, especially in the developing world.  Dr. Michelle Funk, coordinator of mental health policy and substance abuse department at WHO, says: “While mental and substance use disorders account for 13 percent of the global burden of disease, up to 85 percent of people with mental disabilities in low and middle-income countries do not have access to any form of quality treatment.”According to WHO,  out of the 10 diseases that produce most disability, five are related to mental health viz. depression, schizophrenia, dementia, substance abuse, and mental retardation. In fact, depression comes second only to cardiovascular diseases in the list. This stresses the need for having more psychiatric professionals even at the peripheral health centres.  Yet governments have paid little attention. This has been highlighted in a series of articles in the medical journal Lancet. These  articles underlined the fact that mental illnesses constitute a significant proportion of the global burden of disease and that prioritisation and attention on mental health intervention will contribute significantly to both economic and social development.In 2008, the ‘Lancet GMH 2007 Series’ made a call to governments and donors for ‘Action on Mental Health’ drawing attention to the impact of mental illness on the economies of countries and the wellbeing of its citizens, many millions of whom go untreated. The situation in India is far from satisfactory. It is estimated that 30 percent of population has emotional problems and 10 percent will need treatment. At least three percent of the population  needs  active treatment. In our country with more than 110 crore people, the number of psychiatrists is only 4,000 which is woefully inadequate- One psychiatrist for 300,000 people. Most developed nations have 10-15 psychiatrists for 100,000 people. The number of other mental health professionals is  also equally appalling. We need to invest more in mental health by way of training more doctors in psychiatry, opening more post-graduate training centres, modern hospitals and rehabilitation centres. The training of young doctors in psychiatry is very poor. In fact, BSc nurses have 60 lectures in psychiatry, whereas MBBS curriculam has just 20 lectures.  We also need to make psychiatry  a compulsory subject with examination for MBBS course. Most countries of the world, including countries in the SAARC region like Sri Lanka and Nepal, have psychiatry as an examination subject. Despite repeated assurances by the Government of India and Medical Council of India  to  the Indian Psychiatry Society, a decision on this still has not been taken.  Some other developments give us hope as well. India is a signatory to the UN Convention for the Rights of Persons with Disabilities which has come into force on  May 3, 2008. Imbibing the spirit of the convention,  Government of India has decided to adopt the Mental Health Care Act replacing the Mental Health Act of 1987. But the Bill is yet to be brought before Parliament. The National Mental Health Programme has now been extended to 100 districts in the country. It is hoped that NMHP will be extended to all  the 600 districts in the country by the 12th Plan. State Governments must also actively lobby for this.  Another positive development especially in states like Kerala has been  the spread of General Hospital Psychiatry by which mental health services are available not only in Government district hospitals but also in almost all major private hospitals in cities as well as in non- urban areas. Thus mental health services have  become available nearer at hand where you live.Now we need more emphasis on community psychiatry which provides rehabilitation services even in rural communities. The exemplary work done by several NGOs in our state like Navajeevan Centre in Kottayam  is a model for the rest of the country.On the one hand we have had phenomenal advances in ‘molecular’ psychiatry with a greater understanding of the circuits involved in psychotic and affective symptoms. We also have a better understanding of psychiatric genetics  which is relevant in the nature versus nurture debate.  We now know that natural predilection for psychiatric disorders is triggered by nurture and social and interpersonal dynamics.  Psychiatry offers renewed hope in this century  for those afflicted with emotional and mental disorders and mental health should be topmost in  our agenda, especially in this era of commercialisation and globalisation.(The author is  national president-elect of Indian Psychiatric Society)