The current ruling party at centre has lost an opportunity to strengthen mental health care policy. With the allocation of just Rs 50 crore for mental health, in the 2-hour-long budget speech finance minister gave, he did not mention mental health even once. Mental Health Care Act was successfully passed in 2017, however, the Finance Minister did not substantiate how the financial allocation of just Rs 50 crore to National Mental Health Programme will help solve the rising trends of mental anxiety, depression and suicides. No action plan has been outlined to strengthen the outreach programs through the Mental Health Care Act. With the Economic Survey indicating further rural distress and rising trends of unemployment, the vulnerability to mental illness is likely to increase.
In 2015, the National Commission on Macroeconomics and Health reported nearly 650-700 lakh people (5% of the population) in India are in need of care for various mental disorders amongst all age groups. This estimate excludes people with common mental disorders like phobia, anxiety, dissociative disorders, panic states, mild depression and substance abuse. States with large populations in rural areas like Uttar Pradesh, Madhya Pradesh, Bihar, Jharkhand face a heavy burden of the problem. This also needs to be seen in the context of low levels of literacy, income and access to formal health care. The productive states of individuals during adolescence leads to severe degrees of unproductivity and its spiralling effects on quality of life with associated stigma.
With the disturbing trend of adolescent suicides being reported in media in 2017, it was anticipated that the current budget will have the mention of Mental Health Care and policy guidelines aimed at educational institutes. India is expected to have 34.33% share of youth in total population by 2020. National Youth Policy, 2014 defines youth as persons in the age group of 15-29 years. Youth (18-30 yrs) is one of the vulnerable groups resorting to suicides with 33% share of total suicides. As per the data on suicides, 1,360 deaths (below 18 yrs) were due to failure in the examination (National Crime Records Bureau, 2015). These numbers could be even higher as many might go unreported or reasons not clearly classified considering the cultural sensitivities and stigma associated with suicide and failures.
In 2017 Prime Minister Modi addressed the students on examination stress in ‘Mann ki Baat’ but the question is, what are the support mechanisms available for the youth to deal with the competitive and lifestyle stress? In the current budget, the State regulation and the intervention programs are not explained, more importantly, the government failed to set guidelines for the schools/teaching community.
Adolescence is a vibrant and complex age with several changes happening within the human body (physiological and psychological). The period of adolescence is when the human body and mind transitions from teen to young adult, setting the stage for “identity development”, “ego” and “social learning”. Thus, when we talk about adolescence, state need to do so with responsibility as the “Reinforcer” of healthy psychosocial development should be positive and encouraging to build trust and open communication channels.
Increasing privatisation of school education uses the grades of children to market themselves and “profits” depend on performance output of children. With government poised to remove ‘No Detention Policy’, stress is further going to increase amongst the children of young age. The case of Pradyuman at Ryan International School reflects the extent of stress people face with the fear of failing an examination. When we probe into the motivation for the kind of extreme outcomes, the underlying reason is the need to perform or outperform, societal acceptance, peer competition and in psychological terms, we can say the need for “conformity”. Conformity is changing one’s beliefs or behavior in order to fit in with a group and is generally motivated by respective social circles. The role of school psychologist can serve as a positive intervention/reinforcer to fill the gaps left by parents, teachers. School psychologist role is prevalent in many countries and in India, where 50% population is under the age of 25, developing strategies to preserve the mental health is a critical need. In India, teachers undergo training on student psychology as part of their teachers training program. With very high teacher-pupil ratio and dearth of teachers it is very difficult to provide good mental health care in schools. Hence, an independent expertise in the form of psychology counsellors would help the situation.
If we try to understand the pattern of aggression among youngsters, we find a common thread connecting the two outcomes: Self-harm in the form of suicide, and expression of aggression in the form of violence on others. In India, the patriarchal culture helps to aggravate the examples of self-harm and aggression as both the genders are not taught how to deal with changes in sexuality and their associated consequences.
According to WHO study, India has 4.5 percent population (over 5 crore) suffering from depression disorders and 3 percent with anxiety disorders in 2015. From 2005 to 2015 the number has increased by 18.4 percent. The same study also mentions that 78% of global suicides (2015) occurred in low- and middle-income countries in 2015. India being the second most disparate country in the world with richest 10 percent population owning 80.7 percent of the wealth. These figures with continuous pro-capitalist policies are further going to aggrieve the mental health of the poor the most.
Continuous depreciating mental health care services, unending stigma and to the most, missing out on policy framework will further add to the deteriorating primary health services. There is no clarity on the preventive measures adopted for the mental well-being of its population. India being the country with the highest number of people suffering with depression, a policy framework with various levels of intervention and ethics/audit committee to oversee as a regulatory body is the need of hour.
Mental disorders are a tragedy and often the victim is confused as an accused and blamed for the lack of emotional strength to deal with tough life experiences. A timely intervention can help reduce the psychosocial problems faced by majority of the population especially younger ones. The effort must come at the community level, collectively by the government, parents and educational institutes. Interventions on a local level is important to be considered by the State as its responsibility to work towards preserving the mental health capacity of its population.
