BENGALURU : Mental health, which has been a taboo subject in India and associated with stigma and superstition, gained significance this week after Union Finance Minister Nirmala Sitharaman, in her Budget speech, announced that a National Tele-Mental Health Progamme, with the National Institute of Mental Health and Neuro Sciences (Nimhans) as the nodal centre, will be launched to address mental health issues of people of all ages.
The T-MANAS initiative, with active collaboration from the IIIT-B and 23 Centres of Excellence, will work as a pan-India 24x7 tele-mental health facility and provide immediate intervention to people in mental distress, particularly those in remote and underserved areas.
The development comes in the backdrop of the recognition that mental health sequels post Covid-19 infections. Economic distress, uncertainty, death of loved ones due to Covid, isolation, closure of schools and the absence of social support have exacerbated mental distress across the globe.
The National Crime Records Bureau (NCRB) report of October 2020 stated that the overall suicide figures in the country had increased by 10 per cent to 1,53,052, the highest ever. Among those who died by suicide, students and small entrepreneurs were the biggest group, further giving credence to the havoc the pandemic has played on mental health.
But even before the onset of the pandemic, the “scenario for mental health in India was grim. One in seven Indians had mental disorders of varying severity in 2017, and Indians accounted for 26.6% of the global suicide deaths in 2016,” The Lancet report of January 2021 had stated.
The trajectory of awareness on mental health in the country began with the Lunacy Act — the first legislation introduced by the British in 1858. From then to now, mental health remains the most neglected aspect of public health, largely because of lack of awareness and stigma attached to it. From its inception in 1974 to 2006, when the first study on mental health of prisoners was announced and conducted in 2008 at the Bengaluru Central Prison, Nimhans has played a pivotal role in advocacy, awareness and treatment of mental health issues in urban and rural India.
“From institutional care to community and home care, mental health care has come a long way since the 1980s and 90s. Early recognition is important for intervention and treatment. Self-help is very important for mental well-being. Yoga and meditation do help in destressing,” said Nimhans director Prathima Murthy, who was also the driving force behind the pilot mental health study of prisoners.
She added that there has been a steady shift to mainstream mental health in the public discourse over the years. The number of seats for psychiatry and psycho-social work (PSW) has also increased in medical studies. “But these are still not commensurate with the population that maybe affected with mental health illnesses and disorders and requires professional help,” said Murthy.
The National Mental Health Survey of India 2015-2016, conducted by Nimhans, had covered 12 states and 39,532 individuals. The report stated that nearly 15 per cent of adults in India require treatment for one or more mental health disorders and that nearly 70-80 per cent of them received no treatment. The allocation by state governments for mental health was less than 1 per cent of their budgets, which also indicated the level of priority it was given.
“Covid-19 has opened the dialogue on mental illness. Mental health literacy needs to be expanded across the country,” said Prathima Murthy. The national helpline for psycho-social support (080-46110007), launched by Nimhans soon after the onset of the Covid-19 pandemic in March 2020, has received nearly six lakh calls from across India. “Technology is an important tool to take mental health services to remote areas and linking it at all levels of service delivery. We have resources and we need to structure them and train the youth in counselling skills,” she added.
Mental health facilities in Karnataka
Mental health facilities at the district level are better in Karnataka, compared to many other states. Many district civil hospitals in the state have the necessary medical staff and infrastructure to cater to mental health issues of the people. Whether these are adequate needs to be seen. “Only for special cases, we refer the patients to Dimhans - the Dharwad wing of Nimhans,” said District Surgeon, Dr S L Lakkannavar, Vijayapura.
In Gadag, a team of counsellors under psychiatrist Dr Jitendra Mugali from Gadag Institute of Medical Science (GIMS) visits rural areas to counsel senior citizens and women suffering from post-Covid stress. Karnataka State Rural Development and Panchayat Raj (KSRDPR) University, Gadag has started ‘Manochetana’, a free counselling centre. “We have also asked patients to use the e-sanjeevani OPD app in case of emergency,” said DHO Jagadish Nuchchin.
The District General Hospital in Kalaburagi, “on an average, sees at least 60 people with various mental health issues and disorders every month,” said Head, Department of Mental Health, Dr Prabhukiran Gogi.
In Udupi, the district health authorities have taken a slew of initiatives — from having a psychiatrist, a special mental health officer and a counsellor at the district general hospital, Ajjarakad, to opening two tele-psychiatric units at Kandlur and Byndoor where camps are held twice a month. Dr Vasudev, psychiatrist at DGH, Ajjarakad told TNIE that on an average, they see around “35 out-patients and 10 in-patients daily.”
Shivamogga too has good number of psychiatrists and mental health professionals and neuroscientists working in the district and even in taluk headquarters like Bhadravathi, Shikaripura and Tirthahalli, said Dr Harish Delantabettu.
(With inputs from Mahesh Goudar in Bagalkot/Vijaypura, Raghu Koppar in Gadag, Ramkrishna Badeshi in Kalaburagi, Prakash Samaga in Udupi and Ramachandra V Gunari in Shivamogga)