In an interview, newly elected MLA Ramesh Pisharody called for a dedicated ministry for mental health. Currently, most activities fall under the Ministry of Health, while others are scattered across departments.
The mental health of school students is managed by the education department and the Ministry of Women and Child Development. Then there are the police-run student well-being and digital de-addiction initiatives. The excise department handles de-addiction programmes, the Ministry of Youth Welfare pilots youth mental health projects, and women’s well-being initiatives are under the Women’s Welfare Ministry.
Despite numerous programmes, there is little focus, coordination, or impact auditing. With several psychosocial issues signalling declining mental health in Kerala, the MLA’s vision for a unified ministry is timely and relevant.
The burden of mental illness in Kerala
The 2016 National Mental Health Survey found that 11.36% of people in Kerala had a mental disorder at the time of the survey, with a lifetime prevalence of 14.14%. Roughly one in eight people in the state need mental health intervention — higher than national averages. Common conditions include anxiety and stress-related disorders at 5.43%, depression at 2.49%, and substance use disorders at 4.82%. Are they all getting the help they need?
Access versus stigma
Kerala has relatively better mental health care in both the government and private sectors. However, gaps exist in Wayanad and Idukki districts. Yet stigma and shame prevent many from seeking scientific treatment.
Quacks exploit this reluctance, diverting people from professional care. The government must regulate unqualified practitioners in mental health services. This includes mandatory licensing of counselling centres with clear qualification standards.
Stigma-reduction campaigns are essential to convey that mental disorders are health conditions like any other, and that there is no health without mental health.
Modernising services
The three mental health centres in Thrissur, Kozhikode and Thiruvananthapuram, functioning well amidst constraints, should be modernised and made patient-friendly, possibly using corporate social responsibility funds.
A Centre of Excellence for addiction treatment could be integrated with one of them. Such a centre is urgently needed as addiction-related problems rise in the state. It should develop evidence-based protocols and monitor other de-addiction centres across the state. Although the Mental Healthcare Act mandates registration, many de-addiction centres still operate outside such controls.
Psychiatric services at district and taluk levels can be upgraded qualitatively without overwhelming financial burden. What is needed is vision and innovation.
The District Mental Health Programme requires revision with broader objectives and a stronger focus on community-based treatment and rehabilitation. Residential rehabilitation centres should be audited regularly by DMHP teams, which might require additional manpower. This can be solved by pooling assistance from the community medicine departments of local medical colleges.
Safeguarding rights without over-regulation
All psychiatric care homes, public and private, are registered with the State Mental Health Authority. Mental Health Review Boards, mandated by the law, monitor admissions without the consent of patients in view of lack of insight and judgment. The idea is to protect against misuse and human rights violations. The government should ensure the smooth functioning of services without creating undue stress for clinicians and administrators. Legal interference must not deter service providers, nor should compliance escalate costs prohibitively in the private sector.
School mental health needs structure
The rise in aggression, conduct issues, emotional problems, digital addiction, and substance abuse in schools is alarming. A dedicated wing within the Directorate of School Education should plan and monitor interventions and life-skills training. It should also regulate the multiple activities run in schools by various agencies. This wing must monitor the quality of school counselling services and foster liaison with mental health facilities when needed.
Addressing mental health of the elderly
Kerala’s elderly population is growing, with many living alone. The rising prevalence of emotional distress and memory issues is concerning. The government should develop clear action plans for the well-being of senior citizens and implement them in collaboration with local self-governments. The role of the newly formed Elders’ Rights Commission should also be clearly defined.
Urgent need for suicide prevention
Kerala’s suicide rates are escalating. In 2020, it was 24 suicides per lakh; it rose to 26.9 in 2021, 28.5 in 2022, and 30.6 in 2023 — an annual rise of roughly 2 per lakh. With suicide emerging as a leading cause of mortality, the state urgently needs a comprehensive suicide prevention programme.
Building a culture of emotional well-being
Alongside daily physical fitness, we must promote lifestyles that include practices for emotional well-being, starting in schools. Seeking professional help for mental health problems must be normalised in our health culture. That will enhance physical well-being, too.
