A conservative estimate is that one in five people in India suffers from a mental illness in their lifetime. Depression is a leading contributor to the mental health burden in the country. Suicide is one of the major causes of death and an estimate by the World Health Organization (WHO) in 2019 was that one person dies by suicide in India every four minutes. Not surprisingly, then, it was found that India has the highest suicide rate in the world among the 15 to 29 age group. Unfortunately, however, approximately 85% of these people don’t receive the care they need, according to the National Mental Health Survey (NMHS) of 2015-2016.
These people are not mere numbers. The statistics indicate that mental health problems are not just big words in textbooks; they exist in our social circles, in our families and sometimes within us.
With the Covid-19 pandemic, it is important now more than ever to look around us and within ourselves to acknowledge the importance of mental health and wellbeing. It is everybody’s business because it is vital to everybody’s health. Time and again, this WHO statement resonates: “There is no health without mental health.” But, do we really mean it?
What is the buzz?:
Unfortunately, conversations around mental illness in the past have been mired in shame, silence and stigma. Traditional media and their portrayal of mental illnesses have only contributed to the negative stereotypes. And for a very long time, our understanding of mental illness began and ended there—mentally ill persons were said to be unpredictable and dangerous, their treatment involved mind-altering medication and electric shock therapy, they were to be locked away and prevented from harming society.
Knowledge, education and the right information have the power to release us from the shackles of stigma and generate sensitivity and understanding in our societies. As common as some mental illnesses are, they often take a backseat in the discourse about mental health and people are believed to be suffering only when they need medication or professional therapy. Denial of common forms of mental illnesses and their stigmatisation only delay help-seeking and treatment.
With the continued growth of the internet, the rise of social media and the novel circumstances created by the pandemic, the good news is that we are talking about mental health a lot more now. The bad news is, it’s not always contextual or for the right reasons.
While discourse is encouraged and the spread of information is uplifting, we wonder if we still have a long way to go in our understanding of mental health. Sure, the knowledge on mental illnesses is improving—but is it enough?
The WHO’s definition of health states that it is not merely the absence of disease. Similarly, mental health is not just the absence of mental illness. Therefore, as we continue in our efforts as a society to learn and talk more about mental illnesses, let us also delve into mental well-being and the preventive aspects of mental health.
Physical injury is visible, diabetes is measurable, mental illness is neither:
Because mental health is not quantifiable or apparent, it is many times overlooked. A situation commonly encountered these days is impaired sugars or impaired glucose tolerance—when an individual’s sugars are higher than that of a healthy person’s but not quite high enough to diagnose them with diabetes. Without these levels and parameters, is there a grey area for common mental illnesses as well? Is there a method for prioritisation of mental wellbeing and, when possible, prevention of the problem altogether? Like physical health, mental health may exist on a spectrum between wellness and illness.
When we hear of someone suffering from a mental illness, we often try to decode the immediate triggers that led them to have these problems: Did they lose a job? Have they encountered problems at home? And while triggers are important, in our discourse, we often lose sight of the distal factors, their vulnerabilities, their ability to access help in the past, their mental well-being for many years leading up to their apparent suffering and most importantly, their support system. Hence, at all levels (individual, community and administrative), we need to understand and advocate for mental health as having emotional as well as social components.
How do we focus on our mental well-being?:
Similar to physical health, mental well-being can also be strengthened by these factors. Connecting with those around us, spending time with supportive people and having meaningful conversations with them can be energising. There are many studies to support the association between social participation and decreased rates of depression across age groups. Being active, learning new skills, taking on new responsibilities and reflecting on our mental health needs improve awareness. Volunteering, giving and being kind can also uplift one’s mood and contribute to better mental health. Learning to connect and care for ourselves, setting healthy boundaries and observing patterns of what makes us feel good and what doesn’t can improve awareness about our mental health status. Stress is normal, especially in the surreal times of the pandemic. However, taking a hold on the stress through lifestyle changes and professional help will prevent it from developing into full-blown and severe mental disorders.
When do we seek help or provide others with the opportunity to do so?:
These were measures to maintain healthy minds. But just like we would not advocate exercise to someone with a physical injury, we should be mindful when advising someone suffering from a mental illness.
Sometimes, people need help in recognising these feelings, thoughts or behaviours, and there is nothing wrong with asking for it. When these feelings become overwhelming and start to affect how we function, perform or interact with others, it is important to seek professional help and realise that we are not to blame. These overwhelming feelings can be brought on by an event in our lives and sometimes for simply no apparent reason at all. At this time, it is common to become withdrawn, fear being judged and poorly understood.
Thus, it becomes our responsibility to create a non-judgemental and well-informed atmosphere for such individuals so that they can speak out about their overwhelming feelings and ultimately get help like one would for a physical illness. Charity begins at home and so being aware of one’s own mental wellbeing paves the path for helping others. To end with Swami Vivekananda’s evergreen words: “Any action that strengthens the mind is an action worth taking.”
Dr Aishwariya Jha
Dr Debanjan Banerjee
Psychiatrists, National Institute of Mental Health and Neurosciences, Bengaluru
(Views are personal and have no bearing on the employers/institute of the authors)