The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have little.” - Franklin D Roosevelt
The great thing about an aphorism is that it stands the test of time and categories. The one above may have been spoken of keeping the socioeconomic divide in society in mind, but it rings equally true when discussing the glaring inequality that runs across the realm of mental and general healthcare in the current era. The quote, “We are all in this together”, that resonated globally during the pandemic was more wishful thinking than reality.
The society as we know and understand is divided into a multitude of groups, all seemingly rigidly bound. The barriers of federalism, caste, ethnicity, socio-economics, religion, etc., have fostered a sense of pervasive inequality and mutual spitefulness towards each other, pitting one neighbour against the other in a perpetual battle of one-upmanship. But the iron curtain of class division is not without its stark holes, through which many human artifices and infirmities find their way across to the other side. Humanity, which is divided by arbitrary fences, finds solace in the universality of suffering—both mental and physical. There’s no wall fortified enough to prevent the permeation of sadness, longing, despair, alienation, insomnia and melancholy, all of which are the building blocks of mental health issues in the society at large.
As mental health professionals, when we ask anyone what they understand by mental health, most look at it through the lens of a disorder-free state but rarely as a need to ensure one’s mental well-being. The practice of mental health is still fraught with stigma, misinformation and isolation from society. Death due to suicides and people living with mental illnesses are sensationalised in popular media.
This year, the World Mental Health Day (October 10) is observing “Mental Health in an Unequal World” as its theme, declared by the World Federation for Mental Health (WFMH). There’s no denying the fact that in spite of all the ostentatious promises of universal healthcare by lawmakers throughout the world, more so in low- and middle-income countries, it remains a utopian pipe dream rather than reality. Poor mental health is still a more stigmatised cousin of the more readily accepted physical ill health.
People, policymakers, celebrities, etc., are more at ease discussing their poor sugar control and aberrant cardiac rhythms than baring their hearts on the insidious bouts of anxiety or depression, lest it makes them feel feeble-minded compared to others. The issue of mental health thus suffers not only engendered inequality but crippling ignominy as well. There are far more debates and discourses on minor physical health issues than all the serious mental illnesses combined. The outreach to the audiences and the space generated in news and print media is far more for seasonal allergies than depression or schizophrenia.
Even from the piddling amount received from the government for the country’s expenditure on its population’s health, the outlay for mental illnesses remains too paltry. It’s also not that the developed nations are faring much better at dealing with issues of mental health in comparison to the poorer countries. Compiled data from around the world suggests that even in high-income countries, about 75% of the people with mental health disorders do not get proper care. The figure for the low- and middle-income countries jumps up a notch; about 75-90% of the mentally ill receive inadequate or no help for their condition.
The National Mental Health Survey (NMHS) 2015-16 shows a treatment gap of 85% (that is out of every 100 people living with mental illness, only 15 receive the required care). Considering our population, this is disturbing.
The figures will become more disturbing when we take into account the less fortunate and denounced, such as the racial and ethnic minorities, the LGBTQIA+ community, the socio-economically impoverished, older people, etc. Furthermore, the Covid-19 pandemic has widened the gulf of inequality and laid bare the ineptitude of the system that fails those who need it the most.
Against this grim reality, we do have flashes of hope. Many international organisations like the WFMH, WHO, UN, UNESCO, etc., are working tirelessly to further the cause of the mentally ill. There’s increasing receptivity towards mental health issues on the celluloid and the news and print media alike. People with serious mental conditions are becoming more comfortable voicing their struggles. All of these are positive indicators.
But much work remains to be done and it will need a concerted effort from successive governments, regional policymakers, health bodies and health workers to bring the idea of a mentally healthy population to fruition. Emotional health includes a healthy lifestyle, empathy, well-knit social bonds as well as mental well-being, not just disorders and their treatment. Importantly, people who live with mental illnesses need justice and fair treatment in society.
Every year on Mental Health Day, there is a lot of chatter around the cause. However, beyond all the cacophony related to a day, let’s work together to strengthen society as a whole so that the barriers of social inequality, injustice and stigma are scaled and those who require help the most receive it. Till that day arrives, we must put our heads down and keep pushing the boundaries until there are none.
Dr Mayank Rai
Psychiatrist, AIIMS Rishikesh
Dr Debanjan Banerjee
Consultant old age psychiatrist, Kolkata
(rai.mayank0@gmail.com, dr.djan88@gmail.com)