Mental health continues to remain a taboo topic in India despite the high suicide rates in the country. Roma Rajpal-Weiß, WTO Reporter spoke to Dr. Vikram Patel, renowned psychiatrist and the co-founder of NGO Sangath and the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine about the stigma attached to mental health in India and the measures that can be undertaken to give rich and the poor equal access to mental healthcare.

Please explain the term global mental health.

Global mental health is essentially is a discipline of global health which in turn is a discipline of public health. It has been defined as public health for the world and global mental health is pretty much public global mental health for the world. That sounds pretty grand but its primary focus is to address inequalities in health and in mental health. Global mental health is concerned with two sorts of fundamental inequalities. The key focus is on the inequalities in access and care for people with mental health problems, especially in the global context. 90 percent of the world’s population lives in countries that have only 10 percent of the mental health resources in the world. Then there is the second kind of inequality, which is the inequality of opportunity that people with mental health problems experience and the rest of their comrades in the community, in terms of education, employment, a life with dignity to put it quite bluntly.

Why is mental health such a low priority in India?

Deepika Padukone (© STRDEL/AFP/Getty Images)

I think the answer to India would apply to pretty much any part of the world. The first and foremost reason in stigma. People don’t want to be associated with mental health problems, and when mental health problems do hit the news, then they tend to hit them in a highly sensationalist way. The second reason is because there is sort of a belief in many parts of the political world that the management of mental health problems is very expensive, it is very complex, and a poor country like India cannot afford it. The third is the myth that mental health problems are luxury items for poor people and that it is really physical health that is a primary concern. Mental health is something which you only address after you have dealt with physical health problems. So, this is a kind of misinformation that a lot of people have and all of this contributes to a lack of action.

What measures need to be undertaken in India to overcome the stigma attached to psychiatric care?

One of the biggest example in this regard happened a month ago when Deepika Padukone, a popular Bollywood actress, talked on public television about her experience with depression and how she recovered with care. So, essentially identifying with people who have mental health problems is probably the most effective anti-stigma strategy. The moment ordinary people are able to speak out about their mental health problems, the less stigma is attached to it. HIV AIDS is a good example. The single most important factor that I think led to the transformation in public attitudes towards the HIV has been the empowerment of people living with HIV to speak out for their own rights. The second thing is of course very strong legislation that protects the rights of people with mental health illness like you have rights for people with disabilities. These rights prohibit the abuse of people with mental illness for example in hospitals or at home.

What toll does mental illness take on women in India?

The hands of a young Indian couple are bound together as they lie on the ground after jumping from a bride committing suicide on the banks of the Sabarmati river in Ahmedabad on November 10, 2012. © Getty Images/AFP

Depression is probably the leading cause of health problems in women. It is also leading cause of disease in women, especially in young women who are also at a very high risk of suicide in India. When women become mothers, depression during that period of life has a profound impact on the lives of the newborn babies, for example it causes developmental problems in the newborn, in terms of brain development and that in turn affects the future of the baby. So, in many ways you can see that maternal depression is one of the factors that lead to an intergenerational transfer of disadvantage. A mother who is living in a severely disadvantaged situation is likely to get more depressed. When she is depressed, her baby has impaired brain development which leads to the child’s poor educational development, and then you can see the whole cycle of poverty being transmitted from one generation to the other.

What measures need to be undertaken in India to tackle the problem of mental health?

India has a national mental health policy, which was released in October last year. It is a very progressive policy, then there is the District Mental health program which is based on strategies for improving mental healthcare that take into account both resources available in India, but also the particular unique sociocultural context. I am hoping that mental healthcare bill which is currently in the parliament will be passed. Armed with these three documents, the government has all the policy instruments. What it now needs is public health management leadership. There is no one in the government who really knows how to implement a mental health program and I think what they need to do is to start recruiting people who do, either in the form of technical consultants or looking for people who know how to implement programs. The government needs to hire these experts.

Interview: Roma Rajpal-Weiß

Editor: Marjory Linardy

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