Naomi Osaka Episode and Mental health in India – Explained, pointwise

Introduction

According to the World Health Organization (WHO) estimate, mental health illness makes about 15% of the total disease conditions around the world. Mental illness needs psychological, emotional, and social well-being initiatives to get a cure. If not treated properly, it might even lead to suicidal behaviour among the individual.

Recently, Japanese Tennis player Naomi Osaka’s decision to withdraw from the French Open citing depression put mental health issues in the spotlight once again. Earlier she issued a statement saying that she would not do press conferences at the French Open and ready to pay a fine for that. Committing to her statement, she refused to give an interview after the match. But the tennis officials issued a statement to give interview in future. The officials also mentioned that she might face expulsion from the present tournament and other Grand Slam events in case of failure to abide. Following that, she took a decision to withdraw from the current event altogether.

Emotional and mental health is more important, as it impacts the thoughts, behaviours and emotions of an individual. But mental health issues generally don’t receive much attention unless some extreme events occurred. Both the individual and the government have to take the necessary steps to improve mental health.

Previous such examples of mental health issues

• Norwegian Prime Minister diagnosed with depression in 1998. After that he revealed his illness to the public and went on medical leave for three weeks, leaving an acting Prime Minister to carry out the national duty.
• Bollywood actor Sushant Singh Rajput’s tragic death has triggered a much-needed conversation around mental health in India.
• In recent years, several celebrities open up about their mental health concerns. Such as Deepika Padukone, J.K. Rowling, Beyonce and Meghan Markle.

What is Mental illness?

Mental illnesses are health conditions involving changes in a person’s emotion, thinking, or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems of functioning in social, work, or family activities. For example, people with bipolar disorder and schizophrenia are significantly disturbed, dangerous to themselves and others.

Major factors contributing to mental health problems include,

• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Family history of mental health problems

India and Mental health

According to The Lancet report published in February 2020, there were 197.3 million people with mental disorders in India in 2017. The report also explains the following things,

• The top mental illnesses were depressive disorder and anxiety disorder, impacting 45.7 million and 44.9 million respectively.
• The contribution of mental health disorders to the total Disability-Adjusted Life Years (DALYs) in India increased from 2.5% in 1990 to 4.7% in 2017.
• The Southern states namely Tamil Nadu, Kerala, Telangana, Karnataka, and Andhra Pradesh accounted for a higher prevalence of mental disorders.

According to an estimate by the World Health Organization (WHO), India has one of the largest populations affected by mental health illness. So, in 2018 the WHO labelled India as the world’s ‘most depressing country’.

Challenges in improving mental health in India

1. Lack of resources:
   • The low proportion of mental health workforce: According to the WHO, there were 0·301 psychiatrists and 0·047 psychologists for every 100,000 patients suffering from a mental health disorder in India. This is a very low number compares to the number of mental health patients.
   • Low Budgetary allocation: India is barely spending 0.5% of the health budget on the mental health sector. For example, in the recent budget only Rs 40 crore has been allocated for the National Mental Health Programme among the total health sector allocation of Rs. 2.23 lakh crore.
2. Lack of awareness and sensitivity about mental health issues: This is the first and foremost reason for high mental health illness in India. Apart from that, there is also a high prevalence of social stigma and abandonment of being mentally ill in India.
3. Loss to Economy: According to WHO, the burden of mental disorders is maximal in young adults. As most of the population is young, delayed or non-treatment of mentally ill persons will result in economic loss in terms of man-days.
4. Treatment gap: Most of the mental healthcare facilities are located in urban areas. According to estimates, nearly 92% of the people who need mental health care and treatment do not have access to any form of mental health care.
5. High out-of-pocket expenditure: The Majority of mental health issues tend to increase during economic downturns. The insurance schemes also cover only physical injuries, not mental ones. This results in high out-of-pocket expenditure during economically distress time.
6. Prone to abuse: Mentally ill patients are vulnerable to and usually suffer from physical abuse, sexual abuse, wrongful confinement, etc.

Impact of Covid-19 on Mental Health

Many Surveys have indicated that the pandemic is increasing mental health problems in India.

• An integrated health care company, Practo reported a 665% jump in the number of mental health consultation.
• Further, More than two-thirds of these consultations belongs to the age of 21-40.
• Most commonly consulted mental health topics are anxiety, stress and panic attacks.

Global steps to improve mental health

• The Mental Health Atlas was launched by WHO in 2017.
• WHO Special Initiative for Mental Health: It was launched in 2019. It aims to bring attention to the high global burden of disability arising from disorders of mental health. Further, the initiative also aims to accelerate a multi-sectoral response to improve care for mental health problems.
• Target 3.4 and 3.5 of the Sustainable Development Goals talk about reducing mental health illness for the global community.

Indian initiatives to improve mental health

1. National Mental Health Programme (NMHP): India launched NMHP in 1982 to improve the status of mental health in India. It has three important components. Such as Treatment of the Mentally ill, Rehabilitation and Prevention and promotion of positive mental health.
2. The Mental Health Care Act (MHCA) 2017: This Act repealed the Mental Health Act, 1987. The Act seeks to ensure the rights of the person with mental illness to receive care and to live a life with dignity. Few salient provisions of the Act are,
   • Central and State Mental Health Authorities: The Act established these authorities for regulation & coordination of mental health services in India.
   • Right to make an Advance Directive: Under this, every person can state how to be treated or not be treated for the illness during a future mental health situation.
   • Right to appoint a Nominated Representative: Every person also has the right to appoint a nominee to take, on his/her behalf, all health-related decisions.
   • Changes in Section 309 of the Indian Penal Code: This section of IPC criminalized the attempt to commit suicide. After the enactment of the Act, a person who attempts to commit suicide will be presumed as a person “suffering from severe stress’’. The person will also not subject to any investigation or prosecution.
3. KIRAN helpline: It is a  24/7 toll-free helpline launched by the Ministry of Social Justice and Empowerment. This helpline provides support to people facing anxiety, stress, depression, suicidal thoughts, and other mental health concerns.
4. Manodarpan Initiative: It is an initiative launched by the Ministry of Education under Atmanirbhar Bharat Abhiyan. The initiative provides psychosocial support to students, family members, and teachers for their mental health and well-being during the times of Covid-19.
5. RAAH app: It is a mobile application that provides free information to the public on mental health care professionals and mental healthcare centres. The National Institute of Mental Health and Neuro-Sciences(NIMHANS) has compiled a one-stop source online mental health care directory.
6. MANAS App: MANAS stands for Mental Health and Normalcy Augmentation System. It is a comprehensive, scalable, and national digital wellbeing platform. It has been developed to promote the mental well-being of Indian citizens.

Suggestions to improve Mental health in India

1. Increasing Awareness: The government has to increase mental health awareness and also take necessary steps to reduce social stigma. This will improve the timely undertaking of treatment.
2. Increase budgetary allocation: The government has to increase the budgetary allocation to the mental health sector. The government also has to train the ground level (ASHA, ANM, AWW) workers to improve mental health among the public.
3. Better coordination between Center-States: Healthcare is a state subject, so both Center and State should have better coordination
4. Reducing out-of-pocket expenditure: The government has to provide financial support to reduce out of the pocket expenditure. Further, the government and private insurance policies should include mental health care in their insurance benefits.

Conclusion

According to the WHO, the countries have to act swiftly to improve mental health. Else in 2030, depression will be the leading illness globally. So, India has to take the necessary steps to improve the state of mental health. Increasing budgetary spending and creating awareness is the key to reduce mental illness.