Neglect of Mental Health Services in India
Discuss About The Mental Health Management Issues In Rural India.
A close analysis shows that mental health services in India are quite neglected and are in severe need of immediate attention from the government as well as from the policy makers as well as from civil service organizations (Das et al. 2012). In the year 1982, National Mental health Programme had been launched as well as National Mental health mission had been also established. However, very little had been able to be achieved by the government of the nation in the rural areas. Due to the increase in population as well as the changing lifestyle over the nation, mental health issues had become one of the biggest concerns not only in the urban areas but also in the rural areas. Unemployment, lack of education, lack of social security, increasing insecurity and similar other factors had often acted as some of the main reasons by which the rural people have not been able to develop better quality lives (Knaak, Mantler and Szeto 2017). Lives full with depression and anxiety had been a common scenario in every household. Researchers are of the opinion that most of the rural members even does not identify the facts that they have been affected by depression as well as anxiety and hence they live poor quality lives without understanding the fact that they need to attend healthcare centers for getting treatment. Therefore, when human beings are not aware about the fact that they are not living mentally and emotionally healthy lives, they also will not be able to understand the need of mental health services (Kumar 2012). Thus, importance of health promotion programs for identification and positive outcomes of treatment should be introduced. Lack of education and knowledge about the mental health conditions of the rural Indians as well as the lack of knowledge of the government introducing programs for their benefits are some of the barriers that affect the access of such people to the healthcare services (Mathias et al. 2015). This lack of education of mental health as one of the important attribute of health just like physical health had given mental health issues a negative outlook. The rural Indians are not comfortable accepting, mental health issues as any other physical health issues that are bothering their family members, friends and other relatives.
Stigmatization had been one of the most important barrier that prevents a huge number of rural areas in preventing themselves to express their health issues to not only healthcare professionals but also to family members, parents, relative, friends and other community members (Murthy 2017). Interesting depictions of stigmatization had been found to be associated with very remote villages where mental health disorders are perceived and understood in different ways. Associations of mental health disorders as punishments of almighty or as feature of the karma is strongly believed by the elder generations that pass on from generation to generation affecting the conditions of living. Often-aggressive behaviors that remain associated with mental disorders which are curable through different therapies and medications are considered by the rural Indians as the effect of satanic cults on the individuals that lead them to make the patient live outside their community (Patel et al. 2016). They believe that by socially excluding him and debarring him from the community, they will be able to prevent the effects on the healthy individuals. Such form of stigmatization prevents many individuals to not reveal the mental health issues that they are facing. In turn, they keep such issues within themselves and do not take the help of any healthcare professionals with the fear of being stigmatized and socially excluded. Therefore, stigmatization has been another important factor that results in the barriers in accessing mental health services by the rural Indians (Semrau et al. 2015).
Barriers to Accessing Mental Health Services in Rural India
Another very interesting issue that had been noted is the improper infrastructure as well as the poor human resources required for treating the mental health patients. The treatment gap is found to be quite high in the rural areas. According to the estimate that had been provided by researchers, it had been found that even if 3000 psychiatrists available in the country, start working with a face to face patient contacts and undertakes treatment sessions by working for 8 hours a day, five days a week and mainly sees a single patient for about a total of 15 to 30 minutes, over a 12 month period, they would be able to provide care to only about 10 to 20% of the total burden of the serious mental disorders (Shidhaye and Kermode 2013). This has resulted in an estimated treatment gap of about 90% which shows that the human resources in India is not sufficient enough to meet up the requirements of the mental health patients in the rural areas of the nation. Researchers like Das et al., (2012) had supported this fact and had been seen to be stating that unavailability of mental health services as well as lack of resources particularly in terms of the human resources , financial constraints as well as infrastructures are also some of the other barriers that had resulted in the preventing access of the individuals towards the healthcare centers. Shields et al. (2017) had stated that the services that are available in the urban areas of the nation of India is quite are quite far from the rural and remote areas of the villages. The services provided in the urban areas are also quite costly which become very difficult to afford by the people of the rural areas of the nation as they belong to the low socio-economic status of the nation. Therefore, this is also considered important factors that act as the barrier of the access of people in rural areas to mental health services. Other researchers have also identified other important barriers over time other than the already mentioned factors. The human resources allocation as well as providing money to maintaining the infrastructure can be also considered as discriminatory acts of the political powers of the nation (Srivastava et al. 2016).
Discrimination in allocation of funds for the mental health service purposes can be well understood from the fact that although healthcare services for physical health issues are encouraged but mental health issues are not indentified. Low political will of the central as well as the State governments as well as unclear plans of the action and policy are some of the reasons. The healthcare professionals providing mental health services to the rural people even show discriminations. Improper behavior and discriminatory attitudes expressed in their actions while treating the rural people of the nation affects the autonomy and dignity of the patients in a way that they do not want to continue the services of the professionals. Humiliation and discrimination from the healthcare professionals make them feel ostracized from their rights to get healthcare services from the professionals. These discriminations have negative impacts on their mental health that contribute to the worsening of their mental health conditions as they try to suppress their mental health issues. They also become hopeless from the fact thinking that they have no other places to seek help for and such feelings increase their suffering. Many of the researchers are of the opinion that another barrier also observed is the resistance of the healthcare professionals of the nation to that of decentralization (Thornicroft et al. 2016). Moreover, it is also seen that the mental health professionals as well as the associated workers see a specific form of resistance as their interests are mainly served by the large hospitals. Other discriminatory activities can be put forward by stating that mental health services have still not been included in the primary healthcare services in the rural and remote areas of the nation. Primary healthcare workers are seen to be overburdened with the lack of supervision as well as expert support and hence the governments still has to travel a long way to help in development of the quality of life of the patients in rural areas who are suffering from the disorders (John et al. 2015).
Stigmatization as a Barrier to Accessing Mental Health Services
Many of the qualitative researches had included the mental health care patients to reply with answers that shook the researchers entirely. One of the patients was seen to be stating, “People consider me dirty. They call me Mentalu (of unsound mind). My neighbors scold me. I am given to eat stale food. My own daughter scolds me and doesn’t feed me well.” These narrative answers of the mental health patients can easily provide an overview of the various situations they have to face when their information reading their poor mental health gets leaked within the society (Kumar 2012). Stigmatization is of such a level in rural India that even friends and relatives can even take a wrong approach to treat the mental health patients/ it was seen to be stated by a patient “My husband left me because I am mentally ill. When I was pregnant, my in-laws got an abortion done on me, saying the children will also be mentally ill. I used to work as a salesgirl, and they told me that I was too slow and that I just stood at the counter and that they could not pay me for just standing there.”
Stereotyping mainly depicts mental health patients of the rural India as dangerous as well as unpredictable. Such individuals are also held responsible by the society for their disorders and illness and even the society is seen to hold them incompetent in different activities of their lives. All these lead the society to discriminate people with one of the actions beings excluding such people suffering from these conditions from employment as well as social and educational opportunities. Murthy (2017) is also of the opinion that in medical settings, negative stereotypes can make providers less likely to focus on the different patients rather than the diseases, endorsement of the recovery as an outcome of care as well as refer patients to needed consultations and different follow up services. Often it is seen that such displays of discrimination can become internalized which may lead to the development of self-stigma. Often it is seen that people with mental health issues can start believing the negative thoughts expressed by the others (Semra et al. 2015). They start looking down upon themselves as unable to recover, undeserving of care, dangerous as well as responsible for their illness. This make them feel shameful, full with low self-esteem and their inability to accomplish their goals. Again, self-stigma is seen to result in development of “why-try” effect where people start believing that they are unable to recover. Therefore, they themselves prevent themselves from taking mental healthcare services (Thornicroft et al. 2016). Therefore, it is extremely important for the government of health and the policy makers to gather knowledge and try their best to overcome the barriers and provide the much-needed service to the different patients.
Lack of Infrastructure and Resources for Treating Mental Health Patients
Some of the innovative ideas that need to be developed are the health promotion program. This health promotion program would be mainly concerning on the education of the rural people of India. This will help in breaking the stereotypes as well as the stigmatized beliefs that remain intricately associated with their through process regarding mental health. Researchers are of the opinion that the central government should take the help of media through radio, televisions and others to reach the rural people and convey the message. They also have to allocate sufficient amount of funds and try to recruit more staffs in mental healthcare. All these would help in overcoming the discrimination regarding mental health successfully.
References:
Das, J., Holla, A., Das, V., Mohanan, M., Tabak, D. and Chan, B. 2012. In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. Health affairs, 31(12), 2774-2784.
India is facing a possible mental health epidemic, says President. 2018. The Hindu. Retrieved 18 April 2018, from https://www.thehindu.com/news/national/karnataka/india-is-facing-a-possible-mental-health-epidemic-says-president/article22335971.ece.
John, S., Muralidhar, R., Raman, K.J. and Gangadhar, B.N., 2015. Addressing stigma and discrimination towards mental illness: a community based intervention programme from India. Journal of Psychosocial Rehabilitation and Mental Health, 2(1), pp.79-85.
Knaak, S., Mantler, E. and Szeto, A. 2017, March. Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. In Healthcare management forum (Vol. 30, No. 2, pp. 111-116). Sage CA: Los Angeles, CA: SAGE Publications.
Kumar, A. 2012. Mental health services in rural India: challenges and prospects.
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