The neglected mental health crisis


India, a land rich with culture – from the cuisines to the traditional clothes to the vivid history of its people. There is joy seeping from the corners of Chandni Chowk, serenity in the picturesque hills of the North East, the sound of breaking waves and the smell of salt down in the Southern beaches. But beyond the landscape, there is an uneasy silence that filters into everyday conversations – the shushing of a family member’s condition, or more often, the denial of anyone in the family or their social circles being plagued with mental illness.

Madness, ‘pagalpan’- treated by local shamans and priests, when instead one could seek the help of a professional, there is a shame that comes from admitting that such a thing is plaguing someone they know.
According to a study reported in World Health Organisation (WHO), conducted for the National Care Of Medical Health (NCMH), states that at least 6.5 per cent of the Indian population suffers from some form of serious mental disorder, with no discernible rural-urban differences.
By far, India is one of the most dangerous countries where suicides due to lack of proper mental health care is concerned, but with the implementation of the Mental Health Care Act, 2017 and the recently increased discussions about mental health taking place on social media, there seems to be a more hopeful future for people suffering from mental disorders.

The Mental Health Act was passed on 07 April, 2017 and can be summarized as- “An Act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto.’’

Under this Act, it is directed by law that there be wide publicity through media to reduce stigma and give government officials sensitization and awareness training to work better with people with mental illnesses and disorders.

Busting myths and understanding reality
Society at large find “hanging with/around bad company” as one of the biggest factors behind suicides or mental illnesses. This “bad” company is an allusion to drugs and substance abuse, which gives the wrong impression that only people suffering from drug addiction are susceptible to commit suicide. Yet, there have been cases where a person may have had lovely friends, a supportive family, no history of substance abuse whatever and still succumb to the overwhelmingly tragic and abrupt resolution as taking their own life.

To support this argument, a medical paper published on April 2019 in ‘The Journal of Medical Research’ by Satish Rasaily, MD of Psychiatry at Singtam District Hospital, explained that- “The present study negate popularly held beliefs surrounding suicide in the context of Sikkim that promotes substance (drug) abuse as primary cause of suicide as reported in news media/ newspapers regularly as study revealed drug addiction contributes to less than 5 cases out of 231 study sample.” To make it clearer, it simply means there are other factors that contribute to suicide and drug abuse is the smallest portion in that pie chart.

In the same paper, it was observed that- “Psychiatric disorders were noticeable in 68.35% of male and 71.23% females, the most prevalent psychiatric disorder being depression, followed by schizophrenia”, and that became a significant reason behind most completed suicides. Therefore, to get to the root of this problem, there has to be a vital change in the way we view mental illnesses.

The most vulnerable age group is the 21-39 cluster, where the pressures of growing up finally catch up to them and in the age of always being surrounded by information via the internet, there is a certain loneliness that filters through in the lives of young adults who simply cannot find balance between their virtual and real lives.

Garima Seth, a Counselling Psychologist and a School Counsellor, says- “The young population is susceptible to mental illness because there is so much pressure on the young adults – from parents, media, society and peer groups. With growing age, it is becoming more pertinent.”
The adults in the lives of people affected with mental illnesses or personality disorders are hardly serious about the intensity of the sickness. Brushing off young people’s problems as a “phase” or giving the asinine solutions, “just be positive/look at other people who are worse off”, comes off not just rude, but hurtful.

One simply cannot compare sorrow. Social circles of the affected person, whether they may yet be harbouring suicidal thoughts or not, have to be receptive and not find reasons to find faults, ridicule or ostracize them. Families may try to be supportive, but often the guilt or anxiety they feel when accosted with the “madness” of the affected person leads to tiptoeing around the person, which ends up feeling like exclusion.
In both urban and rural areas in Sikkim, finding out that one’s family member is diagnosed with depression leads to various questions of- “What did we do? You have everything, don’t you?”, that ultimately boils down to the patient feeling guilty of feeling the way they do, which in turn leads to more suppression and showing the joyful demeanour demanded by society, thus leading to the inevitable breakdown when the mental illness wins by large, because family pride and ego came before everything else.
In Rasaily’s paper, he writes- “Individuals who attempt to end their own life are regularly endeavouring to make tracks in an opposite direction from a real existence circumstance that appears to be difficult to manage. Numerous who make a suicide endeavour is looking for help from feeling embarrassed, liable, or like a weight to other people, Feeling like an injured individual, sentiments of dismissal, misfortune, or depression. One of every four families is probably going to have a family member with conduct or mental disorder. These families give physical and enthusiastic help, yet additionally, bear the negative effect of shame and segregation. The majority of them (>90%) remain untreated. Poor mindfulness about indications of psychological instability and absence of learning on the treatment accessibility are significant reasons for the high treatment gap. In this manner, connecting with somebody who is battling can make a difference.”

Current Situation in the state
Sikkim is known as one of the more economically stable states in India, but Karma Chewang Nima, Team Leader at Suicide Helpline Crisis Centre thinks differently. He is of the belief that after having had many interactions with people who decided that suicide was the final step for them or survivors of it, there are not many cases where economic reasons are behind the cause of suicide. “The reality is mental health, mental illness. Depression is one of the main causes of suicide and why does it happen? When mental health is not okay”.

Our society is filled with bright individuals who are all struggling to find their place in the world and some of them aren’t as privileged as others. Mental health and well being is for everyone, no matter what their economic background is or what their sexual orientation is important, but treatment, rehabilitation and therapy isn’t all accessible or reasonable. For the LGBTQ+ community, healthcare (both mental and physical) is in a dismal condition – from doctors who refuse to provide treatment/therapy to the insensitivity of the same when dealing with their cases is still a ground reality.
The expenses are high, the pressure on the patient to look normal, higher. Medication such as Ibuprofen for pain, Clonazepam for calming down – expensive and with side effects of their own. Newer methods of treating patients have been introduced but it remains known to only a few. Therapy that doesn’t include medication is cost-effective and non-invasive is a reality, except that it hasn’t broken ground in many states.

Sikkim’s approach to solving the mental health crisis
In Sikkim, the state health department is planning to include mental health counselling into the planned to turn 147 Public Health Centres (PHCs) and Public Health Sub Centres (PHSCs) into state health and welfare centres that would serve to counsel people and spread awareness about mental health and well being.

Sikkim also has a 24×7 helpline number for people who are in need of someone to talk to. Nima, at 24×7 Crisis Center, believes that at present, the society has become selfish and materialistic. If more people empathise with people or could get from their immediate friends and family before coming to a medical health professional if the former were somehow trained to provide emergency assistance.

In the last 4 years, they have received 254 calls – some days there are no calls and sometimes they attend to more than 10 calls in a day. They operate 24×7, with a team of nine people who have morning, afternoon and night shifts.
“It gives meaning to our lives. We are doing something for society”, says Nima.
It isn’t only people from Sikkim who call the crisis centre, but people outside the state too. “You’ll be surprised we have got good numbers of calls from Mumbai, Gujarat, Kolkata, MP, Delhi we have done home visits also but not to those who stay far but we have given them our personal phone numbers, so if they want to speak we will be there and some of them are there in our touch. We have saved 8 lives so far which we had not thought 4 years back. They are all in the mainstream now living a healthy life normally. We take pride in that, we are here attending calls when somebody calls us up and that kind of things”, adds Nima.

Alternative methods
Another solution to the growing problem of suicide and mental disorders is finding alternative methods of treatment. If there can be alternative solutions for environmental problems then we have to keep our options open with health as well.

One of the most unknown alternative methods is music therapy. Music is a beautiful art form that has been revered for ages, with Gods dedicated to it in all cultures and even Plato and Aristotle informing the world in their monumental philosophies that music affects an individual, to a point where it influences their character and work. So it goes without saying that this form of treatment is pleasant, yet effective. In India, there are centres for the same which have produced results.

Dr T. V. Sairam, President of the NADA Centre for Music Therapy, explains that there is a rather simple process to it. At the root of it, he says- “Music therapy is a neurological treatment. The music must sync with the individual, and the latter must be determined in the decision undertaken, then the genre of music is explored. He believes that different ragas have different curative abilities, but at the heart of the matter, the music must inspire positivity even if it is for a temporary period of time. After this, the mind is restructured to change the attitude of the individual, by focusing on the positive, with even going so far as to avoid the television and newspaper, thereby avoiding the negativity or anxiousness that news provides.

“Music therapy is not for the sake of music therapy. It is for growth and nourishment,” he says. “The person must be receptive to the music for the therapy to work.”

Talking about the mental health of the young Indians, he believes that the economic development of the last few decades has led to more people consuming media through the internet, which caused the value for information to decrease since it became easier to procure. Adding to this, he notes that the notion of nuclear families, as opposed to the joint families more prevalent in the past has led to a certain kind of isolation where the idea of sharing one’s joy and sorrow with immediate family members is lost.

But Seth thinks, that to tackle a severe situation of a patient, prescription medication is used to subdue the symptoms so it is still useful in helping people diagnosed with mental disorders. “There is no comparison between alternative therapy and allopathy. They are both effective”.

It doesn’t suffice to say that just music therapy works – yoga, dance, painting etc. are all methods of therapy that can be used to help the patients according to their needs while keeping in mind their area of interest. Plus in severe cases, there has to be medication involved.
Still, if the state health departments and the government considered all the methods of therapy and rehabilitation instead of going for a run of the mill idea then there could be more creative and sustainable ways to treat patients diagnosed with mental disorders. Engaging patients who have tried to commit suicide or have suicidal thoughts with activities that really make them use their body and brain could help them find a skill or hobby they enjoy while finding themselves getting healed.

Nevertheless, like charity, changing mindsets towards people with mental illnesses begin at home. We have to let people know it is okay to talk, to vent and to ask for help. When we begin to see the affected as people not patients, they will begin to see us support systems, not threats.
Sikkim’s tag of the “suicide capital” is shameful – when on one hand, we are lauded for being environmentally conscious, and the other shows the terrifying reality of its people who are succumbing to suicides because of our society’s regressive attitude towards mental health.

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