*October 05, 2010* Psychological problems of the urban middle class are increasing by leaps and bounds and now they are not shy of visiting a shrink. But this is only the tip of the iceberg. *SHWETANK DUBEY* looks at why urban India is headed towards the shrink’s office
It’s a mad, mad world out there. And everyone is getting affected by it, be it housewives, students or executives. If reports and surveys are taken into account, they only point towards one fact — along with India’s economic success and recent failure, people have become more vulnerable mentally in the past 15 years. As a result of this, there’s been a scramble to consult psychiatrists; and while the queues at their clinics have become longer, so has the specialisation in this arena. Gone are the days when people made to consult psychiatrists for mental illnesses were labelled demonic, possessed, witches or lunatics. Now, the urban middle class is not shy to consult psychiatrists for even the smallest mental problems that plague them. Dr Nirmal Bhagat, a Delhi psychiatrist who also works with an NGO in the field of mental health, says, “Illnesses now range from psychiatric disorders like depression, panic attacks, phobias, schizophrenia and drug addiction, to those with emotional, lifestyle, relationship and self-image related problems.” Psychiatry grew as a profession in India after a lot of suicides started coming to the fore resulting from job stress and the failure of people to accept their loss of income and status. Several suicides resulting from job losses highlighted the increased need for mental health services in the country. In March 2009, a 31-year-old unemployed software engineer was found dead in his north Delhi house. He had been in deep depression ever since he lost his job four months back. In February 2009, a 24-year-old banker in Chennai hung herself, unable to cope with life after being laid off. But what has led to this spurt in the visits to the psychiatrists clinics? Dr Ranjan Arneja, a psychiatrist, says that the demographic transition of India has led to the emergence of non-communicable diseases as a major public health problem. “Rapid urbanisation and industrialisation has triggered social upheavals, causing many people stress and anxiety. At the same time, traditional family support systems are disappearing while new forms of external emotional support are few and far in between,” Dr Arneja says. While no definite figures have been released by the Government to determine the effect of the financial crisis on mental health, NGOs and psychiatrists are reporting a spurt in calls and visits. “We saw an almost 30 per cent rise in the number of callers in the past one year,” says Lakshmi Vijaykumar, founder of the Chennai based Sneha Suicide Prevention Centre that offers emotional support to people who are lonely, depressed, or suicidal. Estimates by World Health Organisation (WHO) have predicted depression to be the third highest killer by 2020. But the psychological problems that the urban middle class is facing due to a confrontation with a shrinking job market, lay-offs, and pay cuts is only the tip of the iceberg. In 2008, a joint publication by the National Human Rights Commission and the National Institute of Mental Health and Neuro Sciences (NIMHANS) stated: “Morbidity on account of mental illness is set to overtake cardiovascular diseases as the single largest health risk in India by 2010.” The preliminary findings of a WHO study on mental health in India indicates that about 10 per cent of the population in India have mental health problems. The study was coordinated by WHO and Ministry of Health and Family Affairs, and done in 11 centres across India in collaboration with leading medical colleges. Surveys also point out that the line at psychiatry centres have become serpentine, and considering the intricacies of the situation, doctors no longer want to take patients at random. Emerging areas have made this profession even more challenging. Psychiatrists have divided themselves into the areas of specialisation including child and adolescent psychiatry, drug and alcohol de-addiction psychiatry, geriatric psychiatry, community psychiatry, forensic psychiatry, consultation and liaison psychiatry and neuro psychiatry. “Introduction of life skills and mental health programmes in schoolgoing children for prevention of risky behaviour has emerged in a big way in India,” says Dr Avdhesh Sharma. Given this scenario, Moolchand hospital in south Delhi has even set up a unique Child Development and Adolescent Health Centre dedicated to child and adolescent psychiatry. The same has been done with geriatric psychiatry. Whenever a patient approaches a psychiatrist nowadays, they listen to his/her situation and if it does not meet their specialisation, they refer them to other psychiatrists. Due to this, patients not only lose time in getting proper treatment, but also suffer monetary losses till they find the right psychiatrist to address the problem. Many psychiatrists have also been accused of money minting by holding multiple sessions with patients and then finally referring them to others. But psychaitrists say that it is not their fault that patients suffer monetary losses. “Mental illness is not like a physical ailment where a person knows which doctor he should visit. It is only after a person’s problem is diagnosed that they can be referred to the right shrink. It is better to refer them to another person rather than treat them wrongly,” said Dr Sharma. “Part of this problem is human resources. In a country of over a billion people, there are only around 3,500 psychiatrists. Not only is there an acute shortage of psychiatrists, but even this small number is not equitably distributed. 75 per cent of the psychiatrists are located in urban areas and only 25 per cent cover the rural pockets that account for 75 per cent of the population,” says Dr SK Khandelwal, a professor of psychiatry at AIIMS. Former Health Minister Anbumani Ramadoss had even lamented at a public function in 2009 that India has a shortage of 1,600 psychiatrist social workers and 9,000 psychiatrist nurses. In many States, there are not even enough people to train mental health professionals who can implement the District Mental Health Programme. In India’s Eleventh Five Year Plan (2007—2012), mental health has moved up the priority list. In February 2009, the Union Government approved ` 474 crore to tackle the human resource crisis derailing the National Mental Health Programme. The money was sanctioned for establishing at least 11 centres of excellence of mental health and neurosciences by upgrading existing mental health institutes and strengthening other institutions. This move is expected to add 100 psychiatrists, 400 clinical psychologists, 400 psychiatric social workers, and 800 psychiatric nurses to India’s health workforce every year. The Medical Council of India is also working towards motivating medical college students to take up postgraduate courses in psychiatry to cover the shortage of manpower. India’s mental health burden has now become too huge to be tackled by the existing mental health professionals. But work is underway to close the gap. The world over, trained community health workers are employed to deliver mental health care and the same is being developed in India. Mental math Around 1-2 per cent of India’s population suffers from major mental disorders and about 5 per cent from minor depressive disorders Most people needing treatment have to spend from their own pocket as they are not covered by insurance schemes Most of the psychiatrists are based in cities or private hospitals. But Government hospitals face an acute shortage, although they are the ones which treat the poor The mental health services in Delhi are not adequate to cater to the growing demands and as a result nearly 70 per cent patients never make it to a mental health facility There are only 40 mental health institutes in India with 22,000 beds to treat patients Only 9 Government hospitals in Delhi run a psychiatric OPD and just 5 of these have an in-patient facility for psychiatry patients <goog_581582719> http://www.dailypioneer.com/287220/We%E2%80%99re-going-nuts.html -- You received this message because you are subscribed to the Google Groups "Mental Health Advocacy (News 'N Views) India" group. 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