Mental Health In An Unequal World

It is a common fact that mental health is an ever-evolving health concern in India with over 7.5% of the population suffering from mental illness (WHO, 2019). Several public health organizations have been working towards bridging the gap between mental health professionals and help-seekers. We all experienced how chaotic an affair mental healthcare became in India, especially during the Covid-19 pandemic. Along with the presence of deep-rooted stigma, the struggle around accessibility and availability of mental health services grew multifold. 

World Mental Health Day is celebrated every year on 10th October, 2021. This year, the theme was “Mental health in an Unequal World”. We saw many organizations and people posting content stressing on the importance of mental health, but in less than two weeks, everyone is silent again. Once again, even this year, the fact that mental health matters is reduced to being just a trendy hashtag. 

We cannot deny the benefits and importance of psychoeducation, but we need to take better strategic actions to improve the current situation. I hope that reading this post makes you acknowledge the current situation for mental health in India, and act on it. 

As much as we promote psychoeducative events and learning, it is insignificant until we acknowledge the existing inequalities. Not everybody who needs mental health support is in a position to benefit from it due to other impeding factors such as poverty and lack of psychosocial support. We hear of several therapists offering sliding-scales, but when their services are being advertised online and in non-native languages like English, can we really say that mental healthcare is accessible? Despite several public health interventions by the government, such as the Manodarpan initiative under the Atmanirbhar Bharat Abhiyan, the ASHA program by the Ministry of Health and Family Welfare, policymakers have failed to provide sufficient primary mental healthcare to marginalized communities. 

A large section of the Indian population belongs to the low-income strata, and often, mental healthcare becomes the least of their priorities. There also exists a dearth of government schemes that ensures affordable mental health services to people struggling with high rates of poverty. Even though there are a number of free helplines existing in India, such as the Ministry recommended – KIRAN, Fortis 24×7, and iCALL, they come with negative reviews regarding availability, language, and quality of service. I have personally had an unpleasant experience when I contacted one such helpline during a moment of distress but was turned away not because my crisis wasn’t immediate, but because I began speaking in English and that made them assume that as an English-speaking person, I could definitely afford therapy. Yes, I could afford some therapists. But not at that immediate moment. There weren’t any therapists I knew back then who provided crisis counselling services. 

While some telehealth services are suicide helplines, others are meant for people with not so severe mental health concerns, because people with severe mental health concerns cannot always benefit from them. Similarly, members of indigenous communities, gender, sexual and linguistic minorities, and people with disabilities experience life-stressors that are unique to them and which require careful consideration while tackling accessibility. These socioeconomic factors describe how multilayered the issue of mental health accessibility is. Not only do these factors contribute heavily to the onset and manifestation of mental health concerns, but it also creates a huge divide in treatment efforts and help-seeking behavior. Thus, recognizing the imbalance and then addressing the needs of different communities through an equity lens is important. 

The unequal status of mental health in India is as much due to social factors as it is due to financial inequalities. This can only be addressed by increasing our financial and labour resources. The ratio of mental health care providers to the people seeking care is heavily distorted as well as the budgetary allocation to mental health care is very low. These disparities are a major factor in the widening health inequity and reflect in the incidence of adverse mental disorders in India. Thus, the goal of the policymakers while addressing mental health concerns should be to integrate different sections of the society in a way that is not just equal but equitable.

What are your views on mental health? The onus of making mental healthcare accessible and affordable often falls in the hands of mental health practitioners as a result of which they experience severe burnout, and often fail to provide quality client care. The stigma surrounding mental health also makes people fall for quackery which does them more harm than good. How do you feel you can contribute towards bridging that gap? What steps can you take to make mental health diversely available in this unequal world?

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