Context

Suicides rates in India are amongst the highest when compared to other countries at the same socio-economic level. According to WHO, India’s suicide rate in 2019, at 12.9/1,00,000, was higher than the regional average of 10.2 and the global average of 9.0. Suicide has become the leading cause of death among those aged 15–29 in India.

Background: Mental Health

While every precious life lost through suicide is one too many, it represents only the tip of the mental health iceberg in the country, particularly among young adults. Women tend to suffer more.
Across the world, the prevalence of some mental health disorders is consistently higher among women as compared to men.

The pandemic has further exacerbated the problem: Globally, it might have increased the prevalence of depression by 28 per cent and anxiety by 26 per cent in just one year between 2020 and 2021, according to a study published in Lancet.
Increased among younger age groups: Again, the large increases have been noted among younger age groups, stemming from uncertainty and fear about the virus, financial and job losses, grief, increased childcare burdens, in addition to school closures and social isolation.
Use of social media exacerbating the stress: Increased use of certain kinds of social media is also exacerbating stress for young people. Social media detracts from face-to-face relationships, which are healthier, and reduces investment in meaningful activities. More importantly, it erodes self-esteem through unfavourable social comparison.

People living in poverty are at greater risks: Mental ill health is a leading cause of disability globally and is closely linked to poverty in a vicious cycle of disadvantage. People living in poverty are at greater risk of experiencing such conditions.
People experiencing mental health problems likely to fall in poverty: On the other hand, people experiencing severe mental health conditions are more likely to fall into poverty through loss of employment and increased health expenditure.
Stigma and discrimination: Stigma and discrimination often further undermine their social support structures. This reinforces the vicious cycle of poverty and mental ill-health.
Higher income inequality has high prevalence of ill mental ill health: Not surprisingly, countries with greater income inequalities and social polarization have been found to have a higher prevalence.

Killing the deep stigma surrounding mental health issues: The first step should be killing the deep stigma which prevents patients from seeking timely treatment and makes them feel shameful, isolated and weak. Stigma festers in the dark and scatters in the light. We need a mission to cut through this darkness and shine a light.
Making Mental health an integral part of public health programme: There is need to make mental health an integral part of the public health programme to reduce stress, promote a healthy lifestyle, screen and identify high-risk groups and strengthen interventions like counselling services. Special emphasis will need to be given to schools.
Paying attention to highly vulnerable: In addition, we should pay special attention to groups that are highly vulnerable because of the issues such as victims of domestic or sexual violence, unemployed youth, marginal farmers, armed forces personnel and personnel working under difficult conditions.
Creating a strong infrastructure for mental health care and treatment: Lack of effective treatment and stigma feed into each other. Currently, only 20-30 per cent of people with such disorders receive adequate treatment.
Mental health services should be made affordable for all: Improved coverage without corresponding financial protection will lead to inequitable service uptake and outcomes. All government health assurance schemes, including Ayushman Bharat, should cover the widest possible range.

One major reason for a wide treatment gap is the problem of inadequate resources.
Less than two per cent of the government health budget, which itself is the lowest among all G20 countries, is devoted to mental health issues.
There is a severe shortage of professionals, with the number of psychiatrists in the country being less than those in New York City, according to one estimate.
Substantial investments will be needed to address the gaps in the health infrastructure and human resources.
Currently, most private health insurance covers only a restricted number of mental health conditions. Similarly, the list of essential medicines includes only a limited number of WHO-prescribed medications.

We need an urgent and well-resourced whole of society approach to protecting, promoting and caring for the mental health of our people, like we did for the Covid pandemic. Brock Chisholm, the first Director General of WHO, famously said, “there is no health without mental health”.