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Understanding The Burden Of Mental Disorders In India

World Mental Health Day 2021: The term ‘mental disorders’ is used to denote a range of mental and behavioural disorders, with different presentations. Mental disorders include depression, bipolar disorder, schizophrenia and other psychoses, dementia, and developmental disorders including autism

Understanding The Burden Of Mental Disorders In India
Highlights
  • In 2017, India had 197.3 million people with mental disorders: Lancet Study
  • Mental health conditions now cause 1 in 5 years lived with disability: WHO
  • World Mental Health Day 2021 theme: Mental health in an unequal world

New Delhi: “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices”, says United States’ Centers for Disease Control and Prevention (CDC). The CDC also specifies that although the terms are often used interchangeably, poor mental health and mental illness are not the same. A person can experience poor mental health and not be diagnosed with a mental illness like depression and anxiety.

This year, as we mark World Mental Health Day on October 10, with the theme of ‘Mental Health In An Unequal World’, let’s understand what is a mental disorder, who is at risk of developing one, what’s the burden of mental disorders and where do we stand currently when it comes to addressing the burden.

What Is A Mental Disorder Or Illness?

The term ‘mental disorders’ is used to denote a range of mental and behavioural disorders, with different presentations. They are generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others. Mental Disorders include depression, bipolar disorder, schizophrenia and other psychoses, dementia, and developmental disorders including autism.

Who Is At Risk Of Developing Mental Disorders?

The World Health Organisation (WHO) states that the determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.

Stress, genetics, nutrition, perinatal infections and exposure to environmental hazards are also contributing factors to mental disorders, says WHO.

The Global Support To Mental Health

‘Good health and well-being’ is one of the 17 Sustainable Development Goals of 2030 agenda adopted by all United Nations Member States in 2015. The SDG goal 3 not only focusses on physical health, but mental health as well. The target is to reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being by 2030. The inclusion of mental health in SDG reflects the increased acknowledgment of the role mental health plays.

As per the WHO, despite progress in some countries, people with mental health conditions often experience severe human rights violations, discrimination, and stigma. Many mental health conditions can be effectively treated at a relatively low cost, yet the gap between people needing care and those with access to care remains substantial. Effective treatment coverage remains extremely low, says WHO.

Also Read: How To Ensure Emotional And Mental Well-being During COVID-19? Expert Answers

The Global Burden Of Mental Health Disorders:

  1. There has been a 13 per cent rise in mental health conditions and substance use disorders in the last decade (to 2017): WHO
  2. Mental health conditions now cause 1 in 5 years lived with disability which means the disease affects the full potential of an individual.
  3. Mental health conditions can have a substantial effect on all areas of life, such as school or work performance, relationships with family and friends and ability to participate in the community. A recent WHO-led study estimates that depression and anxiety disorders cost the global economy US$ 1 trillion each year in lost productivity. Despite these figures, the global median of government health expenditure that goes to mental health is less than 2 per cent, noted WHO.
  4. WHO’s review of 129 studies in 39 countries showed that among people who have experienced war or other conflict in the previous 10 years, one in five people (22 per cent) will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia.

Also Read: Impact Of COVID-19 On The Mental Health Of Children And How Parents Can Help Them

The Status Of Mental Health Disorders And Services In India:

1. A study titled “The Burden Of Mental Disorders Across The States Of India: The Global Burden Of Disease Study 1990–2017” released in December 2019 and published in The Lancet Psychiatry has assessed the disease burden of each mental disorder. As per the report, in 2017, there were 197.3 million people with mental disorders in India, comprising 14.3 per cent of the total population of the country. Mental disorders contributed 4.7 per cent of the total DALYs in India in 2017, compared with 2.5 per cent in 1990.

Explaining the term DALYs with an example, Dr Rajesh Sagar, Professor of Psychiatry at AIIMS, New Delhi, said,

DALYs is a sum of the years of life lost (YLLs) due to premature mortality and the years lived with a disability (YLDs). Let’s assume the average life expectancy in a country is 65 years. Due to a particular disease, some people die at the age of 50 which means they are dying 15 years before they are expected to. Hence, YLLs will be 15 years. There is another disease that affects people at the age of 40 but does not lead to mortality. Here, the disease has affected the ability of a person; YLDs will be 25 years.

Talking about how bad is the current DALYs due to depressive orders, Dr Sagar who is also the first author of the said Lancet report and Chair, Global Burden of Disease (India)-mental health expert group said,

To understand the gravity of the current DALYs, we need to look at the trends in India. Our report has data starting from 1990 and it shows that in 27 years, DALYs has almost doubled and it’s a worrying trend. Also, mental disorders were the leading cause of YLDs in India, contributing 14.5 per cent of the total YLDs in 2017.

2. As per the said report, the highest contribution to DALYs due to mental disorders in India in 2017 was from depressive disorders (33.8 per cent) and anxiety disorders (19 per cent).

Also Read: Each COVID-19 Surge Poses A Risk For Healthcare Workers: Post-Traumatic Stress Disorder

3. The Lancet report also highlighted a substantially higher DALY rate of depressive and anxiety disorders in females than males. DALY rate of depressive disorders among females was 38.6 per cent whereas, in males, it stood at 28.9 per cent. Similarly, the DALY rate of anxiety disorders in females was reported at 21.7 per cent whereas, in males, it was at 16.2 per cent.

4. The economic loss due to mental health conditions, between 2012-2030, is estimated at USD 1.03 trillion, as per WHO. Unemployment is a well-recognised risk factor for mental health problems, while returning to, or getting work is protective, says WHO.

5. WHO also states that the mental health workforce in India is not upto the mark and there is a huge shortage of mental health professionals in the country as compared to the number of people suffering from mental health issues. In India, per 1,00,000 population, there are 0.75 psychiatrists against the desired number of 3 psychiatrists, as per a paper published in Indian Journal of Psychiatry, 2019.

Understanding The Burden Of Mental Disorders In India

The status of mental health workforce in India

Similarly, there are 0.067 psychologists working in the mental health sector against the ideal ratio of 1.5 per 1,00,000 population. Important to note that though the data was published in 2019 by WHO, for India, the figures are as of 2016.

6. As per the information shared by the Ministry of Health and Family Welfare in Lok Sabha in 2018, India has 898 psychologists against the requirement of 20,250. The country also has 1,500 psychiatric nurses against the requirement of 3,000.

7. If we look at the mental health infrastructure, India has 0.560 beds for mental health in general hospitals (per 1,00,000) whereas, Brazil has 0.565, Sri Lanka has 3.959 and South Africa has 4.330. Similarly, there are 1.426 beds in mental hospitals (per 1,00,000) in India while Brazil has 9.792, Sri Lanka has 4.968 and South Africa has 16.556.

Understanding The Burden Of Mental Disorders In India

The status of mental health infrastructure in India vs neighbouring countries

A Holistic View Of The Impact Of COVID-19 On Mental Health

According to WHO, the COVID-19 pandemic has disrupted or in some cases halted critical mental health services in 93 per cent of countries worldwide, while the demand for mental health is increasing. Given the chronic nature of the disease, this translates into a significant economic impact worldwide. The data is based on a survey conducted from June to August 2020 among 130 countries across WHO’s six regions and published on October 5, 2020.

Also Read: Consultations For Anxiety, Depression, Gaming Addiction Doubled During COVID-19 Pandemic: Study

Countries reported widespread disruption of many kinds of critical mental health services. Like over 60 per cent of the countries reported disruptions to mental health services for vulnerable people, including children and adolescents, older adults, and women requiring antenatal or postnatal services.

30 per cent reported disruptions in to access for medications for mental, neurological and substance use disorders.

Agewell Foundation, India, a not-for-profit NGO which has been working for the welfare and empowerment of older persons of India since 1999 conducted a telephonic survey in June 2021 to assess the impact of the second COVID wave on elderly. The researchers interacted with 5,000 elderly respondents over the phone in different parts of the country. Anxiety, sleeplessness, lack of appetite and lack of physical activity was termed most critical health challenge according to 34 per cent respondents.

Talking about addressing mental health issues, Dr Samir Parikh, Director, Fortis National Mental Health Program of Fortis Healthcare emphasised on early identification and timely intervention. He said,

By ensuring right treatment, we will significantly reduce suicidal attempts and suicides. By ensuring timely treatment, we will ensure that the cost factor, whether it’s an organisation or an individual – the loss of opportunity and the struggles – they will be largely reduced. We need to end the stigma and talk about mental health in a sensitive, compassionate and corrective manner. We can use digital India to have last mile reach because we have a shortage of experts in our country but if we utilise our digital interface, we will be able to make an impact and ensure that the vulnerable people who need help, get that.

Also Read: Mental Health Explained: What Is Depression?

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

If you need support or know someone who does, please reach out to your nearest mental health specialist. Helplines:

AASRA: 91-9820466726 (24 hours)
Sneha Foundation: 91-44-24640050 (Available from 10am to 10pm)
Vandrevala Foundation for Mental Health: 9999666555 (24 hours)
iCall: 022-25521111 (Available from Monday to Saturday: 8:00am to 10:00pm)
Connecting NGO: 9922004305 | 9922001122 (Available from 12 pm – 8 pm)

NDTV – Dettol have been working towards a clean and healthy India since 2014 via Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ populationindigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity,  that is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India. 

World

24,24,98,327Cases
20,40,54,102Active
3,35,14,449Recovered
49,29,776Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 24,24,98,327 and 49,29,776 have died; 20,40,54,102 are active cases and 3,35,14,449 have recovered as on October 22, 2021 at 5:24 am.

India

3,41,43,236 15,786Cases
1,75,7453,086Active
3,35,14,449 18,641Recovered
4,53,042 231Deaths
In India, there are 3,41,43,236 confirmed cases including 4,53,042 deaths. The number of active cases is 1,75,745 and 3,35,14,449 have recovered as on October 22, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,98,218 1,573

27,899 1,434

64,30,394 2,968

1,39,925 39

Kerala

48,88,523 8,733

82,093 1,240

47,79,228 9,855

27,202 118

Karnataka

29,84,849 365

9,017 86

29,37,848 443

37,984 8

Tamil Nadu

26,91,797 1,164

13,790 268

26,42,039 1,412

35,968 20

Andhra Pradesh

20,62,303 493

5,500 66

20,42,476 552

14,327 7

Uttar Pradesh

17,10,068 10

107 5

16,87,062 14

22,899 1

West Bengal

15,83,646 833

7,535 44

15,57,090 775

19,021 14

Delhi

14,39,488 22

311 1

14,14,087 21

25,090

Odisha

10,37,056 524

4,336 51

10,24,422 573

8,298 2

Chhattisgarh

10,05,773 38

206 21

9,91,995 16

13,572 1

Rajasthan

9,54,395 2

36 2

9,45,405 4

8,954

Gujarat

8,26,353 13

156 20

8,16,110 33

10,087

Madhya Pradesh

7,92,721 12

88 6

7,82,110 6

10,523

Haryana

7,71,125 9

131 2

7,60,945 11

10,049

Bihar

7,26,042 6

30 0

7,16,351 6

9,661

Telangana

6,69,739 183

3,967 1

6,61,829 183

3,943 1

Assam

6,07,811 384

3,762 152

5,98,087 228

5,962 4

Punjab

6,02,135 22

226 6

5,85,358 27

16,551 1

Jharkhand

3,48,526 40

166 24

3,43,225 16

5,135

Uttarakhand

3,43,787 14

176 0

3,36,213 14

7,398

Jammu And Kashmir

3,31,386 87

814 14

3,26,143 73

4,429

Himachal Pradesh

2,22,138 202

1,452 58

2,16,955 140

3,731 4

Goa

1,77,765 59

618 21

1,73,790 35

3,357 3

Puducherry

1,27,564 43

454 7

1,25,258 50

1,852

Manipur

1,23,051 81

1,346 14

1,19,800 94

1,905 1

Mizoram

1,15,944 737

10,034 229

1,05,510 962

400 4

Tripura

84,369 18

105 10

83,448 8

816

Meghalaya

83,210 52

735 26

81,034 76

1,441 2

Chandigarh

65,315 3

26 2

64,469 1

820

Arunachal Pradesh

55,065 22

140 2

54,645 20

280

Sikkim

31,819 19

185 10

31,241 9

393

Nagaland

31,670 11

250 5

30,743 15

677 1

Ladakh

20,896 10

43 9

20,645 1

208

Dadra And Nagar Haveli

10,678 2

4 2

10,670

4

Lakshadweep

10,365

0 0

10,314

51

Andaman And Nicobar Islands

7,646

7 0

7,510

129

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