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Break the silence

Tuesday, April 10, 2018

A panel discussion at Godrej India Culture Lab highlighted the need to discuss issues related to mental health, including lack of sensitivity and the stigma attached, says Menka Shivdasani

The issue of mental health is largely one that remains under wraps because people are often too embarrassed to admit that either they, or their loved ones, may need help. A panel discussion on the subject, organised by Godrej India Culture Lab on April 5, highlighted the issue, as panellists expressed concern over the lack of facilities as well as the stigma attached.

The programme, ‘Why we Need to Talk about Mental Health Now’ was moderated by psychologist Sonali Gupta. Joining her in the discussion were Ratnaboli Ray, a mental health rights activist and founder of Anjali, a mental health rights organisation; Meera Damji, host of the radio show Heart to Heart with Meera; and Nikhil Taneja, host of the upcoming podcast Work In Progress. “All of us have been in therapy,” said Sonali candidly.

Sonali pointed out that “India spends only 0.06% of its budget on mental health, less even than Bangladesh,” adding that there were only three mental health professionals for every 20,000 people, and these were to be found mainly in metros.

She mentioned that there were three issues India struggled with three issues regarding mental health care—awareness, affordability, and accessibility. Later in the conversation, Ratnaboli added two other aspects—autonomy and animators. Ratnaboli also said that while there were officially supposed to be only 5,000 psychiatrists in India, 2,500 was a more accurate number because many of those trained in India had gone abroad.

A turning point for Sonali when she was a young girl involved a visit to the Thane mental asylum when she was a student in her early 20s. “There were these huge doors and we were asked to look at the people inside as ‘projects’,” she said, referring to instructions the students received­­­ to put their interactions into case files. Faced with this new experience, Sonali found herself being afraid but an inmate, she says, noticed her fear and reassured her. “Don’t worry,” she told Sonali. “We are like you. Nothing will happen to you inside”. It was this experience that led Sonali to recognise that we are all “sorted” in different ways—“there are all shades of ‘sorted’,” she said.

Ratnaboli Ray highlighted the social issues surrounding mental health, and pointed out that the whole architecture and ethos of how people looked at mental health came from the criminal justice system. She spoke about how opportunity played a major role and that mental health needed to be looked at in an economic and social context; while people like her, who were privileged, had easy access to mental health care, what about those who were less privileged, she asked. “How do you look at the mental health of a poor Dalit woman, for instance?”

For Meera, mental health was not about being merely “happy”, but about being true to what one was feeling and letting it go. “Emotions are like clouds,” she said. “They come and go.”

Nikhil spoke about the pressures on youngsters as they were growing up, and in the age of social media where “we are all curating versions of ourselves” that may have nothing to do with the low points in our lives. He observed that social media created impossible standards for youngsters, with everyone putting up stories about how great life was for them. “No one’s talking about the things that happen between the stories,” he remarked.

People who know Nikhil on social media generally think of him as being happy but he came out and spoke about his anxiety—the time when he was in York, for the “biggest event” of his life, after being chosen from among 200 people across the world, with people like Barack Obama, Malala and Bill Gates in the audience. For three weeks before the flight, Nikhil worried about things like his baggage being lost and suits that he had spent Rs 10,000 on disappearing, leaving him with nothing to wear on the big day; he also worried that he would say something “dumb”. On the morning of the programme, he found himself unable to get out of bed for 25 minutes, and panicked about being unable to get there on time and the gates being closed. “This was the greatest day of my life,” he said, “and here I was thinking about these dumb things!”

Nikhil pointed out that we often have misplaced ideas of what it means to be happy. “Our happiness is always dependent on this one thing, or person or event,” he said. “We never think of happiness as something that comes from within.” He also observed that often men do not accept their own emotions, believing that feelings were something that only women could experience!

Pointing out that people were expected to work according to plans and goals set by others, he said, “As long as you are doing that, you’re fine.” The moment the plan didn’t work out, however, it would be considered a problem. “Life is about thinking, pausing, feeling,” he remarked. “We are constantly under the pressure of finding happiness”.  Sonali added that people usually had their own answers within them and therapy was nothing but helping people find these.

Ratnaboli highlighted the need for self-awareness and asked why it was such a big deal if people were “not okay”. Speaking of how people were always required to conform, she asked why we took on these burdens. “People will tell you that you’re fat, or that you’re a bad mother. So what?” she asked.

One of the strongest points that Ratnaboli made had to do with how essential it was to work with government authorities, who had the resources to make a difference. “Always loop them in,” she said, “Never let them go”. She spoke of how her organisation approached municipal officers in Kolkata, only to be told—“But madam, we deal with electricity, and water. What is this mental health you are talking about?” So she decided to take a different tack, and pointed out that it was issues like water and electricity that could lead to mental health problems; “if you turn off the water, the woman of the house gets anxious, and if she gets anxious, then the whole family is affected,” she said. Convincing the officers with such arguments, she managed to get a space and a phone, and now runs a mental health clinic! “The state is a very well lubricated, well-resourced entity,” she said. “It has an obligation, so make them accountable.”

Ratnaboli also gave examples of how so-called mentally unwell people were actually productive members of society; she referred to how 36 people in Bengal were running a commercial laundry, and how 12 women were running a hospital canteen.

So what can we do in our own individual spheres to help people who may have issues regarding their mental health? Responding to this question, Nikhil spoke about how he and his family were talking to the young daughter of their domestic help, who seemed to be suffering from symptoms of clinical depression. It’s the sort of thing that any of us can do within our own homes, if we are sensitive to the fact that help may be required.

The panellists also pointed out that one should not dismiss such things; as Nikhil observed, speaking of a family member, who had been clinically depressed for years, “we always thought he was just moody”.

Doctors also need to stop “pathologising everyday behaviour”, as Ratnaboli noted. “If you say you’re not sleeping, they will tell you it might be depression!” On the Godrej India Culture Lab site, she has been quoted as saying: “Access to mental health care needs to become a fundamental right. We need more medical professionals, churn more psychiatrists. Get youngsters to choose psychiatry over surgery. [In the meantime] the government [needs] to show interest in new technologies and ideas of treatment of people with mental health disorders. Community-based mental health services need to be started. We need to look at lay professionals who can implement mental health programs in village—like the free clinic movement, which was started by Sigmund Freud.

 As the panel discussion came to a close, there were many people in the packed auditorium who wanted to ask questions and raise concerns. Clearly, this is one subject that impacts many of us but no one is talking about it enough.

Mental Health Care Act
In India, the Mental Health Care Act 2017 was passed on April 7, 2017. The law was described in its opening paragraph as "An Act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfill the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto." This Act superseded the previously existing the Mental Health Act, 1987.

While it is heartening to note that there is an Act to deal with the issue, there is the larger issue of the stigma associated with mental illness, that needs to change as well.

President highlights the need for action
In November 2017, President Ram Nath Kovind had spoken of how the biggest obstacle mental health patients encountered was stigma and denial. “In India, we have a young population, with 65% of our people below the age of 35. And our society is rapidly urbanising, this leaves us staring at a possible mental health epidemic,” he had said while inaugurating the 21st World Congress of Mental Health, organised by the World Federation for Mental Health in partnership with Caring Foundation and other institutions.

At another event a few weeks later, he had expressed concern over the shortage of mental health professionals and said the gap needed to be addressed on priority.

While delivering the 22nd convocation address at NIMHANS, he had pointed out that there were just about 5,000 psychiatrists and less than 2,000 clinical psychologists in the country while nearly 10% of Indians had one or the other mental health problem.

“The number of affected in India is larger than the entire population of Japan,” he had said. “We need to address this gap and ensure that by 2022 at least those who are suffering from severe mental disorders have been diagnosed and have access to treatment facilities. Let us take it up as a national mission.”

He had also spoken of how society needed to fight the culture of stigma. “We need to talk about mental health issues and treat ailments such as depression and stress as diseases that can be cured—not as guilty secrets to be pushed under the carpet.”

He said the role of counselling services and of practices such as yoga and Vipassana meditation in helping those with mental health problems should also be explored with greater vigour.

“Access to mental health care needs to become a fundamental right. We need more medical professionals, churn more psychiatrists. Get youngsters to choose psychiatry over surgery.”
 - Ratnaboli Ray, mental health rights activist and founder of Anjali

Fact file
India spends only 0.06% of its budget on mental health, less than most other countries in the world.

While an Act is now in place, as a society we need to be more sensitive to the issues involved.

In an age of social media, it is also imperative to realise that not everything is as perfect as it seems.

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