Large Treatment Gap in the World of Mental Health in India

Breakdown of the types of diagnosed mental disorders in India.

Breakdown of the types of diagnosed mental disorders in India.

The public health field visit of the week was to the Asare, which is a home for mentally challenged citizens.  Overall, I thought the visit gave me a better picture of how mental illnesses are regarded and handled in India.  Before going to this field visit I did some research on mental illness and treatment in India to give me a greater understanding of this field of health in this country, as it seems to be very different than in the US based on observations I have made thus far during my semester here.

Recently, the improvement in the health status of the population has been one of the major goals for social development in the country; however, only a small percentage of the total annual budget is spent on health.  Furthermore, of this small percentage there is no separate budget for mental health and therefore, mental health services are extremely under-financed   Looking at statics, there is estimated to be a 50% treatment gap in severe mental disorders and there is a 90% treatment gap in the case of common mental disorders.  These statistics point out the urgent need for increased budget allocation and trained personnel to the field of assessment and treatment of those suffering from mental disorders. Out of the 1.25 billion people living in India, close to 70 million (~6%) are suffering from some form of mental disorders, whether common or severe.  Dispersed throughout the country are merely 43 state-run mental institutions and there are approximately 290 departments of psychiatry in medical colleges throughout India.

People protesting against the provision of involuntary admission in the proposed Mental Health Care Bill. (New Delhi, NYtimes photo)

People protesting against the provision of involuntary admission in the proposed Mental Health Care Bill. (New Delhi, NYtimes photo)

The main objective of the Asare that we visited was the promotion of the general welfare of the mentally challenged individuals in the Udupi district regardless of their type of disability, caste, religion, race, or socioeconomic status. The patients are provided the benefits of care and treatment by the supportive staff of 10 qualified individuals, 3 being special education teachers and the rest being physical therapists and caretakers.  The occupational therapy students of Manipal University provide additional support to the 32 current residents of this Asare.  A typical day for a patient involves waking up around 5:30am where he or she will have breakfast and take any necessary medications and will then attend classes in which placement is based on his or her IQ.  There is a break for lunch and then time for social interactions with the other patients, staff, and volunteers.  Vocational training is also provided to individuals who are capable of completing assigned projects.

I was impressed when they stated that no individual was turned away from the services provided at the Asare.  However, upon learning that each person was required to pay, at minimum excluding medication costs, 6000 rupees (~$120) per month I became concerned about how universally accessible this type of service was to every individual in need.  Due to the lack of monetary funds, the government provides no financial assistance to these types of institutions and people who cannot afford the steep costs must rely on external sponsors.

Altogether I am glad I had the opportunity to visit a facility dedicated to the care of mentally challenged individuals.  Though I have not had much experience in the US with institutions such as this, I was able to pick up on some very distinct differences in the ways in which mentally handicapped individuals were regarded.  The title of an article I read seems to encapsulate the main difference where “Mental illness is still a taboo in India”, whereas it is more openly talked about and accepted in the US. In India, the same attitudes that keep many people from visiting a psychiatrist may also keep many people from becoming one. There are only about 3,500 psychiatrists in India for 1.2 billion people. Schools are increasingly outputting engineers and doctors, but psychiatrists remain continuously underrepresented.  I appreciated the opportunity to see a small glimpse of the mental health situation in India.

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