Stop mental health from becoming an epidemic: Arvind Passey

A short conversation about mental health.

The biggest and the most formidable asset for any country is neither its geography nor its history. No, it isn’t GDP as well. The history, geography, economics, politics, and everything else that matters remains at best a sub-set of people who reside in a country. It is people who build and maintain this corpus of power. Quite obviously, their mental health is what can undo every good work that everyone from politicians to bureaucrats and from professionals to its skilled workforce painstakingly construct. The unskilled and those who stay at home and do what must be done are equally vital when any discussion on mental health is approached. In short, the attack of mental oscillations includes everyone with no barriers to age, gender, beliefs and economic status.

William Styron, author of ‘Darkness Visible: A Memoir of Madness’ writes that ‘the pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne. The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.’ What is playing with the mind are undefined chunks of ‘emotional abuse, the insults, insinuations, criticism, and accusations slowly eat away at the victim’s self-esteem until he or she is incapable of judging a situation realistically’, to quote Beverly Engel, and the final outcome is that the victim generally begin to blame themselves for what the world perceives as abuse.

Statistics say it all

Studies point out that serious mental disorder doesn’t differentiate much between the urban and rural divide and isn’t ever bothered about age, gender or economic differences. One WHO study reports ‘at least 6.5 percent of the Indian population’ being more than threatened. The appalling part of this study is that it reported an extreme shortage of mental health workers and the ratio was as low as ‘one in 100,000 people’ in 2014. As a result of this, we in India we have a high suicide rate that is 10.9 for every 100,000 and a majority of these are reported from the less than 44 years of age group.

A report published in IndianPsychiatry.org mentions nearly 50 million Indian children suffering from mental disorders and this is just one part of the entire statistical data. The same report states that major illnesses affecting both kids and adults, include depressive disorders, agoraphobia, disabilities affecting intellectual status, autism spectrum disorders, psychotic disorders, anxiety disorders, depression, schizophrenia, substance abuse, and seizure disorders.

An article published in Economic Times mentions that ‘42.5% of the employees in the private sector of corporate India suffer from depression or some form anxiety disorder. That’s almost every second person. Studies indicate that two-thirds of people who have suffered from depression face prejudice at work or while applying for new jobs. The World Health Organization estimates that India will suffer economic losses amounting to a staggering 1.03 trillion dollars from mental health conditions between 2012 and 2030.’

If you think that our politicians are not aware of this, think again. Ram Nath Kovind, the President of India has talked about the ‘mental health epidemic’ and said that ‘our National Mental Health Survey, 2016 found that close to 14 percent of India’s population required active mental health interventions. About two percent suffered from severe mental disorders’. However, there is still a severe lack of nationwide data which means that mental health issues need to be taken on a war footing. This is the only way work on viable solutions will be possible. It is obvious that solutions include the availability of medications as well as professionals trained to address these issues.

What is more serious is that studies point out the use of damning terminology like ‘stigma’, ‘retard’, and ‘mad’ and the overwhelming dominance of an unfounded prejudice among nearly 71 percent of Indians. One of the contributing factors could be a woeful absence of professionals to deal with mental health issues. A report published in one of the dailies says that ‘mental health workforce in India (per 100,000 population) include psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07)’.

What do these statistics mean?

Imagine 57 million individuals in India going about their daily work without even knowing how to deal with their ‘depression’. They do not know if it is some maverick biochemical imbalance causing their trauma or if it is related to their income not matching their ambitions or just the fact that one of their loved ones is being missed. This is reason enough to believe that trained psychiatric staff is the need of the hour as most of these cases need customized solutions and answers.

Another shocking revelation that stats point out is that by 2020 around 70 percent of the world’s population aged sixty and above will be living in developing countries and 14.2 percent of them in India. This brings in issues related to loneliness and the utter lack of professional care for the elderly.

We’ve already been reading about farmer suicides in the country and this is yet another serious issue related to mental health. More than 36,000 farmer suicides happened between 2014 and 2016. Talking of suicides, one must mention that the rate is fairly high even amongst students in India and this crisis is projected to become the biggest in the world by 2025. Are we prepared for all these issues?
All these add up to a sheer loss of productive involvement and if we are planning to be a force in the economic strata we must understand that mental health conditions are the second biggest cause of absences from work and a study pointed out that in the UK this led to a loss of 15.4 million work days annually. By the way, if figures from other countries matter, the estimated cost to the global economy due to depression and anxiety is US$ 1 trillion per year in lost productivity. The answer to every issue dealing with mental health lies in not just changes in laws and regulations but also in the way each of us responds to those around us who have been touched by any of the issues mentioned.

There are a number of people who believe that it is the therapist who matters but then there are others who may try to discover any of the myriad other solutions. I know of people who find solace and comfort in long heart-to-heart conversations and all they need is a listener. This may sound a bit frivolous but if going out to have a pint or two of a tippler soothes the brain, go for it.

Make sense out of the chaos

Glenn Close writes that mental health needs ‘more sunlight, more candor, and more unashamed conversation’. The truth is that simply because a lot of people do not understand the right perspective, the journey within tends to get murkier until only darkness prevails. It is thus paramount that people talk about their feelings to make them less upsetting and less scary. let me add here that the hashtag with two simple sounding words #MeToo were as much about a form of protest as they were about dealing with a continually overwhelming struggle to persist and survive.

All those in the throes of debilitating mental health terror must stand up and assert their needs, diffuse arguments and conflicts, and protect themselves as well as others from behavior that hurts and traumatizes. This is done better if one is surrounded by others who have equipped themselves with a better understanding of the issues that are at play. Yes, reading helps. So does the right consultation. I have known a lot of people who were living with guilt, besieged by hostile behavior, subjected to unhealthy criticism, and were drowning in low self-esteem. These are the ones who need to feel good every day and must be slowly brought back to a position where they are able to bounce out of their universe of negativity. Friends and family of those who have problems dealing with mental issues must proactively learn to be great listeners, be ready to assess the worsening situation and intervene with compassion. Someone rightly remarked that when voices in the head become your enemy, the pain that emanates can lead to anger, misery, and sometimes, even suicidal tendencies. We are talking of people who need to exchange the voices in their head with real-time conversations with real people. Conversations directed towards them are one form of comfort that such people seek without actually asking or demanding them. Such friendly interventions happen spontaneously when people are well-read. So yes, reading helps.

Reading helps

One of the correct things to do, besides consulting a professional and besides browsing the net to read up on relevant issues bordering mental health and how to cope with it, is to read books. Reading clarifies and removes cobwebs of misunderstood notions and helps a person deal with issues in a pragmatic way. Those who suffer need people around them who are well read. A few books recommended by some of the experts that I talked to are listed here:
‘Side Effects of Living: An Anthology of Voices on Mental Health’ by Jhilmil Breckenridge and Namarita Kathait.

‘ABC of Mental Health’ by Rachana Awatramani.

‘Feeling Good: The New Mood Therapy’ by David D Burns.

‘Understanding Mental Illness’ by Atul Kakar, Nundy M Chir, and Samiran

‘Think Like a Monk’ by Jay Shetty.

‘I Hate You – Don’t Leave Me: Understanding the Borderline Personality’ by Jerold J Kreisman and Hal Straus.

‘Stop Walking On Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder’ by Kreger Randy and Paul T Mason.

‘Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy’ by Blaise Aguirre.

‘Let Him Not Sink - The First Steps to Mental Health: A Manual for Adults Who Work Closely with Children and Adolescents’ by Samir Parikh and Kamna Chhibber.

‘Shhh! Don’t Talk about Mental Health: Why Being Quiet Is No Longer an Option’ by Arjun Gupta.

There is hope even when the brain says NO

There is no standard normal. There can be as many ‘normal’ as there are people on this planet. Same is the case with brains that have decided to not to remain normal. What this means is that there are no set answers or solutions to mental health that needs intervention. Only one thing is certain… there is hope even when the brain says NO.