Addressing rural mental health necessary for healthy India

While the conversation on mental health has entered mainstream discourses to an extent, the urban-rural divide continues to plague it. According to the World Health Organisation (WHO), out of the 20 percent of the country's population who suffer from mental illness, only 12 per cent at most seek aid for their mental health concerns, and those who do are more likely to be located in urban areas and ensconced in socioeconomic privilege. A lack of timely access to psychiatric care can inevitably prove harmful to individual and communal health and the same needs to be provided to people in non-urban constituencies. The need of the hour, thus, is to skew our conversations towards mental health in rural India.

In general, India needs to bolster its psychiatric support system. The 2015-16 National Mental Health Survey revealed that the number of psychiatrists in the country varied from 0.05 for every 100,000 persons in Madhya Pradesh (central India) to 1.2 in south-eastern Kerala, with the latter being the only state in the country meeting WHO's requirement of 1 psychiatrist per 100,000 persons. In such a circumstance, the provision of mental healthcare itself becomes a rare commodity. The problem becomes compounded in rural India with an acute lack of resources, lack of awareness and stigma against mental disorders. "In many of the villages we work in, people consult faith healers for epileptic attacks," The Hindu quotes Amul Joshi, Country Director of the MINDS Foundation, an international organisation based in the United States that works primarily in the western Indian state of Gujarat. At the same time, there is next to no reportage of mental health problems in rural India in the absence of skilled professionals, good reporting standards and centers for treatment. The need for reportage was spelled out in a 2014 pilot project by The George Institute of Global Health in the tribal belts of Andhra Pradesh, where it found that contrary to the popular notion that mostly city dwellers suffer from mental illness, there is a significant burden of mental illness in rural and tribal belts. The report emphasised that it must be understood that mental illness is closely linked to socio-economic and demographic factors - it strikes the marginalised sections of society, especially women and those who do not identify with heteronormative genders, those who are poor and those from lower caste. Particularly common disorders such as depression and anxiety are linked to socio-environmental factors such as these.

Clearly, there is a need for more health infrastructural development, greater budgetary allocation towards mental well-being in rural areas, campaigns to spread awareness, employment of medical professionals and making treatment accessible in these locations. Exhorting governments to take steps in these directions is thus, most necessary. However, mere presence of psychiatric help would not enable patients to access it on time. A 2017 study published in the International Journal of Social Psychiatry found that while families in urban areas had significantly higher levels of education and greater income than their rural counterparts, there was no difference in urban and rural patients in the duration of untreated illness and no correlation between average years of education of the family members and the duration of untreated illness. Therefore, the larger evil that we must counter is the cultural prohibition against diagnosis, acknowledgment and treatment of psychoses. The stigmatisation of mental health disorders has to be countered.

Rural India however springs up a most unique opportunity for the same. Tightly knit rural communities provide avenues for reaching out to individuals in a most intimate and personal ways and if scientific treatment and rural communitarian care are combined, India can go a long way in consolidating the well-being of its citizens. This calls for increased collaboration between urbanised health centers and authorities and rural communities, where heads of Panchayats and local leaders can effectively gear people towards recognizing mental distress and seeking adequate help. Accredited Social Health Activists or ASHA workers can be instrumental in this regard and training them to deal with cases of mental disorders and using technology to create the needed linkages between the suffering and the healers could be efficacious.

On the whole, to make India a healthier, stronger country, all sides of the Indian spectrum must be covered and ensuring mental well-being for all is most necessary for the same. It is to be understood that our communities, coupled with our scientific advances can lay the foundation for defeating the mass scale of mental health problems and rural India can emerge victorious after fighting this significant battle.

(The author is Founder Upsurge Global and President SAHE (Society for Advancement of Human Endeavour)