Understanding the basics of mental health & suicides

Mental Illness often goes unreported due to stigma attached to it. While it is not limited to depression, the health check-ups include prelim screening



About Author: Dr Achal Bhagat is Senior Consultant, Psychiatry and Clinical Psychology at Indraprastha Apollo Hospitals, New Delhi.

Mental Health is not just an absence of mental illness. Mental Health implies a positive sense of well-being that enables

  • A person to be able to live their life with dignity,
  • Participate in decisions regarding their own life and solve their problems
  • Perform activities in all areas of their life,
  • Interact with and be a part of their families and communities
  • Live a life with purpose.

This subjective sense of well-being is possible when a person is able to think and feel in a manner that helps one accept and balance one’s strengths and limitations.

A positive sense of well-being also derives from a person being able to respond to their experiences in a manner that they have a sense of control over their life and a sense of togetherness and belonging.

Mental Health is a universal need

WHO has recently proposed that mental health is: … a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO 2001a, p.1).

Since its inception, WHO has included mental well-being in the definition of health. WHO defines health as: … a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO 2001, p.1).

Mental, physical, and social functioning is interdependent. Furthermore, health and illness may co-exist. While every one has mental health needs many people live with mental disorders or illnesses. It is important to recognise the universality of mental health needs. If every one has mental health needs then it is not out of ordinary for some to have mental illnesses. Recognition of mental health needs decreases the stigma for mental illness.

There are nearly two hundred types of mental illnesses. The key feature of mental illness is a disorder of mental functioning. It means that one or more processes of brain are disordered. These processes include:

  • Behaviour
  • Thoughts
  • Mood
  • Perception
  • Cognitive functions (attention, memory, judgment, learning and understanding, problem solving, forming concepts etc.)
  • Insight

Most of these impairments of mental functioning are presented as behavioural difficulties and difficulties in social functioning. There are broadly six categories of disorders of mental functioning:

“Organic” Disorders: These are disorders where the cognitive functions are more likely to be affected. There may be a structural change in the brain. There may be a metabolic change in the body that leads to a disordered mental functioning or there may be primarily a physical illness causing the disorder of mental functioning.

Substance Abuse Disorders: These are disorders include addiction to substances like Alcohol, Cannabis, Opiates and Stimulants.

Major Psychiatric Disorders: These are disorders of thoughts, perception, and mood. Many a time these disorders there may be a loss of contact with reality. These disorders may need to a gradual deterioration of personality and functioning. These disorders may run a long course or may be prone to repeated episodes. These disorders cause significant distress, disorganization and dysfunction.

Minor Psychiatric Disorders: These disorders are common. These include unreasonable worry, repetitive doubt and indecision, persistent low mood, pre-occupation with physical symptoms. More often than not the ability to care for oneself or other aspects of functioning are relatively preserved. There is distress but no loss of insight.

There is a myth in India that somehow due to cultural factors the number of people with mental illness is less than other populations and even when people have mental illness it is thought that people with mental illness are somehow more accepted and due to the family support do not need as many resources and systems for rehabilitation. Nothing could be further from truth. A recent review of epidemiological studies of mental illness in India concluded that it would safe to say that at least six percent of the population lives with psychiatric disorders.

Disability-Adjusted Life Years (DALYs) are the sum of the number of years lost due to premature death and the years of life lived with a disability. The DALYs due to neuropsychiatric disorders in India are significantly high and are higher than disability adjusted life years contributed to by cardiovascular illness, cancer, tuberculosis and diabetes.

About half the disability-adjusted life years are contributed to by health conditions and out of these nearly fifty percent are caused by neuropsychiatric disorders. The commonest cause of disability amongst psychiatric disorders is Unipolar Depression followed by Bipolar Affective disorder and Schizophrenia. Even the common mental disorders like Generalized Anxiety and Obsessive Compulsive Disorder cause significant loss of life years due to disability.

Suicides are common in India

 Suicides are very common in India even though these are under reported. There is stigma around reporting of suicide and there is also a law that criminalizes the attempt to suicide. There is a rising incidence of suicides in India. The causes of suicide are multifactorial. The way the suicides are documented, the social causes of suicide are more likely to be documented. The possible mental health correlates and impacts are ignored and mental health diagnosis as the contributory cause of suicide is not recorded.

Mental Health Financing: The financial resources for mental health are extremely limited in India. The percentage of mental health to general health budgets is less than 0.5%. There is no parity even though the impact of mental illness is substantive. Presently, no insurance is available for mental health services.

Mental Health Resources: The current mental health resources in terms of psychiatric beds are abysmally low and with in that too most of the beds are available in mental hospitals. General Hospital Psychiatric beds are low and are limited to Medical Colleges. District level Hospitals do not have any or have minimal number of psychiatric beds. India has a total of around 20,000 beds for mental illness. The country hopes to reach its vast population through a District Mental health Program. The DMHP is only available in 123 districts at present. Even in these Districts the treatment gap is as high as 90%. The country has around 4000 psychiatrists. The numbers of clinical psychologists and psychiatric nurses and social workers is in hundreds and again limited to cities.

Screening for Mental Health Problems: The vision should be “No health without mental health.” It is important to focus on increasing awareness for mental health problems and look at screening in specific organized populations. For example a school going children would benefit from life skills program which specifically focus on managing mental health. All corporates who subscribe to wellness programs should have significant mental health component if wellness has to be achieved. Waiting room screening for all patients attending a general hospital for physical problems will yield an early diagnosis of Depression or Anxiety or Substance Use for at least 40 per cent of the people screened.