by Ramya Kannan, Head of the Tamil Nadu state bureau for The Hindu and health reporter
For anyone who’s been in India, it would be impossible to sidestep the influence of the movie industry. It’s pernicious in its reach; the films are a part and parcel of everyday life, the stars – the aspirational ideal. It does not always work out well, this intimate connect between the people and their movies, but sometimes, just sometimes, there are substantial takeaways. Most of India actually heard of depression when Deepika Padukone, a star in her own right, wrote about her experience with that despondency that would not go away, of it having a scientific name: clinical depression.
If we were to set a rough timeline of sorts, count this at the beginning. The awareness of depression as a serious mood disorder entered the social consciousness about the time of Deepika’s bold confession. It inspired many to come forward with their own mental health issues, it spurred the recognition of depression among those battling that blue feeling day in and day out, not knowing what was bringing them down. It brought people to psychiatrists’ clinics and had them seek treatment for their conditions. After a star confession, even depression is more acceptable. This is a huge step forward, because it has been proved that clinical depression can be life-threatening, and is among the foremost causes of suicide. Everywhere there is an intervention, count that as one life saved, and then, that life made better.
Admittedly there are nooks and crannies in this country where Deepika Padukone or her depression are unheard of. Last year’s National Mental Health Survey provided empirical data to establish that one in every 20 people in India suffer from depression[1]. Look at the numbers. With a population of 1.3 billion and counting, the actual numbers would be simply mind boggling, or around 65 million. But here’s another nugget: According to the WHO, India is one of the most depressed countries in the world with 36% of Indians likely to suffer from major depression at some point in their lives[2].
Are all of them getting treatment? If we had a psychiatrist for every statistic on mental health that has come out, the country might have better mental health indicators. According to a paper on the website of the Royal College of Psychiatrists[3], there are between 3,500 and 5,000 psychiatrists in India, which translates to one psychiatrist per 200,000 to 300,000 people. Another article pegs the average national deficit of India at an estimated 77%. More than one-third of the population has more than 90% deficit of psychiatrists[4].
And it is a safe guess to say that those available are also in the urban centres. Except for a few successful attempts at tele-psychiatry to address this mental health care deficit (such as the SCARF programme[5], and the one being run by the M .S. Chellamuthu Trust in Madurai[6]), the vast section of the rural population is without significant access to facilities. The District Mental Health Programme (DMHP), wherever it is active, takes care of the towns, still leaving a vast population unreached and untouched.
Some of these populations are so remote from health care that all they can grasp at sometimes are traditional faith healers or charlatan quacks. With the limited experience of that form of ‘cure’ it is not surprising these people look at modern science with mistrust and caution. Add to that the stigma of a mental health condition, and a psychiatrist becomes a person to run from, even if by chance she or he is running towards you. A key goal of the DMHP is also to address stigma in order to promote health-seeking behaviour.
Indeed, behaviour change communication is not an overnight task. But unless the state marshals its resources to ensure adequate health care facilities and personnel are within the reach of our population, access and the recognition of depression as a mental health issue will remain a pipe dream.
Sadly, one that not even the dream factory and its stars – the Deepika Padukones and Robin Williams of the world – will be able to touch, or change.
112 is the national emergency number for India.
Samaritans Mumbai: (samaritansmumbai.com) – +91 8422984528, +91 8422984529, +91 8422984530 – 3 pm to 9 pm, all days. samaritans.helpline@gmail.com. Helpline providing emotional support for those who are stressed, distressed, depressed, or suicidal.
AASRA (http://www.aasra.info/): 91-22-27546669 is a 24-hours a day, 7 days a week nationwide voluntary, professional and confidential services.
Sneha India (http://www.snehaindia.org) is available 24/7 on the phone by calling 91 44 24640050.
References
[1]http://www.thehindu.com/news/cities/bangalore/Survey-One-in-every-20-people-is-depressed/article16081373.ece?homepage=true
[2] http://indianexpress.com/article/blogs/with-36-of-india-depressed-we-must-end-taboo-around-mental-health/
[3]http://www.rcpsych.ac.uk/discoverpsychiatry/overseasblogs/india/onepsychiatristper200,000.aspx
[4]Thirunavukarasu, M., Thirunavukarasu, P (2010). Training and National deficit of psychiatrists in India – A critical analysis. Indian J Psychiatry [serial online] 52, Suppl S3:83-8. Available from: http://www.indianjpsychiatry.org/text.asp?2010/52/7/83/69218
[5] http://www.mhinnovation.net/innovations/scarf-tele-psychiatry-puddukottai-step)
[6] http://www.msctrust.org/?s=telemedicine&submit=GO
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