While at the Public Health Research Institute of India (PHRII), Dr. Ramprasad Attur spoke on the topic of Mental Health in India. Dr. Ram is a child and adolescent psychiatric doctor based in southern India. He received his MBBS degree from Mysore Medical College, and DPM from NIMHANS, Bangalore. Dr. Ram trained in the UK for 6 years and obtained a membership from the Royal College of Psychiatrists. During the lecture Dr. Ram spoke briefly covering topics from ancient medicine to the modern day National Mental Health Program. Although the government of India provides medical care free of cost, mental health is a topic still growing in this country. The lecture covers the timeline of mental health break through in the last century, linking together culture and practice. As a person who works with children with mental disabilities I was interested to see how the mental health system in India has grown- along with the social stigmas the country is still facing.

 

    Ayurvedic medicine originated over 3,000 years ago in India and remains to be the country’s traditional health system (NCCIH). Ayurveda promotes the use of herbal medication along with sushuta, which are the four pillars of recovery. Because of the extensive use of herbal medicine, the CDC reports a high volume of lead poisoning. These leads to a problem in the country because, although the ancient practice of medication is highly used, it has been shown to not be effective. Dr. Ram spoke of these implications, and although India has such issues, the country as a whole has grown significantly over the years.

It was during the 2001 Erwadi tragedy in which 27 patients died that India faced a rude awakening. The country was practicing barbaric procedures such as tying up and chaining patients, which was the reason they could not escape the fire. Any person that was in need of a mental health care facility was in put in prison like home structures. The big challenge for the country was crossing various stigmas that followed the topic of mental health, along with accepting other forms of therapy other than ayurvedic medicine. For many years the act of suicide was considered a crime, if a person had a failed suicide attempt they would be taken to jail (Dr. Ram., 2017). Research today shows that communities in Maharashtra, India are reasonably accepting of individuals with mental disorders, but many negative attitudes, false beliefs and stigmas were still evident (Kermode, M., Bowen, K., Arole, S., Pathare, S., & Jorm, A., 2009). In this community there was great social distances between the person suffering from mental illness and other citizens. Those affected by psychosis were perceived as dangerous, and weak minded, those affected by depression were perceived as having family tensions. The vast majority of the community did not agree that those problems were ‘a real medical illness’ (Kermode, M. et al., 2009). Culture in India is very diverse, and stigmas of mental illness must be looked at within sociocultural context to effectively understand its origins, meanings and consequences (Ng, C., 2009).

 

    The Indian belief system holds a stigma against professionals entering the medical field as a psychiatrist (Dr. Ram., 2017). There is only 0-3 psychiatrists per 100,000 citizens, and 1 in 10 people go untreated (Dr. Ram., 2017). Although in urban areas citizens are more likely to seek mental health support, a bigger number of rural area populace have no access to mental health support. If mothers suffering from post partum depression have no access to help, in the end will affect the entire family. Children in school have limited access to guidance counselors will have a difficult time adjusting or dealing with delicate situations. In Indian culture, the female gender is assumed to be strong, no weakness physically or psychologically, because of that most women will go through difficult periods of time with no mental support (Dr. Ram., 2017). The family system in India is communal, meaning not only the father mother and child live in the home, most of the time the in laws, cousins, aunts and uncles will also live very near. Although there is a strong sense of support, the women in the family will uphold many critical responsibilities. If a communal family depends on the women to function daily, but those women are not receiving the proper mental health support they need, the entire culture surrounding the family structure is at stake.

 

    Most recently the national mental health program was enacted in which three objectives are given:

1. To ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of population.

2. To encourage application of mental health knowledge in general health care and in social development.

3. To promote community participation in the mental health services development and to stimulate efforts towards self-help in the community.

Although it is a great start, implementing these objectives in rural areas that have no access to mental health care facilities will be difficult. Availability, accessibility, affordability, and awareness are all needed to implement effective mental health care (Dr. Ram., 2017). Progress for access to mental health care in low-income areas will depend on substantially more attention to politics, leadership, planning, avocation and participation (Saraceno, B., et al. 2007).

 

    Recently I went along with PHRII to bring the mobile clinic to a neighboring village in order to give women access to HPV and cervical cancer screening. Before the women entered to see the doctor, they went through group counseling and one on one counseling. The women were all over 30 years of age and some had never had a pelvic examination even though they already had children. Because in the Indian culture women have the custom of not seeking medical help in terms of their bodies, their psyche is also severally affected. One specific patient came to me after she was finished and squeezed my cheeks, whispered thank you, and cried quiet tears. I asked one of the staff if it was common for these women to cry and I was informed that yes, most of these women are weak in those terms and get emotionally disturbed. It’s important to bring mental health counseling to light, because the body and the mind work together. If these women are physically sick, but do not have the mental strength to seek help, they wont. On the other hand if they are physically okay but are suffering from depression and anxiety, they will not link those mental instabilities as significant. Proper counseling is also given to these women once the result of the screening comes in. Medical professionals need the support of mental health counselors in the field in order to strengthen and support these women in order for them to break the barriers and receive proper medical attention.

 

Works Cited:

 

Araujo, J., Beelen, A. P., Lewis, L. D., Robinson, G. G., DeLaurier, C., Carbajal, M., ...    & Saper, R. B. (2004). Lead poisoning associated with Ayurvedic medications— five states, 2000-2003. MMWR. Morbidity and mortality weekly report, 53(26),      582.

 

Kermode, M., Bowen, K., Arole, S., Pathare, S., & Jorm, A. F. (2009). Attitudes to          people with mental disorders: a mental health literacy survey in a rural area of     Maharashtra, India. Social psychiatry and psychiatric epidemiology, 44(12),            1087-1096.

​

National Mental Health Programme. (2015, April 6). Retrieved June 3, 2017, from            https://www.nhp.gov.in/national-mental-health-programme_pg

 

​Ng, C. H. (1997). The stigma of mental illness in Asian cultures. Australian and New         Zealand Journal of Psychiatry, 31(3), 382-390.

​

​Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., ... &      Underhill, C. (2007). Barriers to improvement of mental health services in low-           income and middle-income countries. The Lancet, 370(9593), 1164-1174.