EDITORIAL

Mental health awareness: The Indian scenario

M ental health is a major concern worldwide and India community‑based systems in low‑income countries and has
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is not far behind in sharing this. If we evaluate also yielded positive results in creating awareness, thereby
developments in the field of mental health, the pace appears impacting participation.[7]
to be slow. Dr. Brock Chisholm, the first Director‑General
of the World Health Organization (WHO), in 1954, had Awareness and health literacy are two sides of the same
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presciently declared that “without mental health there can coin. Stigma and discrimination are negative consequences
be no true physical health.”[1] More than 60 years later, the of ignorance and misinformation.[8] There are a few
scenario has not altered substantially. About 14% of the studies which have measured mental health literacy in the
global burden of disease is attributed to neuropsychiatric Indian context. One study found mental health literacy
disorders. The burden of mental disorders is likely to have among adolescents to be very low, i.e. depression was
been underestimated because of inadequate appreciation identified by 29.04% and schizophrenia/psychosis was
of the inter‑play between mental illness and other recognized only by 1.31%. Stigma was noted to be present
health disorders.[2] There remain considerable issues of in help‑seeking.[9]
priority‑setting based on the burden of health problems
and of addressing inequalities in relation to determinants These findings reinforce the need to increase awareness
and solutions for health problems. of mental health. Mental health literacy is a related
concept which is increasingly seen as an important
Progress in mental health service delivery has been slow in measure of the awareness and knowledge of mental health
most low‑ and middle‑income countries. Barriers include disorders. Health literacy has been described as “ability to
the existing public‑health priorities and its influence on access, understand, and use the information to promote
funding; challenges to delivery of mental health care in and maintain good health.”[10] Mental health literacy
primary‑care settings; the low numbers of those trained encompasses recognition, causes, self‑help, facilitation of
in mental health care; and the lack of mental health professional intervention, and navigating the information
perspective in public‑health leadership.[3] There have been highway [Table 1]. Attitudes which hinder recognition
numerous calls for invoking political will, for enhancing and appropriate help‑seeking can be counter‑acted by
advocacy and for galvanizing community participation; all information which is already readily available in the public
with scant improvement in outcomes. domain. There are plenty of examples of awareness
positively impacting mental health outcomes like the
Thus, it becomes now opportune to explore the paradigm Norwegian campaign to reduce the duration of untreated
of mental health awareness as a means of combating psychosis.[11]
stigma, enhancing prevention, ensuring early recognition,
and also stimulating simple and practical interventions Table 1: Components of mental health literacy:
within the community. Today there are opportunities in Jorm[12]
terms of growing acknowledgement of mental disorders as
key targets of global health action, as well as of leveraging
new technologies particularly internet, big data and cell Knowledge of how to seek mental
health information
phones in amplifying simple field interventions found
successful in primary care and other echelons. Attitudes that facilitate recognition
and help-seeking

Knowledge and beliefs about

MENTAL HEALTH AWARENESS professional help

Knowledge and beliefs about

self-help
Mental health awareness campaigns have yielded positive
outcomes. Some of the strategies undertaken to target Knowledge and beliefs about
causes
awareness and address stigma around mental illness
Ability to recognise psychological
include participation by family members, sensitization to distress
treatment and social inclusion.[4,5] Lack of knowledge about
the mental illnesses poses a challenge to the mental health
care delivery system.[6] Research has highlighted the role of

131 © 2017 Industrial Psychiatry Journal | Published by Wolters Kluwer - Medknow

 Srivastava, et al.: Mental health awareness

The impact of stigma has led to the institution of various awareness contributions shall flow from the following six
programs worldwide to challenge the stereotypes and platforms [Figure 1].
discrimination that generate social disability. Mental health
awareness programs have had favorable impact and can Conventional media
produce positive change in people’s views of mental Media has been the cornerstone of the previous action
illnesses. However, more robust evaluations are needed to in the field of mental health awareness. Celebrity
assess the long‑term impact of approaches to increasing endorsements, like the recent one by actress Deepika
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mental health literacy worldwide.[13] Padukone who shared her experience of depression,
together with succinct tag‑lines of advertisements and
content‑rich narrations and documentaries; have been the
INDIAN SCENARIO mainstay of media drives so far.
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The WHO has defined sustainable development goals and Making evidence‑based mental health information easily
elaborated the impact of mental illnesses and suicide on available to journalists and other content providers like
them. The suicide rate in India in 2015 at 15.7/100,000 internet portals from trusted and reliable sources like
is higher than the regional average of 12.9 and the global Indian Psychiatry Society, research organizations, medical
average of 10.6.[14] Suicide is the leading cause of death colleges, etc., through their websites is a relatively simple
among those aged 15–29 in India.[15] There remains a step. Accessibility of simply translated jargon‑free content
massive unaddressed need within the population. in various regional languages in written and spoken forms
will go a long way. It also behoves professionals in the
The treatment gap, as measured by the absolute difference mental health domain to take the lead in engaging and
between the prevalence of mental illnesses and the partnering with the media. Encouraging recovered patients
treated proportion, has been found to be 76%–85% in to make their success stories accessible to all shall make
less‑developed countries.[16] One of the major reasons good the paucity of authentic narratives.
attributed to such a wide treatment gap is the problem
of inadequate resources. In India, inadequacy exists Government programs
in infrastructure as well as in human resources. [17] Despite some caviling about the quantum, the government
Despite improvements in various health indicators, India remains the biggest single spender in the mental health
contributes disproportionately to the global burden sector. While most new interventions remain isolated and
of disease. Our health indicators compare unfavorably confined to urban areas, it is only the public health system
with other middle‑income countries and India’s regional through large programs which can reach the rural masses.
neighbors. A large proportion of the population ends up
impoverished because of high out‑of‑pocket health‑care
expenditures and suffers the adverse consequences of
Conventional
the poor quality of care.[18] Task‑shifting to nonspecialist Media
community health workers has been recommended as an
effective strategy for delivery of efficacious treatments in
low‑resource settings.[19] Given the dire shortage in numbers
Govt
of psychiatrists, psychologists, psychiatric nurses, and Internet, Social
media etc. Programs
social workers; piggy‑backing on primary care systems and
employing innovative force‑multipliers are future courses
of action.
Mental Health
Awareness
ROADMAP FOR MENTAL HEALTH AWARENESS

For the large Indian population to be involved in its own

mental health, the only way forward is through enhancing Crowd-sourcing
Industry

mental health awareness which will generate its own

demand. With rising awareness, it can be expected that
early recognition and access to treatment will follow, as
will the adoption of preventive measures. It can also be Educational
System
expected that with enlarging awareness in a democratic
society, advocacy, leveraging of political will, funding, and
cross‑synergies shall follow. It is envisaged that bulk of the Figure 1: Model for mental health awareness

Industrial Psychiatry Journal ■ Volume 25 | Issue 2 | July-December 2016 132

 Srivastava, et al.: Mental health awareness

Apart from the National and District Mental Health the way of ending this apathy. Progressive government
Programs, the National Rural Health Mission is on its policies based on evidence‑based approaches, an engaged
way to becoming the vehicle for delivering mental health media, a vibrant educational system, a responsive industry,
as a part of integrated primary care at the cutting edge aggressive utilization of newer technologies and creative
of the public healthcare system. Seeing that it partners crowd‑sourcing might together help dispel the blight of
with existing private and alternative care providers in a mental illnesses.
nonthreatening manner, shall help such large interventions
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synergize and succeed. Kalpana Srivastava, Kaushik Chatterjee, Pookala

Shivaram Bhat
Educational system
Department of Psychiatry, AFMC, Pune, Maharashtra, India
Most chronic and debilitating mental illnesses have their
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onset before 24 years of age when most are a part of Address for correspondence:
the educational system. From including mental health Dr. Kalpana Srivastava,
narratives in curricula toward, de‑stigmatization, removing Department of Psychiatry, AFMC, Pune, Maharashtra, India.
E‑mail: [email protected]
discrimination and early detection, to empowering
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