Very few trained psychiatrists in India: Dr Kersi Chavda, a senior psychiatrist, says, “There is a lack of mental health facilities not just in Mumbai but other parts of the country as well. In our country there are around five to seven thousand psychiatrists, whereas, when it comes to cardiologists, there are as many, in just Mumbai city alone.”
The shame and stigma associated with mental illness, still looms large, say experts. Clinical psychologist Seema Hingorrany, reiterates, “Fundamental resources for handling mental health facilities are lacking big time here. In the entire country, only a handful of psychologists, are trained and researching on severe trauma cases.”
Dr Chavda explains, “An anxiety-ridden or a depressed patient, is usually given tips like, ‘snap out of it’, ‘go for a movie and you will be fine’, or ‘just cheer up’, without realising that these are diseases and they need treatment from qualified doctors.”
Insufficient infrastructure: Experts state that there is a paucity of not just hospitals, but of doctors as well. Most government hospitals have relegated their worst wards with the fewest beds to mental illnesses.
Senior psychiatrist Dr Harish Shetty says, “There is a hospital in Mumbai that has its mental illness ward in the most neglected area — near the morgue. The same hospital has, over the years, built many new buildings and wards, but the number of beds for mentally ill patients has not been increased, nor have the facilities improved. The BMC is kind towards all illnesses except this.”
There has been large social stigma attached to a mentally ill patient in the past, it has reduced over the years, but not significantly. Even now there is a certain hesitation on the part of a family to admit openly that their family member is visiting a therapist. Dr Chavda says, “There are non-voluntary patients (patients who say they are fine but people around them say that they are mentally ill) who cannot be admitted to hospitals here because of the Mental Health Act.”
No insurance for mentally ill: This happens to be one of the sad truths — insurance companies do not provide medical insurance to people who are admitted in hospitals with mental illnesses, says Dr Chavda. He adds, “Admission to a good hospital is out of reach for some because of this. It is sad that a patient in an ICU is billed a few lakhs but there is no insurance just because it is mental illness.”
Treatment of mental illness: Psychologist Varkha Chulani says, “Treatment of a mental illness depends on why it has occurred. Is it chemically caused? Or is it attitudinally caused? If it’s chemical, medication is required and if need be ECTs too. And if it’s attitudinal, then intensive psychotherapy is needed.”
Cost of care for mentally ill patients is on the rise. Dr Shetty says that the government hospitals in the city do not have medicines for mentally ill patients who are poor, and they have to pay a lot in private hospitals.
People use words like ‘mad’, ‘asylum’, carelessly: The term mental illness has been sold very poorly, says Varkha. “People are labelled crazy, screwed up, mad, bonkers, etc if they seek help. The connotation is so negative when you say you need help, that, people are ashamed to admit it to themselves or their families that they are not in a good place,” she says.
Terms like pagal and asylum are carelessly used due to old conditioning deeply ingrained in people since generations, says Seema. “Sometimes, it is depression or obsessive thoughts, but people exaggerate the symptoms and bracket the person as ‘insane’ which is sad. A mental asylum is only for chronic cases. I think rehabilitation facilities is a better word,” Seema adds.
Suicide is criminal act; not enough helplines: In our country, suicide is a criminal act, it is a police case. Dr Chavda says, “We still have to realise that a person who commits suicide is not a criminal rather, a patient who needs help.”
According to National Crime Records Bureau report 2013, Maharashtra has one of the highest suicide rates, however, there are not enough helplines, states Dr Shetty. “Three to four people commit suicide everyday in Mumbai, yet, there are not philanthropic activities and no steps to prevent this,” he says.
No rehabilitation facilities: When it comes to mental health, the rehabilitation period is important, it is the period between recovery and reintegration. But unfortunately, that is absent here, say experts.
Mentally ill people are discriminated in jobs: Once a person has been branded as mentally ill, he/she faces difficulties in the job market. “People are thrown out of jobs if they are mentally ill,” says Dr Shetty.
Mental health is important: Mental health is about being able, fit and in balance and it is not about being crazy. Varkha reasons, “Only fat people do not visit gyms, rather, people who wish to stay fit, do. If I want to be healthier, I diet and eat well. Similarly, if I want to be alert, cope with challenges of life, get along easily with people, I should seek professional help.”
Psychiatrists are not recognised: “It is sad that though many psychiatrists have treated ministers and done well in their jobs, one does not find any of them being awarded with a Padma Bhushan,” says Dr Shetty.
Common mental illnesses in the city: In Mumbai, mental illnesses range from psychosis — which is chemical imbalances in the body — to neurosis — which is poor attitudinal learning due to poor training in growing years compounded by silly ideas propagated by society at large, says Varkha. “So, a good clinician needs to distinguish between the two. Everyone does not need medication. And not everyone will only benefit from therapy. Anxiety, depression, jealousy, anger and guilt are some common emotions that are lasting so long that they are becoming chronic and leading to illness,” she adds.