UPSC MAINS 2019: Importance of Mental Health

Importance of Mental Health

 

Topic: Importance of Mental Health

 

Importance of Mental Health

What is mental health?

Health is important for development of the country. World health Organization (WHO) defines health as “a state of physical, mental, social and spiritual well-being and not merely the absence of disease or infirmity”. 

WHO defines mental health as mental well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community?  In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.

 

Mental health has impact on

  • Educational out come
  • Productivity at work
  • Development of Positive personal relationships
  • Crime rate
  • Alcohol & drug abuse

 

Why is mental health important?

More than 450 million people suffer from mental disorders.  According to WHO, by the year 2020, depression will constitute the second largest disease burden worldwide (Murray & Lopez, 1996).  Global burden of mental health will be well beyond the treatment capacities of developed and developing countries.

  • Physical health and mental health are closely associated and it is proved beyond doubt that depression leads to heart and vascular diseases
  • Mental disorders also affect persons health behaviour like eating sensibly, regular exercise, adequate sleep, engaging in safe sexual practices, alcohol and tobacco use, adhering to medical therapies thus increasing the risk of physical illness.
  • Mental ill health also leads to social problems like unemployment, broken families, poverty, drug abuse and related crime.
  • Poor mental health plays a significant role in diminished immune functioning.
  • Medically ill patients with depression have worse outcome than those without.
  • Chronic illnesses like diabetes, cancer, heart disease increases the risk of depression.

 

What are the difficulties in implementation of mental health programmes?

  • Stigma is associated with mental illness and patients are discriminated in the society in all aspects like education, employment, marriage etc, which leads to delay in seeking medical advice.
  • Vagueness in concepts of mental health and illness, with lack of definitive signs and symptoms which result in diagnostic confusion.
  • People feel that mental illnesses occur in those who are mentally weak or due to spirits
  • Many people are in the opinion that mental illness is irreversible that lead to therapeutic nihilism.
  • Many people believe that preventive measures are unlikely to succeed.
  • Many people believe that drugs used to treat mental illness may cause many side effects and leads to addiction. They feel that these drugs merely induce sleeping.
  • Data collected by WHO demonstrated that there is large gap between burden caused by mental health problems and the resources available in countries to prevent and treat them.
  • In most parts of the world, the treatment of mental illness was alienated from rest of medicine and health care until recently.
  • Psychiatric patients and their families fail to act like pressure groups as they are reluctant to come together because of severe social stigma and lack of knowledge about their rights.
  • Even Non-Governmental Organizations (NGOs) consider this as a difficult field as it needs long term commitment and they are scared to deal with mentally handicapped.

 

What causes mental illness?

 

Biological factors

  • Neuro transmitters: Mental illnesses have been linked to an abnormal balance of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other.
  • Genetics (heredity): Many mental illnesses run in families, suggesting that people who have a family member with a mental illness are more likely to develop a mental illness. Susceptibility is passed on in families through genes.
  • Infections: Certain infections have been linked to brain damage and the development of mental illness or the worsening of its symptoms
  • Brain defects or injury: Defects in or injury to certain areas of the brain has also been linked to some mental illnesses

 

WHO response to Mental Health:

WHO supports governments in the goal of strengthening and promoting mental health.  WHO has evaluated evidence for promoting mental health and is working with governments to disseminate this information and to integrate the effective strategies into policies and plans. 

  • support to children (e.g. skills building programmes, child and youth development programmes)
  • socio-economic empowerment of women (e.g. improving access to education and micro credit schemes)
  • social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged)
  • programmes targeted at vulnerable groups, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters)
  • mental health promotional activities in schools (e.g. programmes supporting ecological changes in schools and child-friendly schools)
  • mental health interventions at work (e.g. stress prevention programmes)
  • housing policies (e.g. housing improvement)

 

National Mental Health Programme:

The Government of India has launched the National Mental Health Programme (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it.

 

NMHP has 3 components:

  • Treatment of Mentally ill
  • Rehabilitation
  • Prevention and promotion of positive mental health.

 

Aims

  • Prevention and treatment of mental and neurological disorders and their associated disabilities.
  • Use of mental health technology to improve general health services.
  • Application of mental health principles in total national development to improve quality of life.

 

Objectives:

  • To ensure availability and accessibility of minimum mental health care for all in the forseeable future, particularly to the most vulnerable and underprivileged sections of population.
  • To encourage application of mental health knowledge in general health care and in social development.
  • To promote community participation in the mental health services development and to stimulate efforts towards self-help in the community.

 

Strategies

  • Integration mental health with primary health care through the NMHP
  • Provision of tertiary care institutions for treatment of mental disorders
  • Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority, and State Mental health Authority.

 

Mental Health care

  • The mental morbidity requires priority in mental health treatment
  • Primary health care at village and sub center level
  • At Primary Health Center level
  • At the District Hospital level
  • Mental Hospital and teaching Psychiatric Units

 

District Mental Health Programme

Components:

  • Training programmes of all workers in the mental health team at the identified Nodal Institute in the State.
  • Public education in the mental health to increase awareness and reduce stigma.
  • For early detection and treatment, the OPD and indoor services are provided.
  • Providing valuable data and experience at the level of community to the state and Centre for future planning, improvement in service and research.

 

Mental Health Care Bill 2016:

  • The Bill is the first mental health law framed as per the United Nations Convention on the Rights of Persons with Disabilities to which India is signatory. It requires the countries to align their laws with the Convention.
  • The Bill repeals the existing Mental Health Act, 1987, which is vastly different in letter and spirit. The Act of 1987 had been widely criticised for proving to be inadequate to protect the rights of mentally ill persons.

 

Key provisions:

  • Rights of persons with mental illness:
    • It gives every person right to access mental healthcare services operated or funded by the government.
    • It also includes good quality, easy and affordable access to services.
    • It also provides right to equality of treatment, protect such persons from inhuman treatment, access to free legal services, medical records and right to complain in case of deficiencies in provisions.
  • Advance Directive: It empowers a mentally-ill person to have the right to make an advance directive that explains how they want to be treated for the requisite illness and nominate their representative.
  • Mental Health Establishments: Every mental health establishment must register with the respective Central or State Mental Health Authority. For registration, the concerned establishment must fulfil different criteria as mentioned in the Bill.
  • Procedure and process: It also outlines the procedure and process for admission, treatment and subsequent discharge of mentally ill persons.
  • Community based treatment: It focuses on community based treatment and special provisions for women and health.
  • Mental Health Review Commission and Board:
    • It will be quasi-judicial body responsible for reviewing procedure for making advance directives.
    • It will advise the government on the protection of rights of mentally ill persons’.
    • It will constitute Mental Health Review Boards in states’ districts with the help of state governments.
  • Decriminalizing suicide: It effectively decriminalises suicide attempt under the section 309 (attempt to commit suicide) of Indian Penal Code (IPC) by mentally ill persons by making it non-punishable
  • Prohibits electro-convulsive therapy: It will be not used for minors. It will be allowed only with the use of anaesthesia.

 

Mental Health Authority (MHA)

  • The Government would set-up Central Mental Health Authority at national-level and State Mental Health Authority in every State.
  • Every mental health institute and mental health practitioners including clinical psychologists, mental health nurses and psychiatric social workers will have to be registered with this Authority.

 

Mental Health care Act 2017:

  • Every person shall have a right to access mental health care treatment, run or funded by appropriate government at an affordable price; free for homeless and BPL.
  • Advance Directives by the person regarding his treatment & who shall be her nominated representative
  • Specifies the procedures to be followed for admission, treatment and discharge of mentally-ill individuals
  • A person with mental illness shall not be subjected to electro-convulsive therapy without the use of muscle relaxants and anesthesia
  • Central and State Mental Health Authority –
    • register, supervise and maintain a register of all mental health establishments
    • develop quality and service provision norms for such establishments
    • train law enforcement officials and mental health professionals on the provisions of the act
    • receive complaints about deficiencies in provision of services
  • Suicide is decriminalized – Person attempting suicide will be treated as mentally ill
  • Mental Health Review Commission – periodically review the procedure for making advance directives

 

Significance of the Act

  • Rights-based approach for the health of mentally ill patients
  • It is a step forward in making heath as a fundamental right
  • Will help in creating awareness that will help in early detection of patients & decrease in chances of suicide
  • Decriminalisation of suicide implies that the government has accepted that the people trying to commit suicide need help and not punishment

 

National Mental Health Policy:

 

Vision:

  • As per Census 2011, there are 15, 05,624 mentally challenged persons in the country.
  • The vision of the National Mental Health Policy is to promote mental health, prevent mental illness, enable recovery from mental illness, promote destigmatization and desegregation, and ensure socio-economic inclusion of persons affected by mental illness by providing accessible, affordable and quality health and social care to all persons through their life-span within a rights-based frame work.

 

Goals of the policy:

  • To reduce distress, disability, exclusion morbidity and premature mortality associated with mental health problems across life span of the person.
  • To enhance understanding of the mental health in the country.
  • To strengthen the leadership in the mental health sector at the national, state and district levels.

 

Objectives of the Policy:

  • To provide universal access to mental health care.
  • To increase access to and utilisation of comprehensive mental health services by persons with mental health problems.
  • To increase access to mental health care especially to vulnerable groups including homeless persons, persons in remote areas, educationally, socially and deprived sections.
  • To reduce prevalence and impact of risk factors associated with mental health problems.
  • To reduce risk and incidence of suicide and attempted suicide.
  • To ensure respect for rights and protection from harm of persons with mental health problems.
  • To reduce stigma associated with mental health problems.
  • To enhance availability and equitable distribution of skilled human resources for mental health.
  • To progressively enhance financial allocation and improve utilisation for mental health promotion and care.
  • To identify and address the social, biological and psychological determinants of mental health problems and to provide appropriate interventions.

 

Sample Question:

Discuss why India needs to talk about mental illness? Examine the importance of mental health.


 

Importance of Mental Health - Info graphics - Mar6th