Every year, World Mental Health Day is celebrated world over on 10th October to raise awareness about mental health issues. This year, the theme of the World Mental Health Day is “Mental Health in an Unequal World” and its purpose is to highlight the impact of unequal socioeconomic conditions and disproportionately less allocation of resources to mental health in access to mental health care for large majority of persons residing in poorly resourced settings.
As per the latest study by Global Burden of Disease, released in 2019, around 970 million persons suffer from mental disorders worldwide, out of which 197•3 million are in India, including 45•7 million with depressive disorders and 44•9 million with anxiety disorders.
The most recent World Mental Health Atlas of World Health Organisation (WHO) of 2017 reveals that only 29% of WHO Member states compile mental health data as part of general health statistics, 57% have a standalone mental health law and only 20% of Member States had indicators available that are used to monitor implementation of most of the components of their action plans.
Globally, inequalities exist in the resources available for mental health care. The median number of mental health workers varies from below 1 per 1 lakh in low-income countries to 72 per 1 lakh in high-income countries. The median number of mental health beds per 1,00,000 population ranges below 7 in low and lower middle-income countries to over 50 in high-income countries.
Globally, the median number of beds for children and adolescents is less than 1 per 1,00,000 population and ranges from below 0.2 in low and lower middle-income countries to over 1.5 in high income countries.
It has been reported that 35–50% of the serious cases in developed countries and 76–85% in the less-developed countries had received no treatment in the previous 12 months. One of the most important reasons is very low levels of public expenditure on mental health in low and middle-income countries.
The situation in India has also been more or less similar. India is a country of 1.39 billion people. The National Mental Health Survey of India says that the lifetime prevalence of having any mental illness is 13.7% which when translated to real numbers means that nearly 150 million Indians are in need of active interventions.
However, only one fourth of these persons receive some mental health care. The important barriers to access care are lack of awareness, low mental health literacy, stigma, misinformation or cultural beliefs about the nature of mental disorder, social policy or other approaches that limit access to services.
The average national deficit of psychiatrists in India is estimated to be 77%. But there are inequalities in availability of psychiatrists within India. Four states, namely, Chandigarh, Delhi, Goa and Pondicherry have a surplus of psychiatrists, ranging from 244% surplus in Chandigarh to a 13% surplus in Pondicherry.
Nine states have more than 90% deficit. The stigma and discrimination experienced by persons with mental ill health results in poor opportunities for education, finding vocation, having friends, getting married, their families and loved ones.
The crisis and inequalities have further been exacerbated by the COVID 19 pandemic. Excess morbidity, mortality, socio-economic difficulties and social isolation has resulted in mental health issues like stress, anxiety and depression. A number of initiatives have been taken by the mental health professionals such as starting telepsychiatry services, psychosocial help to patients with COVID, development and translation of various psychoeducational material related to COVID in different languages. This year’s theme of World Mental Health Day, ‘Mental Health in an Unequal World’ will help to highlight the reasons for inequalities in mental health care and find ways to mitigate this inequality, both locally and globally.