Volume 4 Issue 15 - August 01, 2006

This country does not have any legal provision on mental health: Dr. Abdul Mabood

Dr. Abdul Mabood, Director, Snehi, shares his views and concerns regarding child and adolescent mental health in India, in an interview with Chitra S. Shankar.

1. Please define mental health. What is the difference between mental health and mental illness?

In India, mental health has always been equated with mental illness. If you have a mental health problem at a mild or moderate level and you do not take care, this emotional problem can lead to mental illness. On the parameter of a hundred scale, only about 2 to 3 per cent persons who have been mentally disturbed for a long period, may cross the borderline and reach the level of mental illness. The rest of the people suffering from any kind of mental disturbance are not mentally ill.

We have tried to define mental health in the Indian context as, a state of successful performance of the mind, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and a positive contribution to society.

2. What are the estimated figures for those affected by mental health problems in India?

It has been estimated that there are about 65 million children and young persons suffering from a range of mental health problems. There is no accurate data.

There is only one study by the Indian Council for Medical Research (I.C.M.R.), which till date has not been formally published. The study says that between 7 to 12 per cent children and adolescents suffer from mental disorders ranging from the moderate to the severe.

As per W.H.O. 10 to 15 per cent children and adolescents around the world suffer from mental health problems.

3. What are the major mental health problems that children and adolescents face?

Attention deficient hyperactivity disorders (A.D.H.D.) play a very deterrent role in the development of a child in the area of learning. Children and adolescents also suffer from a lot of adjustment and anxiety problems. Violence is another area, and children are the worst affected in states such as Jammu & Kashmir, Andhra Pradesh, Nagaland, etc. In case of natural calamities such as Tsunami, eighty per cent children suffer from one or other mental disorder.

Unfortunately, the dichotomy of our society is that our whole thrust is on physical needs, while emotional or psychological needs are totally neglected. Studies have shown that if you do not cater to mental health problems they also translate into physical problems.

4. Is there any specific area or state in India where incidence of mental health problems is high?

Yes. The incidence of mental health problems in India is highest in Kerala. The state, which has the highest literacy rate, has maximum number of people suffering from mental problems due to unemployment, alcoholism, etc. The rate of suicides is also high.

5. What are the Government policies and the legal provisions that exist with regard to mental health in India? How effective are they?

In India 42 per cent of the population is below 18 years, and 54 per cent is below 24 years. But this country does not have any plan that can effectively cater to this 42 per cent. There is no policy, especially regarding child and adolescent mental health. One should understand that there is great difference between adult and child mental health issues, because, the approach, prevention and intervention are different for both groups.

We are so shameless that we have signed the U.N. Convention on Child Rights, promising to take care of their physical, educational, mental and psychological well-being whatever be the circumstances, but have done nothing to take care of the psychological, emotional and mental suffering of our children and adolescents.

There is a Mental Health Act 1987, which only deals with mental illness, hospitalisation, and mental asylum. Moreover, there is no provision for rehabilitation even under the Mental Health Act. In effect, this country does not have any legal provision on mental health.

6. What are the Government interventions with regard to prevention, treatment and rehabilitation of people suffering from mental health problems?

The Indian Government has done nothing. Their policies only deal with psychiatric department and mental asylum. Even in the Rural Health Mission Programme 2005, there is nothing on mental health. In the Integrated Child Development Service (I.C.D.S.), they have talked under protection of the child, a bit on psychological well being or counselling. But counselling is a very small part of mental health care and management.

With regard to treatment, there is nothing very conducive. There is no test or method to pinpoint a particular problem or symptom that has become a syndrome, etc. Unfortunately there are not many medical psychiatric professionals.

As for rehabilitation, everyone knows the situation of the mental asylums. Thanks to the National Human Rights Commission and the Supreme Court, the Ministry of Health is at least now discussing the subject.

7. Could you tell us about funds allocated for child and adolescent mental health under the Tenth and Eleventh Five Year Plans?

Not a single rupee has been allocated till date for child and adolescent mental health. Even under the Tenth Plan there was no allocation.

In policy plans they only talk about mental illness. Even in this area there has been no Government action. But after the Erawadi incident in Tamil Nadu, they thought people might react. Further, the Supreme Court came down heavily on them. So the Health Ministry was given around 190 crores as budgetary support. You will be surprised that even 10 per cent of that amount has not been spent for the purpose it was allotted. A reliable source also told me that a good part of that money was transferred to physical health care.

We are now lobbying with the Planning Commission for fund allocation in the Eleventh Five Year Plan, but the demand should also go from the Health Ministry. They must ensure that child and adolescent mental health is made a part of the school curriculum.

8. Mental health is one of the most neglected areas in India. What are the reasons for this neglect?

The main reasons are social and cultural. The Indian attitude is such that you are considered normal till you behave according to the expectation of the society. The moment you stop behaving as per the social norms, social culture and show any deviation, you are tagged as not only abnormal but mad - Yeh to pagal hey! The Government is also run by people who are part of the same society. Thats why the ignorance and ultimately the neglect. Social stigma is another major reason.

Awareness is low on this issue. People tend to interpret mental health as mental illness. If you see historically and socially, in our society, any issue related to mental disorders or behavioural disorders, has always been equated with mental asylum and an issue to be pushed under the carpet.

9. What remedies do you suggest to create awareness regarding mental health problems?

First, there should be a very effective mental health policy. It must be divided into three or four components. Community mental health programmes should go up to the panchayat level, and should mainly be based on awareness, whether it is in the urban or rural setup. It should be a part of the educational syllabus in schools, where school teachers should be sensitised and trained in this area. They should observe the children and the moment any child has a moderate or even minor mental problem, they should be able to identify it and send the child to the counsellor or a mental health professional.

There is a need for effective training programmes for mental health professionals as well. The number now is negligible. There should be more professionals such as para counsellors, para mental health professionals, and community mental health professionals.

10. Is there representation from the Mental Health sector on any Steering Committee or Working Group that has been set up by the Planning Commission?

There is absolutely no representation.

11. What about the Health Ministry?

Fortunately, for the first time in history, they called two N.G.O.s, Snehi and Sanjeevni, for a meeting held in April 2006. The reason was that the present Secretary of Mental Health Authority of India is a very concerned person.

The meeting was basically to discuss ways to implement district mental health programme vis-a-vis the Supreme Court order. The Supreme Court has given a stricture to the Ministry of Health on the situation of the mental hospitals and mental asylums. Since then, three months have passed and even the Minutes have not yet reached me. The meeting itself was on district mental health programmes but those present, including experts from N.I.M.H.A.N.S., etc., were talking only about mental illness.

12. What is the way forward?

In mental health, the best approach is that of prevention rather than cure, and prevention is only possible at the childhood and the adolescent level. Once you are an adult it is very difficult to contain it. Thus mental health should be part of the panchayati raj system, part of our social development and part of our child development. The attitude of the policy makers has to change. And this is the responsibility of not just one organisation, but all organisations and every individual of this country.

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