Dr. Tasaduk Hussain Itoo
Mental health is a state of well-being in which the 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. However, in the current times , mental health issues are becoming a grevious issue of concern. World Mental Health Day established by World Federation for Mental Health (WFMH) seeks to raise awareness of mental health illnesses while educating the population and mobilizing efforts to support mental health.
BURDEN OF MENTAL HEALTH ISSUES
Burden of mental disorders had risen over last few decades. WHO estimated that globally over 450 million people suffer from mental disorders. Currently mental and behavioural disorders account for about 12 percent of the global burden of diseases. This is likely to increase to 15 percent by 2020. Major proportions of mental disorders come from low and middle income countries. In India, the burden of mental and behavioural disorders ranged from 9.5 to 102 per 1000 population.
In Jammu and Kashmir State, as per the recent study done by the Institute of Mental Health and Neurosciences (IMHANS), Kashmir, in collaboration with Action Aid Association with support of Directorate General for Humanitarian Aid and Civil Protection (ECHO), shows, 11.3 percent of adult population suffers from mental illness in the valley with political disturbances as the prime reason. This prevalence is significantly higher than the Indian national average of 7.3 percent. The study shows the prevalence of mental health disorders is more in females (12.9 percent) than males (8.4 percent).
ISSUES AND CHALLENGES OF MENTAL HEALTH
As per a recent research study, most strongly associated factors with mental disorders are deprivation and poverty. Individuals with lower levels of education, low household income, lack of access to basic amenities are at high risk of mental disorder . Lifetime risk of affective disorders, panic disorders, generalized anxiety disorder, specific phobia and substance use disorders is found to be highest among illiterate and unemployed persons.
Suicidal behavior is found to have relation with female gender, working condition, independent decision making, premarital sex, physical abuse and sexual abuse. Ongoing stress and chronic pain heightened the risk of suicide. Living alone and a break in a steady relationship are also significantly associated with suicide. Work environment, school environment and family environment plays important role in pathogenesis of mental disorders.
Females are more predisposed to mental disorders due to rapid social change, gender discrimination, social exclusion, gender disadvantage like marrying at young age, concern about the husband’s substance misuse habits, and domestic violence. Divorced and widowed women are at slightly elevated risk of mental disorders. Poorer women are more likely to suffer from adverse life events, to live in crowded or stressful conditions, to have fewer occupational opportunities and to have chronic illnesses; all of these are recognized risk factors for common mental disorders.
Psychological factors such as headache and body ache, sensory symptoms and nonspecific symptoms such as tiredness and weakness also makes people vulnerable to mental disorders. Biological factors affecting mental disorders are genetic origin, abnormal physiology and congenital defect.
Disasters are potentially traumatic events which impose massive collective stress consequent to violent encounters with nature, technology or mankind. A meta-analysis showed that post-traumatic stress disorder, generalized anxiety disorder and panic disorder were common among disaster victims. As per WHO estimates, 10 percent of the people who experience traumatic events will have serious mental health problems and another 10 percent will develop behaviour that will hinder their ability to function effectively, in the situations of armed conflicts.
Stigma related to mental disorders, lack of awareness in common people, delayed treatment seeking behavior, lack of low cost diagnostic test and lack of easily available treatment are the main hurdles in combating the problem of mental health issues. In addition factors pertaining to traditional medicine and beliefs in supernatural powers in community delays diagnosis and treatment. Much focused attention mainly to maternal and child health and communicable diseases has lead to lack of political commitment to non communicable diseases, thus further aggravating the load of mental disorders.
THE WAY FORWARD
Burden of mental disorders seen by the world is only a tip of iceberg. While going through a recent research journal, I acknowledged that the authors have validated and enormously worked on mental health. To promote mental health, there is a need to create such living conditions and environment that support mental health and allow people to adopt and maintain healthy lifestyle. A society that respects and protects basic, civil, political, and cultural rights is needed to be built to promote mental health.
Mental health policies should not be solely concerned with mental disorders, but should also recognize and address the broader issues which promote mental health. This includes education, labour, justice, transport, environment, housing, and health sector. For attaining this, intersectoral coordination is a mainstream. There is need to aim at improving child development by early childhood interventions like preschool psychosocial activities, nutritional and psycho-social help to give roots for a healthy community. Presently, the community is also demanding the skills building programme and child and youth development programme.
To reduce the burden of mental disorders in women, there is need to do socioeconomic empowerment of women by improving access to education and employment opportunities. Women should be involved in group activities like farmer’s clubs, mahila mandal and adolescent girls’ groups. These group activities will bring people together for social, health and educational reasons as well as income generation activities.
Society needs to be free of discrimination and violence. Reducing discrimination against sex, caste, disability and socioeconomic status is an important aspect to reduce mental disorders.
Social support for elderly people needs to be strengthened. More community and day centres for the aged should be developed. Programmes targeting towards indigenous people, migrants and people affected by disasters and armed -related violence need to be established. Programme could be implemented through school like programmes supporting ecological changes in schools or at work place like stress prevention programmes.
Another key to reduce mental morbidity is to strengthen the treatment of mental disorders at the level of primary health care. There are multiple interventions needed to prevent the progression of mental disorders from early manifestations to more serious and chronic cases. There is an urgent need of simple, easily available diagnostic test and low cost treatment to provide better primary health care.
Psychiatric specialists and epidemiologists need to reorient their research in such a way that true burden of mental disorders are estimated at community level. This would provide true situation of the mental health problem. Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment.
(The authoris Medico/ Motivational Speaker/Activist/ Columnist/ Educator Awardee.)