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Why mental health matters in India and what we can do about it? Vikram Patel

London School of Hygiene & Tropical Medicine

Public Health Foundation of India

Sangath

Mental health problems affect people across the life course

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Because mental health problems are common

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The staggering numbers

About 15-20 million persons with a severe, enduring mental disorder or disability

(nearly 1 million in Gujarat)

Between 50 to 100 million persons with a wide range of mental health problems

(3 to 6 million in Gujarat)

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Because they are profoundly disabling (GBD 2010)

Because they worsen the outcomes of other health conditions

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Because they affect the poor and disadvantaged

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A CITY OF UNENDING NIGHTS

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Because they kill our youth(Patel et al, Lancet 2012)

and the dispossessed

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Because they are associated with stigma and discrimination

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And are exposed to inhumane care

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Or irrational and costly care

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Leaving some families with no choice

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The public health challenge

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Despite evidence on what works

The treatment gap is over 50% in India

Reaches an astonishing 90% in rural India, with profound abuses of human rights for

many affected persons

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India’s population

1.2 billion

132000

psychiatrists

3000 psychiatrists

Task-sharing for mental health

We know what works, but how do we deliver these treatments in low resource settings?

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Community mental health workers delivering care for schizophrenia in rural India(Chatterjee et al, Br J Psych 2003, 2009)

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Community health workers supporting caregivers of persons affected by dementia

(Dias et al, PLoS One, 2008)

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Lady health visitors using CBT to treat postnatal depression in rural Pakistan

(Rahman et al, Lancet 2008)

Lay health worker led intervention for common mental disorders in primary care

(Patel et al, Lancet, 2010; Br J Psych 2011)

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Reaching out to remote areas through tele-psychiatry

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The solution?

To provide comprehensive, integrated and responsive mental health and social care services in community-based settings.

WHO Comprehensive Mental Health Action Plan, 2012-2020

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Six actions to achieve this goal

1. Empower people with mental health problems, for e.g. through self-help groups

2. Build a diverse mental health workforce, in particular community mental health workers to deliver psychosocial care

3. Establish collaborative mental health care teams with linkages between the community, PHC and medical colleges

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Six actions to achieve this goal

4. Use technology to reach out to remote and rural areas

5. Start early to detect and treatment mental health problems, for e.g. child mental health programs

6. Reduce premature mortality, for e.g. through comprehensive suicide prevention programs

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An enabling policy environment

Radically new District Mental Health Program

Considerably increased NMHP resources

Draft radcially new Mental Health Care Bill

Draft Mental Health Policy

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Summary

Mental health problems are the most neglected causes of health related human suffering in India

Cost-effective and culturally appropriate interventions are available, and the policy

environment has never been better

The time to act is NOW!

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