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mental illness and poverty in India
There is a web of denial that people weave around the issue of mental health in India. Most families and communities refuse to see mental health as a serious concern. Adding on to the stigma, there is also a lack of physicians available to treat mental illnesses and those affected often go unchecked. While mental health can affect individuals of all income levels, there is a significant link between mental health and poverty in India.

The Relationship Between Mental Health and Poverty

Specifically, there is a cyclical link between mental health and poverty in India. A case-control study conducted in Delhi from November 2011 to June 2012 found that the intensity of multidimensional poverty increases for persons with severe mental illnesses (PSMI) compared to the rest of the population.

As people receive diagnoses of mental illness, their work performance and social status decrease. Without much treatment available, these individuals continue to suffer in silence, slowly falling back from their jobs, families and friends. These individuals lose employment, which means they have a lack of income, ending up without a support system and resulting in poverty. In particular, women with severe mental illness (SMI) or those who are a part of the lower castes (Untouchables or Shudras) suffering from SMI are more likely to face multidimensional poverty. Because society often looks down on women and individuals of the lower caste system, they are the least likely to receive treatment or assistance when they receive a diagnosis of mental illnesses.

On the other side of this relationship, poverty, which many describe as a lack of employment and income, aggravates mental illness. When individuals do not have the necessities for survival, mental disorders such as depression or anxiety can develop and intensify. Without treatment, these disorders build up, eventually leading medical professionals to diagnose individuals with SMIs. Out of those in poverty, women, individuals of the lower castes and individuals with SMIs suffer the most, as they have the hardest time finding work or receiving external help.

In short, untreated mental illnesses can lead to or further exacerbate poverty, but unchecked poverty can cause mental illnesses as well, creating this link between mental health and poverty.

In an attempt to fix the cyclical link between mental health and poverty in India, the government, doctors and businesses have taken action which aims to increase treatment and guarantee more rights to persons with mental illnesses.

Past Actions by the Government

In 2016, the Parliament in India passed the Mental Health Care Bill. This law replaced the older Act which stigmatized mental health and prevented people from receiving treatment. The new legislation provides state health care facilities, claiming that anyone with mental illness in India has a right to good quality, affordable health care. Individuals with mental health now have a guarantee of informed consent, the power to make decisions, the right to live in a community and the right to confidentiality.

The hope is that the act will help people from all levels of income because if an individual cannot afford care, the government must provide treatment. Even in rural or urban areas, mental health care is a requirement and the government is working to build access to such facilities. Anyone who violates or infringes on the rights of those with mental illnesses is punishable by law.  The government is hoping that by taking legal action for individuals with mental illnesses, society will slowly stigmatize the issue less, increasing overall acceptance.

Individuals and Organizations Taking On Mental Health

As the issue of mental health persists, doctors in India have attempted to integrate their services of mental health within the primary health care system. Since 1999, trained medical officers have an obligation to diagnose and treat mental disorders during their general primary care routines. Furthermore, district-level mental health teams have increased outreach clinical services. The results have shown that if people receive treatment in primary health care facilities, the number of successful health outcomes increases. In the future, doctors are looking to expand services into more rural areas, hoping to offer more affordable care to those in severe poverty because there is such a significant link between mental health and poverty.

Alongside medical professionals, businesses are using the shortage of mental health care treatments in India to expand their consumer outreach; these companies rely on technology to bring together a global community of psychologists, life coaches and psychiatrists to help individuals through their journey. Using AI, companies like Wysa can use empathetic and anonymous conversations to understand the roots of people’s problems. Companies, such as Trustcircle, rely on clinically validated tests to allow individuals to determine their depression, anxiety or stress levels, enabling them to understand when to seek help. These companies are all providing free or drastically low-costing help, giving people feasible access to the treatment they need. The hope is that with quicker and cheaper access to treatment, people can address mental health on a wider scale.

Further Action Necessary

Despite the increasing support for mental health, there is a great deal of change that needs to take place. Currently, only 10 percent of patients suffering from mental illnesses receive treatment in India; while all patients do have the right to treatment, the shortage of money and psychiatrists hinders the accessibility. India spends as little as 0.06 percent of its budget on mental health, and there are only 0.3 psychiatrists per 100,000 people in the country. India needs to primarily focus on changing the societal culture regarding mental health. By educating children from a young age about the importance of mental health and acknowledging that mental illness is real and valid, the overall acceptance of mental health can increase. Changing the stigma surrounding mental health will enable more people to pursue jobs in treating mental health, increasing access. The cyclical link between mental health and poverty in India can only be broken by giving people, regardless of income, social status or gender and equal access to mental health treatment.

If India does not take a more aggressive stance on the issue of mental health, the country could face serious problems in the future. The World Health Organization predicts that if mental health remains unchecked, 20 percent of the Indian population will suffer from some form of mental illness by 2020; additionally, it determines that mental illness could reduce India’s economic growth by $11 trillion in 2030. Essentially, the cyclical link between mental health and poverty in India must break to enable optimal growth in the future.

Shvetali Thatte
Photo: Pixabay

Mental Health in South AfricaThe South African Depression and Anxiety Group (SADAG) conducted a study that revealed the shocking state of mental health in the country. In fact, one-third of South Africans have a mental illness. However, 75 percent of them will not get any kind of help.

This is where SADAG comes in. SADAG is Africa’s largest mental health support and advocacy group. It is made up of experts who take calls from South Africans about their mental health questions and concerns. The group has a 16-line “counseling-and-referral” call center and work in “urban, peri-urban and the most rural communities across South Africa.”

SADAG is comprised of a network of over 200 mental health treatment facilities and support groups throughout the country. Its focus is on areas lacking widespread community health resources. The organization believes access to this type of treatment is fundamental to improving mental health in South Africa. Additionally, SADAG believes it can improve the overall quality of life while simultaneously influencing socio-economic issues in a positive way.

SADAG and Language

Since South Africa has 11 different official languages, SADAG offers workshops and training programs tailored to these languages for individual members. In fact, the programs also are tailored to corporate businesses, healers, doctors, care workers, correctional facilities, schools and churches.

Workshops and Campaigns

These workshops focus on how to openly and productively talk about illnesses such as depression, panic disorders, bipolar disorder, PTSD and suicide prevention. Furthermore, the workshop explores healthy ways to deal with stress in an attempt to reduce the stigma surrounding mental health.

SADAG is also working to disseminate mental health awareness beyond just those member organizations within the group. They have created media campaigns with a message of de-stigmatization of mental illness that runs on TV and radio. Additionally, the campaign runs via print and electronic press releases.

Finally, SADAG has been working especially hard with HIV and AIDS patients on coping skills to conquer depression and other mental illnesses that accompany a diagnosis. This is pivotal in the country where the leading cause of death is HIV/AIDS.

There are several other organizations located in the nine different provinces doing important work to improve mental health in South Africa.

  1. Care Haven Psychiatric Centre: This center provides residential accommodation and an arts and crafts area. The main purpose is to provide therapeutic care for those with mental illnesses who have been discharged from psychiatric hospitals, and who struggle to function independently in society.
  2. Port Elizabeth Mental Health: Located in Port Elizabeth, this organization provides social work intervention services, skills training and prevention towards better mental health. It also promotes neighborhood unities for children with disabilities who cannot access special daycare centers. Finally, the organization offers youth skills development centers.
  3. Bloemcare Psychiatric Hospital: This is a private psychiatric hospital in Bloemfontein in the Free State. It offers psychiatric programs and nursing care. Its programs help develop coping skills and group therapy environments to connect with others. Furthermore, the hospital has recreational facilities and dietitians to help promote the balance between physical and mental health.
  4. SA Federation for Mental Health: This is the largest mental health organization in South Africa located in Randburg, South Africa. They work to implement national awareness campaigns, empower mental health care users and organizations, advocate for human rights of mental health care users and conduct mental health research.
  5. Ekupholeni Mental Health and Trauma Centre: Located in Katlehong, South Africa, this center provides HIV/AIDS support and a bereavement program to counsel infected children, youth and adults.
  6. PsySSA: The Psychological Society of South Africa works to negotiate with the government and other legislative bodies to create programs that focus on mental health awareness development. Specifically, these programs focus on the unique circumstances of a post-Apartheid society.
  7. Durban & Coastal Mental Health Society: In addition to standard psychiatric care, this organization offers protective training workshops that promote self-worth, dignity and self-reliance for those with mental illnesses. The organization does this through job creation initiatives that encourage block making projects, gardening projects and supported employment.
  8. NICRO: This organization focuses on social crime prevention, juvenile justice and the reintegration of criminals into society during a tough transition.
  9. Mpumalanga Mental Health Society: Located in Secunda, South Africa, this organization advocates for the rights of the disabled, trains caregivers and provides social work services to those dealing with substance abuse.
  10. Careline Clinic: The goal of this clinic is to provide care while upholding human dignity. It provides psychotherapy and crisis resolution skills to encourage empathy for patients going through emotional trauma.
  11. MSF Rustenburg: This international NGO provides medical services and support, initiated by Doctors Without Borders. It focuses on providing support to domestic violence and sexual assault survivors. It is located in Rustenburg, South Africa.
  12. Bendiga House: Bendiga House is a facility helping those in recovery from trauma and those suffering from mental illness. It teaches independent living through lessons. For example, lessons are offered on budgeting, shopping and chores. It also provides group and music therapy, life skills training, exercise programs and supervised leisure and entertainment.

These great initiatives are tackling inter-sectional and systemic barriers that prevent adequate care for many marginalized communities. Overall, mental health in South Africa is improving via these organizations and initiatives.

– Meredith Breda
Photo: Flickr