This article reflects the author’s volunteer experience in the prevention and promotion of mental health in community and organizational settings, and aims to highlight the importance and urgency needed to scale up promotional interventions.
Enormous efforts have been made and are ongoing to improve mental health in India. Despite these efforts, the latest statistics from the National Mental Health Survey (2015-2016) and the National Crime Records Bureau reveal the grim picture of the situation. There is a high prevalence of suicidal risk, a suicide rate that reflected 10 cases per lakh across the population in 2017, and depression particularly amongst disadvantaged and vulnerable groups and communities especially those are females, widowed/separated, residents of low-income quintile and urban metros, and those in the productive age group of 40-49 years. Psychoactive substance use disorders were also reportedly high. Additionally, the COVID-19 pandemic has further deteriorated the mental health of these high prevalence groups and impacted many more into distressed conditions.
Accessing mental healthcare is still a challenge in India even two and half decades after the implementation of the District Mental Health Program (DMHP). This program was implemented to address the burden of mental health disorders and the shortage of qualified professionals in the field of mental health under the National Mental Health Program by the Ministry of Health and Family Welfare in 1996. The DMHP has several key components; prevention activities such as suicide prevention services; promotional activities such as life skills education, counselling services at schools, colleges, and workplaces; awareness camps at the community level; establishment of linkages with self-help groups and non-governmental organizations, families and care-givers. Even though the prevention and promotion of mental health have been given immense importance in the program, the DMHP – and the health system in general – highly prioritizes the curative aspect through diagnosis, treatment and management. Promotional initiatives at the community and organizational level have high potential to address societal stigma which is hindering both the seeking of early professional help and care, and prevention of mental illnesses and reduction of suicide. Therefore, the promotion of mental health serves dual purpose.
At the public health system level, there is ongoing effort to integrate mental healthcare into the general medical practice. Given the low utilization of public mental health services due to the associated stigma, there is an urgent need for outreach or mobile health services to improve the seeking of mental healthcare, its access and service delivery, especially to disadvantaged communities.
Based on the author’s experience as a professional volunteer, observations from interaction with individuals in an urban slum in Bengaluru reflect that many exhibit symptoms of mental disorders, but they have never been counselled, diagnosed or treated despite the presence of a mental health clinic at a nearby public community health center which operates twice per week by an NGO. The psychological problems among these individuals likely persist due to the management of chronic illness with multiple comorbidities and are also influenced by their class, caste, occupation, income and living standard. Therefore, it requires a combined effort through prevention, promotion and quality treatment to reduce the burden of mental disorders. Given the burden and urgency to treat mental disorders, it is important that the community outreach component of mental healthcare services be strengthened at all levels within the public health system. In addition, DMHP also must include a component that promotes the mental health of healthcare workers working in the health system setting.
Volunteering efforts have been ongoing by trained wellbeing volunteers and mental health support professionals to create awareness and improve help-and care-seeking in the community as well as at the organization level. Based on the author’s volunteering experience, addressing mental health at the workplace is still likely a neglected area even after being aware of the high prevalence of common mental disorders among the productive age group. Even if counselling service is available at the workplace, staff are less likely to utilize such services. Individuals with severe psychological problems or those diagnosed with mental health disorders either leave their job due to decreased productivity or have difficulty in getting a job during or after recovery. Even if they find employment, they perform with low productivity and support offered from the organization and/or trained professionals is rarely utilized. Cases indicate that such individuals do not reveal or report mental disorders during job seeking, mainly due to stigma and organizations fail to provide support due to either low preparedness to address this issue and/or unawareness of the illnesses. Given the gradual increase in suicides at institutions of higher education as reported by media, it is essential to implement long-term strategies ‘beyond counselling’ through promotional interventions to address the mental wellbeing of the students and staff.
Further, there is an urgent need for addressing the mental health of the caregivers through targeted intervention. These challenges could be addressed by implementing settings-based promotional interventions to address the broader issues of wellbeing through health and wellbeing inclusive policies. Therefore, not only those suffering from mental disorders, but also caregivers and the general population, would benefit from promotional interventions.
There is an urgent need for promoting mental health to remove the stigma from our society and improve early help-and care-seeking to prevent and reduce the burden of mental disorders. As there is little to no evidence on what works in a particular setting, interventions need to be tested to understand their impact and sustainability. Further, there is an urgent need for targeted promotional interventions for the vulnerable groups in urban areas. It is better to act on mental health promotion now rather than later.