Crazy, mad, losing-your-mind…? Mental health challenges go beyond that

For a very long time, mental health has carried a stigma of weakness. Talking about private emotion and troubles, material failures and intellectual letdowns, falling KRAs and pink slips aren’t what the jet-setting era folks are supposed to do, at least in front of outsiders (caregivers, as it were). But it turns out not doing precisely all of that, and more, has led to a downward spiral. The overall burden of mental health surpasses the burden of cardiovascular disease and cancer combined – 13%.

Sample the statistics: depression is the third leading contributor to the global disease burden; every 7 seconds someone develops dementia costing the world up to $609 billion (in 2009); by 2020, an estimated 1.5 million people will die each year by suicide and between 15 and 30 million will make the attempt. (For comparison, India gets about 2 million cases of tuberculosis every year.)

Depression is the third biggest disease in the world now. Reuters

The tragedy is not only there are no cures for many of these diseases, but even for which there are effective treatments, they don’t reach the needy. For instance, in most of the low-income countries, there are no anti-Parkinsonian treatments in primary care. (If you are wondering if Parkinson’s is prevalent in India, read this. Indians are getting it at an earlier age.)

Let me concede that, at a metaphysical level, the debate is inconclusive whether depression is even a disease at all. At the scientific level, data is still emerging how these medicines actually work; at the commercial level (owing to pharma companies’ direct-to-consumer advertising) anti-depressants have been so over-sold that people take them even for eating disorders, alcoholism, and premature ejaculation!

But the truth lies in between. Certainly, a person who is different (someone who has a rational reaction to a crazy world), can’t be dubbed having mental illness!

In a representative paper published in Nature today, Grand Challenges in Global Mental Health, a consortium of researchers from across the world enlists 25 grand challenges of mental health to set global and national priorities. The challenges capture several broad themes. First, the results underscore the need for research that uses a life-course approach. “This approach acknowledges that many MNS disorders either begin or manifest in early life, and is equally attentive to risk factors and disorders affecting children and the elderly. Efforts to build mental capital—the cognitive and emotional resources that influence how well an individual is able to contribute to society and experience a high quality of life—could also mitigate the risk of disorders such as depression, substance-use disorders, bipolar disorder and dementia.”

The economic loss

Secondly, the challenges recognize that the suffering caused by mental and neurological disorders extends beyond the patient to family members and communities. Thus, health-system-wide changes are crucial, together with attention to social exclusion and discrimination.

Thirdly, the challenges underline that all care and treatment interventions should have an evidence base to provide planners, clinicians and policy makers with effective care packages.

It’s an exhaustive list that can pretty well set a country’s national agenda if it were to take rising mental health conditions seriously.

For India, which has far too long been preoccupied with infectious diseases and is just waking up to the challenges of non-communicable diseases (cardiovascular, diabetes, etc) what do you think will the health minister Ghulam Nabi Azad say to these alarming projections? Yes, the minister, who calls MSM’s (men-having-sex-with-men) a disease?

“People have gone out of their minds.”