Dearth of coping mechanisms for mental health issues in India adds to growing spectre of violence, say experts
The latest National Mental Health Survey from 2015-16 emphasised that an estimated 150 million people across India need mental health care interventions.
— On 6 October, 40-year-old Vijender, a father of two, was stabbed to death in Delhi's Uttam Nagar allegedly because his mini truck had brushed past his neighbour's pet Labrador. The neighbours had demand that he apologise to their dog, and when he refused, they used six kitchen knives and a screw driver to kill Vijender.
— Angered by the constant nagging of his parents over his wayward lifestyle, 19-year-old Sarnam Verma killed his father, an interior designer, his mother and his 16-year-old sister on 10 October. The family lived in a posh neighbourhood of Kishangarh near Vasant Kunj in South Delhi.
— Two days later, Head Constable Mahipal shot the wife and her son of a Gurugram district judge. The Haryana Police had deputed Mahipal as the personal security officer of the judge and his family, but the constable own reportedly troubled marriage with a Haryanvi folk singer is said to be one of the factors that made him take the step. Both victims succumbed to their injuries later.
— On 26 October, 8-year old Mohammed Aseem died in Malviya Nagar in South Delhi after a scuffle broke out between him and his friends and children from the nearby Balmiki Camp slum. The boys from the slum picked Aseem up and threw him against a motorcycle and then a rickshaw. He died of injuries to his head.
The face of violence has changed in our mega cities, with both the young and the old resorting to violence at the drop of a hat. This veritable implosion of violence seems to have become the hallmark of our society. None of the perpetrators in the cases mentioned above were economically deprived. And yet, in all these cases, the culprit did not hesitate before resorting to the brutality.
Dr B Kapoor, a Bengaluru-based psychiatrist, believes that the rising cases of violence must be linked to our current, stressful lifestyle. "Our social structures are under extreme stress. Unfortunately, the institution of marriage is also facing tremendous stress. This complete disruption of our social structures is being reflected in the life of our citizens because their lives are now full of tension," he said.
Dr Monica Chib, a psychiatrist at the Apollo Hospital in Delhi's Indraprastha area, is of the opinion that such behaviour culminates from several factors. "These cases reflect maladaptive coping strategies. Obviously, the ability of people to cope with issues is extremely poor. Earlier, people had religion and joint families that helped them develop coping strategies. These also helped buttress them against stress," she said.
With a lack of coping strategies, people often turn to drugs and substance abuse as well as alcoholism. "Unfortunately, no comprehensive study has been carried out in this field to help provide a broad picture of these trends," Dr Chib pointed out, also clarifying that crossing the tipping point and suffering from psychotic disorders were not the same.
"Statistics show that the prevalence of psychotic disorders has remained the same in our society," she explained. "These cases of violence do not fall into the category of psychotic disorders, which is why I feel it is imperative for institutions and families to teach coping strategies to their employees, children and others."
The growing pressures on individuals and families are creating a major health crisis. The latest National Mental Health Survey (NMHS), conducted in 2015-16, emphasised that an estimated 150 million people across India need mental health care interventions, both short- and long-term.
This survey was conducted across 12 states, with mental health morbidity found to be 10.6 percent. Despite such a high number of people needing care, mental health remains a neglected area, and there is no doubt that poor awareness about the symptoms of mental illnesses has created a significant treatment deficit. The acute shortage of trained mental health care professionals worsens the situations, with NMHS having found that there are just 0.3 psychiatrists, 0.07 psychologists and 0.07 social workers per one lakh people in India.
Ultimately, mental health care will have to be integrated with general care at community health service centres. Until there is such a roll-out, wherein a team of psychiatrists, psychologists and psychiatric social workers and nurses are provided at the district level, little will change on the ground.
Dr Rajesh Kumar, director of the Society for Promotion of Youth and Masses, who works with delinquents, inmates of Tihar jail and members of the armed forces, blames the growing sense of alienation in familial relationships for violent behaviour.
"The State has to detect early symptoms, but there is such a shortage of trained professionals," he said, giving the example of the Delhi government appointing 50 counsellors to address this problem. "But because there is such a paucity of teachers in government schools, these counsellors are presently being used as teachers. This is a misuse of professionals, but this is how our governments function."
Dr Nimesh Desai, who heads the National Institute of Mental Health and Neuro Sciences, believes that several factors add to this increasing sense of frustration among people.
"I believe human nature is becoming increasingly intolerant. The very control mechanisms that used to keep a society going are now beginning to fail us, as are the social and psychological control mechanisms that should have been in place. Today, it is either my way or high way."
"Earlier, societies had more tools for equalisation in place. Today, the dominance of the media is so preponderant. It projects a lifestyle, which if an individual fails to follow, he or she is left with a tremendous sense of frustration and grief, and this, in turn, can manifest into aggressive behaviour," Desai warned.
"We may lambaste western culture, but there, people have respect for others' boundaries. Here, we have no respect for boundaries. We have no fear of the law, and as a consequence, we have become an increasingly lawless society," he added.
Rajender Singh, a psychodynamic psychotherapist at the Ambedkar University in Delhi, echoed Desai's feelings. He believes that much of this imbalance is because of a tectonic shift in our society, which has become both consumeristic and materialistic.
"If the neighbour buys a car and I am not able to buy one, I am filled with a sense of rage and frustration. Addiction to social media only serves to accentuate this sense of alienation, with youngsters spending all their time gaming," he said.
In a recent study, the World Health Organization highlighted how advancement in modern technology has resulted in social isolation of people who are no longer willing to accept frustration at even minimal levels. Singh cited the example of a teenage boy, who committed suicide after his mother — a single parent from a poorer section of society — refused to buy him an expensive motorcycle, asking him to wait till he is older.
Singh believes that urban living is adding to this stress. "There is rampant substance abuse among school- and college-going students. In our colleges today, boys openly drink and smoke in classrooms, and if teachers try to stop them, they end up getting attacked," he claimed, adding that there is a lack of safe places for both adults and children in our society.
"This impacts our consciousnesses, and when you combine this with inter-generational trauma, it is bound to adversely affect the public at large... Our education, our society is not willing to cope with different voices. As a result, we have evolved into a very repressive society, with people feeling that they have no safety mechanisms left to voice their opinions," he said.
Simple interventions such as listening, talking and making minor lifestyle changes can make a difference. "Many people suffer from tension, fatigue and body aches and pains. They just need someone to talk to, to sit with them and support them," Singh said.
Those with more severe mental health illnesses need to be attended to by trained psychiatrists, which can prove difficult given the dearth of such professionals.
Most trained psychiatrists and psychologists are certain that the situation will only worsen. Establishing common community centres and strengthening the existing ones are the only ways out. Frequent interactions will help increase a sense of participation among people and reduce feelings of frustration and marginalisation, which have become the hallmark of modern India.
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