India is facing a growing mental health problem, comprehensive road map the need of the hour

India is facing an unprecedented crisis in mental health. This can be reflected from the fact that we are reporting the largest number of adolescent suicide deaths in the world. This is a fact reinforced by the National Crime Record Bureau, which confirms that we are presently witnessing a 20 percent increase in suicides every year.

A 2015 WHO study further emphasises that between 30 and 40 people per 100,000 Indians aged between 15 and 29 kill themselves. This accounts for about a third of all suicides in the country.

Shockingly, a study done by Dr Anuradha Bose at Christian Medical College, Vellore, confirmed that suicides account for 50 to 75 percent of all deaths among adolescents. The study, which was published in The Lancet, found that the suicide rate in the 15-19 age group for those in Vellore was 148 per one lakh women and 58 per one lakh men. This shows that three times more younger women were committing suicide than men.

These findings have been reinforced by Dr Vikram Patel of Harvard Medical School who also heads the NGO Sangath who pointed out that suicides cause twice as many deaths as HIV/AIDS and about the same number as maternal mortality cases among young women.

Representational image. Reuters

Dr Patel, who was in India to attend the 11th World Congress on Adolescent Health, told this reporter that he was also concerned at the rising graph of juvenile delinquency in India.

"Children coming in conflict with the law is almost always the result of social deprivation. The effects of social deprivation effect the child’s ability to understand what is socially acceptable and what is anti-social. For example, if a child grows up in a family where the mother is being regularly beaten or the father is an alcoholic or grows up in a neighbourhood where theft and violence is routine, this is going to affect the way s/he interacts with other people. We have to look at adolescent delinquents as a failure of society to take care of their social needs,’ said Patel.

He cites the example of the Jyoti Singh case, where some journalists wrote some poignant narratives about the kind of deprivation faced by these boys. Patel cites the example of one particular boy whose father, suffering from a mental illness, had disappeared when the boy was five years of age. "The boy grew up on rubbish heap and from a young age got involved with working with gangs and indulging in petty crimes. He never went to school and by the early years of his adolescent had become a hardened street criminal. How can you simply blame him? This is a failure of the child development system. The fact is whichever part of Delhi he grew up in, not a single person from the Ministry of Women and Child Development intervened to either detect or protect his childhood needs," Patel added.

"This is the biggest area of concern affecting the lives of millions of kids. It is an area of greater concern than sexual abuse. Sexual abuse is receiving all the attention but through the common forms of neglect, where parents are either too poor to look after their children, or have conflicts with each other, the essential development of children is getting affected,’ Patel added.

Dr Saurabh Malhotra of Medanta agrees, “There are several reasons for this exponential rise in suicides. Young people are witnessing a great deal of friction in their homes. There is no parenting in a large number of families. The social fabric of our society is breaking down.”

“Drug abuse among youngsters is rampant. This makes them more impulsive. Their mindsets have become so fragile that tolerance levels have reached an all-time low,” Malhotra said.

Dr Sunil Mehra, the executive director of MAMTA Health Institute for Mother and Child, feels there is much more need to focus on adolescent heath especially since they comprise more than 253 million of our population.

Mehra told Firstpost in an exclusive interview, "Adolescent mental health challenges need to be addressed by families, schools and society before they become major problems."

When Mehra was asked to explain why children in conflict with law were showing propensity towards violence to the extent of even murdering victims they had raped, Mehra said, "Violence exists because of gender inequality. There is a lot of gap between what adolescents know and what they expect. Adolescents have an exploratory thought process and are prone to risk-taking behaviour. It is when they harm others or commit self- harm that their behaviour is abnormal. People, and especially parents, need to understand adolescent physiology better.’

Zoya Ali Rizvi from the Ministry of Health and Family Welfare emphasised that migration from rural to urban cities is also a major cause of stress for adolescents and families. "Who do children and adolescents talk to, especially when both parents are working? We need to have counsellors and the government has appointed 1700 counsellors in adolescent health centres. But, of course, given the population, we need many more,’ said Rizvi.

Rizvi also regretted that mental health is not a priority for parents in rural areas. "Issues such as safe drinking water, schools, sexual reproductive health, drugs, injuries and the need for toilets take precedence over mental health issues unless the case is very severe," she said.

Larger numbers of adolescent girls are committing suicide as compared to men. Of course, pregnancy complications, such as haemorrhage, sepsis, obstructed labour, and complications from unsafe abortions, are the top cause of death among 15–19-year-old girls, but this is followed by suicides.

Dr Kanika Malik of the Public Health Foundation of India points to statistics which emphasise that 11 per cent of girls worldwide are prone to depression.

Malik cites the example of how in the mid-nineties, China one million women would have committed suicide every year due to financial and emotional neglect had the government not come up with a strong country-level intervention providing better educational programmes and better job facilities for girls.` This helped reverse the trend,’ said Malik.

India needs to come up with a similar road map. The Ministry of Health and Family Welfare has launched a Rashtriya Kishor Swasthya Karyakram, but it needs to come up with a comprehensive mental road map to reverse growing mental depression and suicides that are engulfing our youth.

But Dr Sonali Bali, a psychiatrist with VIMHANS believes that this can happen only when mental health services in India improve in order to cope with larger numbers of patients. "We have only 3,000 psychiatrists for a population of 125 crore and these are concentrated in the metros," she said.