World Mental Health Day, observed annually on October 10, serves as a vital platform to raise awareness and combat the social stigma surrounding mental health worldwide. Established in 1992 by the World Federation for Mental Health.

Recent years have witnessed growing recognition of the pivotal role mental health plays in achieving global development goals, as highlighted by its inclusion in the Sustainable Development Goals. According to the World Health Organization (WHO), depression ranks among the foremost causes of disability, and suicide is the fourth leading cause of death among 15-29-year-olds. Shockingly, individuals with severe mental health conditions face a premature mortality rate up to two decades earlier due to preventable physical conditions.

In 2019, the World Health Organization (WHO) reported that 1 in every 8 people globally, totaling 970 million individuals, lived with a mental disorder, with anxiety and depressive disorders being the most prevalent. The COVID-19 pandemic exacerbated these numbers significantly, witnessing a 26 percent rise in anxiety disorders and a 28 percent increase in major depressive disorders in just a year.

India, deeply affected by this crisis, had 197 million individuals, constituting 14.3 percent of its population, grappling with mental disorders in 2017, as per the National Centre for Biotechnology Information (NCBI). Mental diseases accounted for 4.7 percent of the total Disability-Adjusted Life Years (DALYs) in India in 2017, up from 2.5 percent in 1990. Depressive disorders (33.8 percent) and anxiety disorders (19.0 percent) were the leading contributors to DALYs in India that year, followed by dissociative identity disorder (10.8 percent), schizophrenia (9.8 percent), bipolar disorder (6.9 percent), and conduct disorder (5.9 percent).

India's mental healthcare system faces a glaring challenge of severe understaffing. WHO's data reveals a stark reality: there are merely. Three psychiatrists and psychologists for every 100,000 people in the country. This scarcity, exacerbated by the pandemic's impact, is projected to worsen, potentially affecting up to 20 percent of the country's population with mental disorders.

As per the National Mental Health Survey conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore in 12 States of the country, the prevalence of mental disorders including common mental disorders, severe mental disorders, and alcohol and substance use disorders (excluding tobacco use disorder) in adults over the age of 18 years is about 10.6%. The major findings of the survey are as under:

• The prevalence of mental morbidity is high in urban metropolitan areas.
• Mental disorders are closely linked to both causation and consequences of several non-communicable disorders (NCD).
• Nearly 1 in 40 and 1 in 20 persons suffer from past and current depression, respectively.
• Neurosis and stress related disorders affect 3.5% of the population and was reported to be higher among females (nearly twice as much in males).
• Data indicate that 0.9 % of the survey population were at high risk of suicide.
• Nearly 50% of persons with major depressive disorders reported difficulties in carrying out their daily activities.

To combat all these issues Government of India has been time to time various guidelines, rule & regulations with regard to various institutions be it legislative bill, awareness program, in education field etc.
There are in following points...

1. Legislative Changes:
   • Mental Healthcare Act, 2017: This landmark legislation replaced the outdated Mental Health Act of 1987. The new act emphasizes the rights of individuals with mental illness, providing them with the right to make decisions regarding their treatment. It also mandates the provision of mental health services in every district and recognizes the importance of advance directives for treatment.
   • Decriminalization: The Mental Healthcare Act, 2017, decriminalized suicide attempts by considering them as a manifestation of mental illness. This change represents a major shift in how society perceives mental health and the struggles associated with it.
      
2. Increased Awareness and Education:
   • Campaigns and Initiatives: Government and non-governmental organizations have launched campaigns to raise awareness about mental health issues and combat stigma. Initiatives such as the National Mental Health Program (NMHP) and the National Institute of Mental Health and NeuroSciences (NIMHANS) are actively engaged in educating the public about mental health.
   • Media Representation: Bollywood and other forms of media have begun to address mental health issues more openly, contributing to the reduction of stigma and encouraging conversations on the topic.
      
3. Mental Health Services and Infrastructure:
   • District Mental Health Programs: The government has established district mental health programs across India to provide accessible and affordable mental health services at the community level.
   • Telemedicine and Telepsychiatry: With the advent of technology, telemedicine and Telepsychiatry have grown in popularity, making mental health services more accessible to people in rural and remote areas.
      
4. Workplace Initiatives:
   • Corporate Policies: Many companies in India are now implementing mental health policies and initiatives to support their employees' well-being. This includes counseling services, stress management programs, and flexible work arrangements.
   • Mental Health Days: Some organizations have started offering mental health days as part of their leave policies to acknowledge the importance of mental health in the workplace.
      
5. Education and Training:
   • Training of Healthcare Professionals: Efforts are being made to train more healthcare professionals in the field of mental health to address the shortage of qualified practitioners.
   • Incorporating Mental Health into Medical Education: Medical colleges are increasingly integrating mental health education into their curriculum to ensure that future doctors are equipped with the knowledge and skills to address mental health issues.
      
6. Community and Support Groups:
   • Peer Support: Community-based organizations and support groups for individuals with mental health issues and their families have gained traction in India. These groups provide emotional support and practical guidance to those in need.
      
7. Research and Data Collection:
   • Studies and Surveys: Research on mental health issues in India has increased in recent years, providing valuable data for policymakers and healthcare providers to better understand the scope of mental health challenges and develop effective interventions.

Realizing the impact that COVID-19 may have on the mental health of the people, the Government has taken a number of initiatives, including:

• Setting up of a 24/7 helpline to provide psychosocial support, by mental health professionals, to the entire affected population, divided into different target groups viz children, adult, elderly, women and healthcare workers.
• Issuance of guidelines/ advisories on management of mental health issues, catering to different segments of the society.
• Advocacy through various media platforms in the form of creative and audio-visual materials on managing stress and anxiety and promoting an environment of support and care for all.
• Issuance and dissemination of detailed guidelines by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru- "Mental Health in the times of COVID-19 Pandemic - Guidance for General Medical and Specialized Mental Health Care Settings".
• All the guidelines, advisories and advocacy material can be accessed on Ministry of Health and Family Welfare website under Behavioral Health – Psychosocial helpline (https://www.mohfw.gov.in/).
• Online capacity building of health workers by NIMHANS in providing psychosocial support and training through (iGOT)-Diksha platform.

Further, with a view to provide affordable and accessible mental healthcare facilities, the Government is implementing the National Mental Health Programme (NMHP) in the country. The District Mental Health Programme (DMHP) component of the NMHP has been sanctioned for implementation in 704 districts for which support is provided to States/UTs through the National Health Mission.

Facilities made available under DMHP at the Community Health Centre (CHC) and Primary Health Centre (PHC) levels, include outpatient services, assessment, counselling/ psycho-social interventions, continuing care and support to persons with severe mental disorders, drugs, outreach services, ambulance services etc. In addition to above services there is a provision of 10 bedded in-patient facility at the district level.

Besides the above, the Government has announced a National Tele Mental Health Program in the Budget of 2022-23, to further improve access to quality mental health counselling and care services in the country.
To generate awareness among masses about mental illnesses Information, Education and Communication (IEC) activities are an integral part of the NMHP.

At the District level, sufficient funds are provided to each District under the DMHP under the Non-communicable Diseases flexi-pool of National Health Mission for IEC and awareness generation activities in the community, schools, workplaces, with community involvement. Under the DMHP various IEC activities such as awareness messages in local newspapers and radio, street plays, wall paintings etc. are undertaken by the States/UTs.

Various Policies And Scheme Implemented By Government:

1. National Mental Health Program (NMHP) 1982.
   • Prevention and treatment of people with mental health problems and their rehabilitation.
   • Promotion of positive mental health by improving human and material resources.
      
2. District Mental Health Program (DMHP) (National Mental Health Program)1996.
   • Community-based mental health services, early detection and treatment, awareness generation, basic psychiatric care, and integration of mental health within public health system.
      
3. National Mental Health Policy (New Pathways New Hope National Mental Health Policy, 2014)
   • Universal access to mental health care across lifespan, emphasis on suicide prevention, children of people with mental health problems, recommends expansion of DMHP to cover all the districts in the country.
      
4. Rashtriya Kishor Swasthya Karyakram (RKSK, National Adolescent Health Program) (Adolescent Health, National Health Mission, 2014)
    
   • Peer education program for improving awareness about adolescent health problems including mental health and substance abuse at school and community, observing 'Adolescent Health Days' at village level, convening 'Adolescent Friendly Club' monthly meetings at sub-center (covering five villages) and facility-based counseling and healthcare support through 'Adolescent Friendly Health Clinics'.
5. Mental Healthcare Act (MHCA, 2017)
    
   • Decriminalization of suicides, promotes rights-based approach to access mental health services for people with mental health problems, medical insurance for the treatment of mental health problems on the same basis as the treatment of physical ailments.
      
6. National Health Policy (NHP, 2017)
   • Improving health services for young people in general, developing sustainable networks for community to strengthen mental health services, universal health coverage, addressing tobacco and substance use.
      
7. School Health Program (Ayushman Bharat) (School Health & Wellness Programme, National Health Mission, 2020)
   • It is a joint program with the Ministry of Education encompassing physical and mental fitness by promoting healthy behavior, yoga and meditation, safe use of internet and digital literacy. The curriculum and training material for teachers designated as the Health and Wellness
      
8. Telepsychiatry Operational Guidelines (Telepsychiatry, 2020)
   • Jointly developed by National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru, Indian Psychiatric Society, and Telemedicine Society of India as specific guidance to psychiatrists in setting up, implementation, administration, and provision of telepsychiatry services.
   • These guidelines complement the Telemedicine Operational Guidelines prepared by the Board of Governors, Medical Council of India, in partnership with the National Institution for Transforming India (NITI Aayog) and released by MOHFW in 2020.
      
9. National Digital Health Mission (Official websites of Ayushman Bharat Digital Mission, 2022): 2020
   • Envisaged to develop the 'Digi Doctor' platform for including information on doctors from across the country to streamline telemedicine and telepsychiatry services.
      
10. National Youth Policy (NYP, 2014)
    • Emotional well-being, awareness generation around mental health problems including substance use disorders, maintaining healthy lifestyles, awareness about health, nutrition, and preventive care, targeted disease control programs through National Service Scheme (NSS) and Nehru Yuva Kendra Sangathan (NYKS).

References:

• https://pib.gov.in/PressReleasePage.aspx?PRID=1910381
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10460242/
• https://www.sciencedirect.com/science/article/pii/S2666560322000858/
• https://www.cnbctv18.com/healthcare/world-mental-health-day-a-look-at-prevalence-of-mental-health-disorders-in-india-17999151.htm

Written By: Shivam Kumar Sahu, 2nd Year From Central University Of Kashmir.

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• Indian Legal System And Mental Health