From The Desk of Editor

Volume 11 Issues 10 October, 2021

Guest Editorial: Mental Health: from Illness to Wellness

October 10 is World Mental Health Day. World Federation of Mental Health (WFMH) has chosen ‘Mental health in an Unequal World’ as the theme and W.H.O. ‘Mental Health for All- Let us Make it a Reality.

There are challenges to reaching the goal of mental health for all in both countries. Prof. Mohan Issac, who has worked in India and Australia, observed at the recent  AFPA meeting (watch recording on YouTube) though Australia has over 150 times the mental health resources of India, the challenges are similar. ‘MeHeLP’, a three-year innovative project focussing on mental health literacy in Kerala, observed that though Kerala has far more significant mental health resources, the challenges are the same as in the rest of India. In India, the  2016 National Mental Health Survey has shown, over 80% of the mentally ill are not receiving care. There are barriers to availability, accessibility, affordability and acceptability (4A’s) of mental health care.

Why is this so?

Historically, institutional care has been the image of mental health. There are inadequate resources for mental health care. There is stigma limiting the utilisation of the services and experiences of discrimination. In 1989, after studying the impact of the eight-year Iran-Iraq war, Prof. Wig of PGI, Chandigarh, expressed ‘mental health is too important to be limited to mental health professionals. In his talk on  “Future of psychiatry” ‘, Prof. N. Sartorius, the former Director, Department of  Mental Health of W.H.O on Sept 25, 2021, emphasised the importance of making mental health high in the values of individuals, families and communities (watch recording on YouTube) .There is repeated reference to the coming tsunami of mental health needs during the current pandemic. The total mental health needs can’t be addressed only using the ‘illness’ framework and ‘delivery of services’ approach to overcoming the 4A’s.

Newer Understandings of mental health

Indian philosophy has always emphasised positive mental health (Bhagavad Gita- Samatva Yoga Uchayate-Equanimity is the goal of all existence). However, the illnesses received societal attention through the human history of mental health. Recently,  new understanding about both the positive actions that can promote mental health (exercise, sleep, yoga/meditation, nutrition and connectedness) and psychological measures by individuals that can address  ‘distress’,  like skills of sharing of feelings, journaling, listening to music/practice of art, thinking differently and spirituality have been documented. Information technology provides opportunities to reach all individuals directly. There is growing evidence of the value of integrating behavioural interventions to increase the effectiveness of all medical care. 

What do we need to do to address this situation?

There is a need to shift the focus from mental illness to wellness. We have to aim towards making mental health-relevant and responsible for every member of the society and not limited to persons with illnesses.

Three actions are needed. 

Firstly, shifting focus from purely clinical care to public mental health (patients to population) and secondly, generating evidence for the various psycho-social-spiritual factors facilitating the promotion of mental health, prevention of mental disorders. Recovery from disorders and self-care. Thirdly, networking with all stakeholders to address social determinants for the better mental health of the population.

Such an approach has many benefits:

(1) It increases resources for mental health manyfold;

(2) Easy acceptability of care when needed;

(3) Stigma will be minimised;

(4) Will utilise all community strengths;

(5) Resource becomes unlimited; and

(6) Will utilise the Indian wisdom of ages. The worldwide acceptance of yoga/meditation is a good example to follow.

To summarize, our goal should be to address the population to accept their emotional vulnerability and ways to develop resilience through personal, family, community actions. This can occur by ‘Making Psychiatry a People’s Movement’ rather than ‘Taking Psychiatry to People’. This will also be bringing ancient Indian wisdom to the modern world. Here lie the challenges and opportunities for mental health professionals.

Resources:

1. Srinivasa Murthy R. Pandemic Blues, The Hindu, April 25, 2021.
2. Firth J et al. (2020) A meta-review of “Lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders, World Psychiatry, 19:360-380.
3. Gupta S. Keep Sharp: Build a better brain at any age. Hachette, London.2021.
4. Murthy, V H. Together: the healing power of human connection in a sometimes lonely world. Harper Collins, Noida, 2021.
5. Jeste D. Wiser: the scientific roots of wisdom, compassion and what makes us good. Sounds True, Boulder, 2020.