HOW CAN WE UNDERSTAND INDIA’S MENTAL HEALTH PROBLEM?

HOW CAN WE UNDERSTAND INDIA’S MENTAL HEALTH PROBLEM?

ANNA CUTTERIDGE IN CONVERSATION WITH MARIWALA HEALTH INITIATIVE (MHI)

TRIGGER WARNING: SUICIDE. This piece discusses suicide which some people might find disturbing.

In a 2016 Lancet Global Health study, suicide was found to be the leading cause of deaths among young people in India. In the following year, India enacted the National Mental Healthcare Act, “to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services.”

Yet, India’s mental health crisis is still rife, and it is time for a change.

Mariwala Health Initiative (MHI) is a mental health advocacy and funding agency which aims at making mental health accessible to marginalised groups in India. Their motivation is to create a “big picture of mental health”, away from narrow medicalised views, and towards “more inclusive, holistic, and empathetic practices”.

Its director is Raj Mariwala, board advisor for BluePrint Group - a global joint advocacy and learning coalition on mental health, as well as for Lancet Commission on Stigma and Discrimination. In this interview, Mariwala shares her views on the mental health situation in India as it stands, and how she sees it evolving.

In 2017, India enacted the National Mental Healthcare Act “to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services.” – How effectively do you feel this act has been adhered to?

Having the MHCA means that access to mental health care is an enactable right – free and good quality of mental health care to ALL citizens, with or without belowpoverty-line proof. It also mentions making psychiatric medication available for free state-run facilities. There are some important provisions that are critical, such as state mental health authorities and mental health review boards that remain to be set up.

The MHCA mandates a national suicide prevention policy as well, which remains uninitiated. There are some provisions which I am personally excited by, such as Advance Directives and the right to a Nominated Representative. However, policies do not work if they remain unimplemented, which is the current state of affairs.

MHI fully funds a programme by the Centre for Mental Health Law and Policy which provides training to stakeholders like lawyers, mental health professionals, social workers and the judiciary on the MHCA. For some states like Chhattisgarh and Gujarat, they have been open to, and thus received training on, the MHCA for multiple arms of government and judiciary. The most recent development is an #MHCA e-Legal Support Unit in Chhattisgarh, in collaboration with Directorate of Health Service to provide remote guidance and support to stakeholders for legal queries on the implementation of the Mental Healthcare Act.