Mental Health : Strengthening Our Response

April 7 of each year marks the celebration of World Health Day. From its inception at the First Health Assembly in 1948 and since taking effect in 1950, the celebration has aimed to create awareness of a specific health theme to highlight a priority area of concern for the World Health Organization (WHO).

Mental health is an integral and essential component of health. The WHO constitution states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities. Mental health is one of the most neglected areas of health globally. This was true before COVID-19 (coronavirus), but the pandemic has further worsened the status of mental health.

Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which individuals realise their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and are able to make a positive contribution to their community. Mental health refers to a broad array of activities directly or indirectly related to mental wellbeing. Mental health is also related to promotion of mental well-being, prevention of mental disorders, and treatment and rehabilitation of people affected by mental disorders.

The numbers are staggering. Today, nearly one billion people live with a mental disorder and in low-income countries, more than 75% of people with the disorder do not receive treatment. Every year, close to 3 million people die due to substance abuse. Every 40 seconds, a person dies by suicide. About 50% of mental health disorders start by the age of 14. It is estimated that over 160 million people need humanitarian assistance because of conflicts, natural disasters, and other emergencies. The rates of mental disorders can double during such crises. 1 in 5 individuals affected by conflict is estimated to have a mental health condition. (https://blogs. worldbank. org/health/mentalhealth-lessons-learned-2020- 2021-and-forward)

There are several reasons why mental health has been ignored. The first one is an associated stigma. The second is a perception of mental health disorders as a "luxury good", as opposed to actual illnesses. The additional top reasons include a fragmented and outdated service model. Some of these include the provision of mental health services mainly in psychiatric hospitals, severe lack of preventative mental health service; lagging policy changes and also a shortage of human resources.

Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one's thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.

Mental health is an integral part of our overall health endeavour. Thus, a holistic approach that recognises strong linkage of body, mind, and soul is necessary. To address the burden of mental disorders, including depression, the Department of Health and Family Welfare has been implementing the National Mental Health Programme (NMHP) since 1982. Under NMHP, as part of National Health Mission (NHM), Central Government provides technical and financial support to the States/UTs, based on the proposals received from them, for implementation of the District Mental Health Programme (DMHP) with the objectives to:

i.                    Provide mental health services including prevention, promotion and longterm continuing care at different levels upto district healthcare delivery system.

ii.                  Provide suicide prevention services, work place stress management, life skills training and counselling in schools and colleges.

iii.                Augment institutional capacity in terms of infrastructure, equipment and human resource for mental healthcare.

iv.                Promote community awareness and participation in the delivery of mental healthcare services.

The NMHP is inclusive in nature and incorporates an integrated, participatory, rights and evidence-based approach. Mental health issues are addressed in a comprehensive manner to address medical and non-medical aspects of mental health. The strategic areas identified under the NMHP are, inter alia, effective governance and accountability, promotion of mental health, prevention of mental disorders and suicide, universal access to mental health services, enhanced availability of human resources for mental health, community participation, research, monitoring and evaluation.

Further, with a view to improve access to mental health services, the Government is taking steps to strengthen mental healthcare services at the primary healthcare level. Mental healthcare services have been added in the package of services under Comprehensive Primary Health Care under Ayushman Bharat - HWC Scheme. Operational guidelines on Mental, Neurological, and Substance Use Disorders (MNS) at Health and Wellness Centers (HWC) have been released under the ambit of Ayushman Bharat. Through these guidelines, mental health services are being provided to all sections of the society, at the primary level.

The Ministry of Education has undertaken a proactive initiative, named, 'Manodarpan', covering a wide range of activities to provide psychosocial support to students, teachers and families for Mental Health and Emotional Wellbeing during the COVID outbreak and beyond. A Working Group, having experts from the fields of education, mental health and psychosocial issues as its members, has been set up to monitor and promote the mental health issues and concerns of students and to facilitate providing of support to address the mental health and psychosocial aspects during and after COVID-19, through counselling services, online resources and helpline.

The following components are included in the 'Manodarpan' initiative:

a. Advisory Guidelines for students, teachers and faculty of School systems and Universities along with families.

b. Web page on Ministry of Education website (www. manodarpan.education. gov.in) carrying advisory, practical tips, posters, videos, DOs and DON'Ts for psychosocial support, FAQs and online query system.

c. National level database and directory of counsellors at School and University levels.

d. National Toll-free Helpline (8448440632) for a country wide outreach to students from school, universities and colleges.

e. Handbook on Psychosocial Support: Enriching Life skills and Wellbeing of Students.

 f. Webinars, audio-visual resources including videos, posters, flyers, comics, and short films with focus on convergence of resources from other Ministries/ Departments on physical and creative well-being which are essential parts of mental well-being.

The National Council of Educational Research and Training started 'NCERT Counseling Services for School Children' in April 2020 to help school students across the country share their concerns. This service is provided free of charge across different regions of the country. Live interactive sessions on 'SAHYOG: Guidance for Mental Wellbeing of Children' are telecast at 12 PM on eVidya DTH-TV channels for classes 1 to 12. To handle stress and anxiety, recorded videos on Yoga are telecast through 12 DTH TV channels with effect from September 2020 for classes 1 to 12 and also digital resources are made available in digital platform DIKSHA.

Under the aegis of the School Health Programme under Ayushman Bharat, the NCERT has developed a comprehensive package titled "Training and Resource Material: Health and Wellness of School-going Children. A specific module has been included on "Emotional Well-being and Mental Health", which has activities related to the mental health and well-being of students and teachers.

Compiled by: Annesha Banerjee & Anuja Bhardwajan Source: PIB/World Bank/ WHO/ National Health Mission