Mental Health & Well-Being for All A Global Priority

Upmesh K.Talwar Madhur Mrinal

10th October is observed as 'World Mental Health Day' every year to raise public awareness about mental health, mental illnesses, and associated disorders. The day was first observed on 10th October 1992 on the clarion call of the World Federation for Mental Health (WFMH). According to an estimate by the World Health Organization (WHO), 450 million people suffer from mental disorders in the world. One in four people in the world is affected by mental or neurological disorders at some point of time in their lives. Hence, health encompasses spiritual, mental, and social dimensions, apart from the physical aspect. In the words of the WHO, "mental health and well-being are fundamental to quality of life, enabling people to experience life as meaningful, become creative and active citizens."

Mental Well-Being: A Global Priority : This year, the central theme of the World Mental Health Day is 'Mental Health & Well-Being for All: A Global Priority'. The world is currently witnessing the aftereffects of the corona virus pandemic, wars, displacement, and climate emergency, all of which have consequences for the well-being of the human race. Earlier, mental health was not considered a priority by the governments of the world. Stigma and discrimination deterred those suffering from mental health issues to access appropriate care and seek social inclusion. However, research provided the world with credible information that it was possible to treat mental health issues with both general as well as targeted, evidence-based interventions. Such interventions could improve outcomes for individuals across the spectrum of mental disorders. This led to the realization that awareness and sensitization played a crucial role in preventing mental health issues and facilitating timely interventions. Today, the governments are working in close association with other stakeholders in effectively implementing universal preventive measures to reduce risk of mental ill-health. This may include the promotion of social inclusion policies, support and direct investment for vulnerable populations and investment in communities and young people to reduce crime. There is a growing urge to support wellbeing interventions across the life span, from pregnancy, birth, early childhood, early teens, and adulthood to older adulthood. Efforts are also being made to improve the socio-cultural determinants of health and address them appropriately for reducing mental health stigma and discrimination.

Mental Health and Sustainable Development:  The 2030 Agenda for Sustainable Development and Sustainable Development Goals (SDGs) were adopted by the UN General Assembly in 2015. These cannot be achieved unless we make a meaningful investment in improving mental well-being for all. The COVID- 19 pandemic has shown that many of our health systems are illprepared to deal with the physical and mental health challenges. Employers generally are not well prepared. There is a need to establish global mental health and well-being targets that can bring together evidence that captures the social determinants of health, including promoting exercise, widening access to good nutrition and food, all of which will have a positive impact on mental health and well-being. The mental health and well-being of many health, social care and frontline workers has been affected by the pandemic and systems need to be strengthened to better support such staff during times of crisis and challenge. The COVID-19 pandemic exposed how nations were ill prepared for the associated mental health crisis triggered by the pandemic.

Mental Health, Society and Citizens : Civil society's role needs to be enhanced and enabled so that people can make their own contribution to mental health and well-being in their communities and workplaces, including harnessing peer support. Collaboration between governments, citizens and planners needs to be strengthened. Policy change is often seen as a tool to deliver care packages, but this should not be the case. Policies should be regarded as care packages. The international community and those who pay for services need to understand this so that we can develop concerted processes that deliver mental health and well-being to all. No community and no individual should be left behind.

Government Initiatives for Mental Health : The Mental Health Care Act2018, subsequently, Ayushman Bharat, Health and Wellness Centers, Manodarpan (an initiative to provide psychosocial support to school students), SAMVAD (National Initiative & Integrated Resource for Child Protection, Mental Health, & Psychosocial Care) and Stree Manoraksha are some recent initiatives of the Government of India to promote mental wellbeing of Indian citizens. The Mental Health Care (MHC) Act came into being in May 2018. The MHC Act-2018 guarantees to every person with mental illness, the right to access mental healthcare and treatment facilitates without any discrimination. It aims to make mental health care services affordable for the 1.3 billion people in our country. It promises to facilitate the best treatment and facilities, along with promoting and protecting the rights of individuals with mental illness. This act empowers the government to set-up the Central Mental Health Authority at National level and State Mental Health Authority in each state. Every mental health institute and other mental health practitioners including Psychiatric Social Worker, Clinical Psychologist and Psychiatric Nurse have to register as mental health professionals under this Act.

National Mental Health Program (1982): Government of India has been implementing National Mental Health Programme (NMHP) since 1982 to ensure the availability and accessibility of minimum mental healthcare for all with its key implementation unit- District Mental Health Programme (DMHP). The aim is to integrate mental health care into primary health care and to proceed towards community health care. The NMHP is inclusive in nature and incorporates an integrated, participatory, rights and evidencebased approach. Mental health issues are addressed in a comprehensive manner to address medical and nonmedical 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.

District Mental Health Programme (1996): The Ministry of Health and Family Welfare formulated the District Mental Health Programme in 1996. The District Mental Health Programme ventures to bring mental health care to the disadvantaged sections and rural areas of the society. The DMHP aims to provide mental health services to the community and also integrate these services with other services; early detection and treatment of the patients suffering from mental illness within the community itself; providing services such as hospitals and nursing homes in cities for avoiding travel to long distance for treatment; rehabilitate patients discharged from the mental hospital within the community

Ayushman Bharat and Mental Health : Mental healthcare services have been added in the package of services under Comprehensive Primary Health Care in the Ayushman Bharat - Health and Wellness Centers (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. Ayushman Bharat offers up to Rs 5 lakh insurance cover and for the first time, mental illnesses have been covered by insurance. It has 17 packages for mental health disorders, which also includes psychoactive substance use. But insurance facilities are applicable to public sector hospitals only and not private hospitals whereas, for other medical disorders, it covers treatment in private hospitals also.

Mental Health and Students : Project Manodarpan was announced to provide psychosocial support to students, teachers and families for mental health and emotional well-being during the COVID-19 outbreak. It is an initiative of Ministry of Education which aims to address the mental health and psychosocial aspects through counseling services, online resources and help line. The NCERT started a programme on "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. Recently Manodarpan released its report, Mental Health and Well-being of School Students - 2022, based on a survey of 3,79,842 boys and girls students of 6th to 12th class on issues impacting their mental health. Moreover, the NCERT has developed a comprehensive package titled 'Training and Resource Material: Health and Wellness of Schoolgoing 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. It aims to provide psychosocial support to students, family members and teachers for their mental health and well-being.

Mental Health and Children: The Ministry of Women & Child Development (MWCD) supports the SAMVAD (Support, Advocacy & Mental Health Interventions for Children in Vulnerable Circumstances and Distress). It is a national initiative and integrated resource for child protection, mental health, and psychosocial care and is located in National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru. The SAMVAD team provides assistance for training and capacity building support to various State child protection and mental health systems. Recently, they have focused on supporting child care service providers in child care institutions, schools, secondary health care facilities and vulnerable communities, to address psychosocial and mental health issues in the context of COVID-19.

Mental Health and Women: The Ministry of Women and Child Development launched the 'Stree Manoraksha Project' on 2nd March 2022 in collaboration with NIMHANS, Bengaluru. The project aims at improving mental health of women by enhancing the One-Stop Centers (OSC) across India particularly for those who have experienced violence and distress, and needed to be dealt with compassion and care.

Digital Interventions in Mental Health Care Delivery: Considering the after effects of the COVID-19 and its impact on mental health, the Telepsychiatry Operational Guidelines were formulated as part of the Telemedicine Practice Guidelines 2020. The guidelines lay the rules for treatment of mental illnesses and associated disorders via electronic mode of communication between patient and doctors/therapists. Tele-psychiatry is a practice of psychiatric care using data or interactive digital audio and video communication. It can also be defined as the application of information and communication technology to provide psychiatric care. Telepsychiatry services may include a broad spectrum of clinical, preventive, diagnostic, and therapeutic care provided to remote users based on Telemedicine Practice Guidelines (2020). Telemedicine Practice Guidelines (2020) were jointly developed by Indian Psychiatric Society (IPS), the National Institute of Mental Health and NeuroSciences (NIMHANS) and Telemedicine Society of India. These have added novel aspects of care in mental health. These guidelines inform psychiatrists on starting, establishing, executing and maintaining the provision of tele psychiatry services providing organisations, institutes, clinics or hospitals.

The guidelines divide medicines which can be prescribed through tele-consultation in four groups- O, A, B and C-list. List O, A and B are over-the-counter medications. List-C is prohibited for online prescribing. List-A medicines are relatively safe and have low potential for misuse and it needs a live and simultaneous video consultation. List-B medicines are described as 'add-on' medicines employed to optimise a psychiatric condition in the patients.

Yoga and Other Ways Mental Health professionals recommend various plans or activities, including Yoga to improve mental health. Yoga camps, walkathon and rallies help educate the general public about mental health, improve existing mental health institutions; enhance support of voluntary organisation for rehabilitation and reduce discrimination with people suffering from mental health issues.

Conclusion Sound mental health is a prerequisite for a healthy and purposeful life. Therefore maintaining good mental health and treatment and management of mental health issues are of utmost importance for the well being of the individual and the society.

(Upmesh K. Talwar is Assistant Professor (PSW), Department of Social work, M. G. Central University, Motihari, Bihar. Madhur Mrinal is a PhD Scholar, School of Medical and Health Sciences, Bangor University, Wales, United Kingdom. They can be reached at mdm21rbc@ bangor.ac.uk and talwarmsw@gmail.com respectively).

Views expressed are personal.