Mahatma Gandhi once said, “A nation’s greatness is measured by how it looks after its weakest members.”
As the long-awaited Mental Healthcare Bill is debated in the Rajya Sabha, it is interesting to consider the state of care in Bihar. Bihar has seen great leaps forward in recent years towards helping those in need, with a growth strategy which prioritises development. However, mental healthcare is one area where perhaps progress is being made at a slower pace. But why should we focus on mental health? Widespread stigma around mental illness may lead many to wonder whether there is a need for mental health care in Bihar at all. The answer is unequivocally yes.
There is plenty of evidence to show that mental illness is common worldwide, and Bihar is no exception: as evidenced by the large numbers of people accessing existing services. But these services are limited. At present there is only one specialist hospital for mental health in the entire state, and amongst state health facilities only Medical College Hospitals provide mental healthcare. None of these hospitals provide any psychosocial therapies – increasingly seen as the gold standard elsewhere in the world. Furthermore, medications prescribed are often unavailable at Medical College Hospitals so patients are required to purchase them from private pharmacies. To understand why this is so problematic it is important to understand what is meant by “mental illness”.
Mental illnesses are wide-ranging: from those that are common such as depression, anxiety and addiction, to those that are more severe like schizophrenia and bipolar disorder. They are thought to be caused by a combination of biological, social and psychological factors, therefore anyone can be affected. However episodes of mental illness can often be transient, and with appropriate care those affected can live normal lives. But due to the combination of possible causes, social and psychological interventions can be just as important as medication.
Improvements in care are important because there is a vicious cycle between mental illness and poverty. Poverty is a significant social risk factor for mental illness, and those with mental illness are more likely to experience poverty due to problems such as unemployment. Many people with mental illness must travel extremely long distances every month, sometimes for many years, to access care. This is not only difficult due to the illness but also because of the cost. Understandably, it often leads to people stopping treatment early or not taking medications regularly.
A common misconception is that care is unaffordable; in a state like Bihar there are limited resources so basic needs must be prioritised. Actually, a new model of health care is being developed, specifically to address this problem. Non-specialists are trained to provide care within communities, and only those who do not respond to conventional treatments or have a severe illness are referred to a specialist. To those keen on implementing the Western model of specialised care, this may seem concerning. However there is a vast amount of research, including a number of studies in India, to show that this is effective. In fact, this model is likely to be outlined in the new District Mental Health Plan.
Furthermore, state provision of treatments may actually be cost-effective due to an increase in productivity of those receiving treatment. An NGO treatment programme for mental illness in Bihar demonstrated an improvement in employment status, reduced number of days out of employment due to illness, and reduced requirement of number of hours of care provided by a caregiver.
Internationally India is considered a pioneer among low and middle income countries in identifying the importance of mental health. With the Mental Healthcare Bill announcing governmental responsibility to provide care, perhaps it is time that Bihar incorporates treatment of mental illness into its development strategy. The launch of the new District Mental Health Plan provides an ideal opportunity. And with special status, central government sponsorship will be increased substantially. The fate of thousands suffering due to difficulties in accessing care may be about to change.
Prianka Padmanathan is a final year medical student from the United Kingdom who is doing a short student placement with BasicNeeds.