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LATEST NEWS UPDATES | Mental illness, a secret often hidden away in urban families -Johnson TA

Mental illness, a secret often hidden away in urban families -Johnson TA

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published Published on Jun 19, 2013   modified Modified on Jun 19, 2013
-The Indian Express


Last October, authorities in the north Karnataka city of Davangere rescued a 37-year-old man whose family had walled him into a room, with only a tiny window for ventilation, for 10 years after he had begun showing signs of schizophrenia.

This month, authorities in Bangalore rescued a 35-year-old woman whose parents are said to have confined her at home for over five years after she showed signs of possible mental and physical illness, and a 91-year-old whose son had chained him to a room following signs of mental illness.

Family and community structures once formed the informal first layer of mental healthcare in India. With these structures changing under the influence of urbanisation, and with formal mental health care support systems not keeping pace, families are choosing to hide such problems away in their homes, according to experts at the National Institute of Mental Health and Neurosciences (NIMHANS).

"You would expect greater awareness and lower stigma in urban areas for mental healthcare, but what we have found is that people tend to use the anonymity offered by cities and changing community structures to hide away illnesses," says Santosh Loganathan, associate professor of psychiatry at NIMHANS and author of papers on mental health stigmas in urban and rural settings.

"What is happening in the country, I think, is that there were certain institutions that were taking care of mental health in a very informal way. We had large families, and there was possibly enough support within the family for taking care of the ill. We also had well-knit communities and some kind of compassion and care. These are dwindling and we do not have another approach in place," says Pratima Murthy, professor of psychiatry at NIMHANS and co-author of Mental Health Care and Human Rights.

She cites a 2001 incident in Erwadi in Tamil Nadu, where a fire accident killed 28 persons with mental illnesses who had been chained at a faith healing facility, as an example of the community failing the mentally ill. And the recent incidents in Bangalore, she says, are examples of families failing them.

She stresses the importance of families as a support source. "If we don't support families in looking after their own, then they don't know how to handle these things, or they don't know these things are illegal. It ends up in negative publicity. The danger of not supporting families is to end up with very cold, formal social security systems like in the West."

Mental healthcare has progressed in terms of outcomes of treatment, the experts say, but awareness has not grown comparably. "Mental health problems are treatable these days but this message has not travelled far and wide. Mental healthcare is no longer sanatorium- or asylum-based but increasingly community-based," says Prof Mathew Varghese, head of the department of psychiatry at NIMHANS.

Among the main problems is, according to Murthy, the isolation of mental healthcare from healthcare in general and the lack of enough professionals in the country. According to the 2008 book Mental Health Care and Human Rights, edited and co-authored by Murthy for the National Human Rights Commission, India has over two crore people who need treatment for serious mental disorder and about five crore affected by common mental disorders.

"About 30 to 35 lakh persons need hospitalisation at any time for mental illness. In contrast, there are about 29,000 beds available. This huge treatment gap, with 50-90% people not able to access services, is a serious human rights issue. Stigma-related discrimination faced by persons with mental illness also makes it a matter of deep concern," reads the book.

"Unfortunately what has happened is that there has been no adequate understanding that mental health services can be provided in a wide range of settings. For example you can go to a doctor... People generally equate all mental illnesses with mental hospitals. That is a perception that needs to change," Murthy says.

"In the two cases in point in Bangalore, I do not know what mental illnesses they had, but certainly their families would have benefited from appropriate counselling and the individuals themselves would have benefited," she says.

She cites the lack of a dedicated policy approach to mental healthcare. "We do not have a single agency that addresses mental healthcare. In the new mental healthcare act, there is a provision for a mental health commission, but it is only for legal aspects. What is needed is a mental healthcare division in the ministry that actually pays attention to the needs of people."

According to one of the papers in the 2008 book, there are likely to be 200 million elderly people in India by 2030. "Our public health system often ignores elderly people who are mentally ill and such negligence is a form of elder abuse. Elderly people in poor health are more likely to become victims of abuse... They turn out to be victims of the worst forms of neglect and violation of human rights," states the paper.

 


The Indian Express, 19 June, 2013, http://www.indianexpress.com/news/mental-illness-a-secret-often-hidden-away-in-urban-families/1130687/0


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