Mental health is a massive issue that a large chunk of global population deals with. In India, the problem is massive as well and often results in various social problems. Is India’s mental health problem not resolvable?
Indian society suffers from a large base of population troubled by problems in regard to poor mental health. About 13% of the Indian population is, according to reliable sources, the proportion of the population suffering from mental illness. And then there is the huge section of the population that is not mentally ill but is not characterized by the pink of such health.
All mood disorders – be they simple clinical depression or manic disorders – result in a lowering of capacity to function given that the mood may be too high or inappropriately or totally low. These afflictions result in either zero decision making power or extremely impulsive decision making resulting in financial losses and quarrels. Bipolar decisions have their origins in genetic composition, about which we still have a poor idea, interacting with the outside environment. Mood or other mental disorders also result in poor performance at school or at the university level, with damaging implications for the financial prospects of the concerned individual.
Thus, we have two possible scenarios confronting the concerned patient: he/she gets suitable treatment from a well-appointed psychiatrist and this prevents her from losing too much of present or future income; she might not be encouraged or persuaded to seek treatment, in which case she goes undiagnosed and therefore untreated for a long term time period with the result that targeted government programmes do not show any significant beneficial outcomes such as a significant increase in income from baseline levels or that in the level of human capital.
But individuals themselves are not to blame for their own afflictions. Given that any clash between the said gene and the circumstances in which the individual, mere carrier of destiny that he is, adopts the blamed behaviour, different psychiatrists of course would interpret the mood disorder in different ways. The diagnoses of the concerned individual and those that preceded him should be merely used to seek the best possible cure according to the Hippocratic oath, not used to keep the individual languishing in an affliction of lower or moderate-intensity assuring the doctor of a steady source of income and but affording only a tarnished conscience.
Consider the following example: an individual might be actually suffering from bipolar disorder but it is interpreted as the individual suffering from acute mental clinical depression, given that he is currently located at the lower level of the bipolar pendulum. This is a wrong diagnosis akin to a wrong deduction. Whenever the psychiatrist is unable to provide an interpretation that helps even though the same medicine has been administered to the patient for long periods of time, he/she and the patient’s guardian must retreat, taking the patient to a different psychiatrist or providing a change of medication through the current psychiatrist.
The role for information, in this case, is massive: humans change doctors based on information from other families. But as we have seen, there is a stigma around mental disorders. This makes it difficult for the adults in a family to disclose their familial incidence in this regard to other families, let alone compare notes about doctors. Once this notion about ‘stigma’ associated with a mental illness goes there is bound to be more information flowing about psychiatrists: their flexibility in changing medications if the initial medications do not work; the overall effectiveness of medications; and the amount of the time they spend in reassuring parents of patients etc.
The moment heads of families share these notes, the propensities supporting a higher quality of care and medicine are set free to attain hitherto unreached heights, with a producer’s market converted, albeit partially, to a buyer’s market. Heightened competition among doctors, the producers of health care, would give rise to a lower price of consultation and a higher average quality of mental health care.
Treatment is however only part of the whole chore of managing mental problems. Physical exercise is a must. In Denmark people come together in rooms or rendezvous that are well maintained and are characterized by slow music and the gentle flicker of lit candles – the idea is to effect mental rejuvenation. The government also has the option of coming down heavily on those whose who create noise pollution in the presence of legislated noise barriers.
The reduction of crime has the implication of loosening people onto the streets resulting in better buys from vendors and greater physical exercise, with possible positive implications for physical health. People have according to Prof. Paul Dolan of the London School of Economics, the right to design their life to take their happiness to satisfactory levels by taking account of the benefits accruing to them of pleasure and purpose.
But past studies of levels of happiness and mental illness can take account of what macro-econometric studies tell us: Muslims with their higher levels of internal networking have propensities to acquire higher levels of happiness; urban populations marked by higher competition and a greater propensity for change lead to less happy individuals. The above deduction has major implications for the design of society to enhance happiness.
In other words, the following are needed for a higher incidence of mental wellbeing in society: a change in the incidence and nature of incentives facing the psychiatrist and the consumer; and a redesign of activities by the man on the street, some of them targeted at other humans.
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(Siddhartha Mitra is Professor of Economics at Jadavpur University, Kolkata.)
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