While it is important to treat a person’s physical illness, it’s equally important to pay attention to any mental illness that may accompany it. Prof Dinesh Bhugra, president of World Psychiatric Association, spoke to Priyanka Mantripragadaof White Swan Foundation about India’s challenges, which are the stigma and discrimination against people with mental health issues, as well as the role of key stakeholders in weeding it out. Edited excerpts:
What challenges do people with mental illnesses and their caregivers face in society?
I think one of the major issues is access to treatment – where do you go for treatment and who pays for it. We know that there are a lot of social factors which cause mental illness and once you develop mental illness, there are lots of sequelae of mental illness. For example, people who have mental illness quite often lose their jobs. They may have to move house, they may lose families. What we need to bear in mind is that human beings are social animals and by developing a psychiatric disorder, quite often they get rejected by the family, by society as a whole. And it affects their self-esteem and social functioning.
How are their lives impacted by these challenges?
The major issue for patients with any illness, whether it is psychiatric or physical illness- is that you want to have a reasonable standard of living, you want to have a job, you want to be busy, you want to have a house, you need to have a set of friends, and you need to have a family. But one of the biggest challenges for psychiatric patients is the stigma which prevents them from engaging and re-engaging with the society.
Are there countries that have successfully overcome stigma?
I don't think there is any country in the world where it is perfect. Each country has its own challenges, and challenges depend upon money being invested. My understanding is that in India, for example, less than one percent of the country’s GDP is spent on health. Of this, less than 10 per cent is spent on mental health, if that. Whereas in other countries like America for example, 21 per cent of the GDP is spent on health; in UK and large parts of Europe, it's between eight and 10 per cent. So it is a question about resources and also, it's about where the money is spent in terms of mental health – whether it is spent on asylums, in hospitals, or in the community; whether on public mental health, and teaching people how to look after themselves better.
How do we weed out stigma in India?
Like in any other society, India faces its own challenges. It's a culture in transition. The traditional models of family are changing. More and more people are moving into urban areas. If we look at the patient at the centre of the need for treatment, they are surrounded by their family and kin who are the key stakeholders, because they want their loved ones to be better and function independently. That, surrounded by the larger society which is represented by politicians, policymakers, professionals, leaders - whether they are community leaders, religious leaders or teachers. So there is a whole group. And it is worth bearing in mind that health, and particularly mental health, is everyone's business.
How can psychiatrists help build awareness?
One of the major challenges for psychiatrists is that we have to advocate for our patients. By and large, psychiatric patients do not have a voice. So they need people to stand up for them and say, “This is what is needed.”And one of the ways that psychiatrists can do this is by talking to politicians and other professionals, letting them know that patients need right intervention at the right time and at the right level. We know that if you have diabetes and you develop depression, both your diabetes and depression will get worse. We know that if you have high blood pressure and depression, your high blood pressure will be difficult to control. So, the physicians and surgeons need to know how to identify the depression, and work with psychiatrists in treating depression and other psychiatric disorders.