Introduction

Antara's work is based in South 24 Parganas district of West Bengal, a state in North East India.

West Bengal borders with Bangladesh (East) and Nepal (North West) and Antara receives patients from these countries and from other states in India. West Bengal is the most densely populated state in India and 32% of its population is below the official poverty line.(1)

This page provides the context for Antara's work by describing national and regional realities of mental illness, mental healthcare and their associations with poverty.

India has a large burden of disease from psychiatric disorders which is inadequately met by a poorly funded mental healthcare system. However, it has a National Mental Health Programme which has made some positive moves towards less institutionalised and community based care.

Burden of Disease

Overview:

An estimated 66.6 million people (c.5% of the population) are affected by major and treatable mental illnesses or neuro-psychiatric disorders, in India. (2)

Note: The 'Burden of Disease' is often measured in Disability Adjusted Life Years (DALYs) which combines both mortality (Potential Years of Life Lost - YLL) and morbidity (Years Lived with Disability - YLD).

Mortality (deaths)

Suicide is the leading cause of death in young men in India and causes c.120,000 deaths every year.
Research has demonstrated financial concerns are a major risk factor for suicide and clusters in rural, deprived areas following changes in markets or productivity, have made media headlines.

Morbidity (Illness and disease)

Common psychiatric disorders, serious and enduring mental health problems and substance abuse are all prevalent in India. Approximately 1% of the population has a serious mental illness and c.0.5% of the population (5 million) require active treatment. (3)

• Over 3 million people are affected by Schizophrenia or psychotic disorders.
• Over 16 million are affected by mood disorders (depression and bipolar disorder).
• 10-80 million are alcohol dependent (2), 8 million by cannabise abuse and over 3 million are affected by opiate abuse.  (2)
• Over 25 million children and adolescent are affected by mental health disorders.
• Over 1 million have severe learning disabilities.

Healthcare

Less than 1% (0.83%) of India's total health budget is spent on mental healthcare.

There are  2-3 psychiatrists for every million of the population (compared to 50-150 million in Highly Developed Nations).

Government mental healthcare in West Bengal has been critcised as "inaccessible or unavailable to many ...[with] mental health and care-seekers, due to a lack of adequate resources". (3) The number of beds has failed to keep pace with rapid growth in the population.

Antara is one of a handful of NGOs which provide a valuable and substantial adjunct to the government mental health services. (3)

On the other hand India has had a National Mental Health Programme since 1982 which has sought to implement changes which the World Health Organisation has endorsed for all countries. These changes include a move away from custodial and institutionalised responses to therapeutic and community-based ones. Attempts have been made to use India's informal healthcare network by employing village (lay) health-workers and a District Mental Health Programme (piloted in 1996-1997) is being expanded.

Connections with Poverty and Specific Issues

General Connections

As in other areas of the world, mental illness has been associated with poverty in India.

• Schizophrenia: Studies have demonstrated poverty, stigma, single marital status, poor access to healthcare and social isolation are risk factors. (2)
• Substance abuse: One study in India found 26% of  slum-dwellers were substance abusers. (Mohan D et al, 1992)
• Learning Disabilities: Strong risk factors include poor access to maternal health services, neonatal infections, birth trauma, infections of the nervous system and poor nutrition.

Gender Inequalities

Gender inequalities are strong in West Bengal and some other parts of India. Health and development organisations now that women are the key to the health of children and families as a whole, so mental illness in women has a particularly strong impact.

Studies have demonstrated the women also develop mental health problems because of their social (and economic) disadvantage. Domestic abuse is strongly correlated with poor mental health. It is estimated that 75% of deaths in young women 15-24 year are due to suicide.(2)

Economic transition and rural-urban migration

Just as in other areas of the world (e.g. Eastern Europe) which have experienced major economic transitions and socio-political changes, India's changing society has created new risk factors for mental health including social isolation and rural-urban migration. Studies have demonstrated increased rates of anxiety and depression in those who have migrated to urban areas. (2)

Natural Disasters

India and the sub-continent have suffer a number of major natural disasters every decade. West Bengal and surrounding countries or states (e.g. Bangladesh and Orissa) are especially prone to the effects of cyclones. 

Natural disasters create their own mental health burden both in terms of immediate trauma and longer-term effects of economic crisis and societal disruption. One study found rates of Post Traumatic Stress Disorder in  56% of the population after the Gujurat earthquake and a general increase in psycho-pathology of 20-24%. (2)

References

(1) Gvt of West Bengal (2004) "West Bengal Human Development Report 2004: Introduction and Human Development Indices for West Bengal", Development and Planning Department, Government of West Bengal (May 2004).

(2) Gururaj, G., Girish, N., and Isaac, M.K., (2006) "Mental, neurological and substance abuse disorders: Strategies towards a systems approach", NCMH Background Papers·Burden of Disease in India, Departments of Epidemiology and Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore.

(3) Kumar Das, A., (2006) "Role of NGOs and Voluntary Societies in Mental Healthcare in West Bengal: A critical Appraisal", Centre de Sciences Humaines and Delhi School of Economics. Emerging Health Challenges and the Response of the Indian Healthcare System.