“I want to tell my countrymen that depression is not incurable. There is a need to create a psychologically conducive environment to begin with. The first mantra is the expression of depression instead of its suppression.” That was Prime Minister Modi speaking on Mann Ki Baat, last March. He addressed the issue of mental health in India with a focus on depression.
Later on in the address, he said, “Your friends, your family, your surroundings, and the environment, all these can prevent you from going into depression and if you, unfortunately, have gone into it, they can also pull you out.”
The term ‘environment’, which Modi used in his speech, is used commonly enough while talking about mental health. But it is not always scrutinised thoroughly.
In psychology, ‘environment’ constitutes everything (all external factors) around us that isn’t genetically inherited. Psychologists thus encourage a psychosocial perspective while addressing mental health.
In everyday usage, the ‘environment’ is often assumed to be something personal, related to the individual himself. Modi seemed to take this line of thought in his speech as well. After speaking about the ‘environment,’ he went on to say, “Share openly what you are going through, with your colleagues, friends, parents, brothers, and teachers. Sometimes one is overcome by a sense of loneliness…”
But what about the environment which includes politics and government policy across sectors, their implementation and their failures? These policies can impact one’s physical well being and eventually one’s mental health. Thus, it is not comprehensive enough to look at mental health only as a pathological entity caused by internal and personal issues.
Last March, the Parliament successfully passed the Mental Healthcare Act, which is expected to come into effect soon. It has been a year since this encouraging development for the mental healthcare movement in India. Apart from the mental healthcare act, the NDA government has also brought in the mental health policy in 2014. India thus had a mental health policy even before a general health policy which came only last year.
So while the right kind of noises are being made politically and in policy, what about the inverse relationship– how do policies and politics impact a citizen’s mental health?
In 2011, Rachel Jenkins, professor of epidemiology and International Mental Health Policy in King’s College London, along with four fellow contributors, wrote a paper that addressed the political challenges to global mental health. The analysis focused on low and middle-income countries and looked at the impact of non-health sectors on developing sustainable mental health. The paper concluded by calling for the mental health paradigm to be viewed in collaboration with sectors like education, social welfare, employment, social, agricultural, business development sectors and the criminal justice system and for a strong interventional structure based on mutual dialogue.
Job crisis affects school exam stress
The Mann Ki Baat episode was aired last March, during the time of school exams. In fact, Modi began his address by speaking to parents who must be under “pressure” for their children’s exams. This February, Modi released a book, Exam Warriors, to help children with their exam stress.
In his speech, Modi mentioned the stress of students particularly, and said: “Sometimes one is overcome by a sense of loneliness… students living in hostels are particularly vulnerable to it. We are fortunate that we have been raised in joint families, large families, where there is communication, which eliminates the chances of getting into depression.”
The staggering rise of 175% in the cost of a single child’s school and college education, between 2008 and 2014, has a strong bearing on their future pressure to find well-paid jobs. Credit: PTI
Though stress from academic lives was a concern, there was no mention of the backgrounds and contexts of these ‘stressors’– a term used by mental health professionals to describe the agents that cause stress in a living being.
Any discussion on parental pressures on students to do well in school needs to be seen within the dimension of societal class. Parents worry about their children’s performance in school, their college prospects and finally their job prospects, incomes and other materialistic dignities.
The staggering rise of 175% in the cost of a single child’s school and college education, between 2008 and 2014, has a strong bearing on their future pressure to find well-paid jobs. But jobs are in short supply, with the current government’s record reaching an eight year low on job-creation, leading to the phenomenon of ‘jobless growth.’
But while discussing the stress of school exams, the job crisis did not feature in the prime minister’s talk.
School children graduate with their stress, and take it into Indian universities. A study published in the Asian Journal of Psychiatry found about 37% of Indian university students suffering from moderate depression.
The suicides of Dalit university students– Rohit Vemula and Rajni Krish– raised important debates about the role that government aid has in affirming the lives and struggles of marginalised university students.
Links between marginalised groups, mental health, suicide and governance
There is a complex relationship between suicide and mental health. Though a major number of people suffering from mental illness do not commit suicide, a large number of suicides are due to untreated mental health issues. Suicide isn’t always a result of a diagnosed mental illness but is accompanied by a grave amount of emotional distress which fits the spectrum of mental health issues faced by any individual.
The widespread phenomenon of farmer suicides over years shows that the profession of farming has specific factors which put them at risk of suicide. Debts and loans have been identified as a key reason for farmer suicides by Indian government data. And these are, of course, the result of government policies.
If government policies can cause stress on farmers, then should the solution come from mental healthcare practitioners, laws and policies, or from other government policies?
Some studies say the solutions to these mental health problems lie elsewhere in the mental health paradigm. One paper published in the Indian Journal of Psychiatry on farmer distress suggests preventive measures by political administration over mental health intervention: “There is a certain folly in suggesting a mental health professional’s role; can such a professional go from farm to farm each season that crops fail to offer antidepressants and psychotherapy to farmers whose families face financial ruin? This is not to say that such secondary and tertiary prevention interventions are useless; rather, it is more important to address the root cause of the problem as a step toward primary prevention.”
Suicides in another marginalised group could also be an area for further study. Self immolations have been reported in the denotified Pardhi tribal community in Madhya Pradesh and Maharashtra by youth and women, allegedly due to harassment by the police. It has been reported that this is amidst a devastated livelihood that offers no space to explore work or resources.
Following the death of Dalit scholar Rohith Vemula at Hyderabad Central University, columnist Manu Joseph asked if these suicides were due to depression or oppression. He posited them as separate things, when they can in fact be linked and even simultaneous. His column assumed that one’s mental health is one’s own doing, free from external influences of power, or in his words, “oppression.” Many educational institutions claim to provide “inclusive education,” when in fact, their structures need to be inspected– when do these institutions fail, to what extent? How do those failures precipitate instability in mental health? The power and politics of these structures need to be examined for their impact on mental health.
Although factors like bankruptcy, police violence or bigotry cannot be tangibly held accountable for driving farmers, oppressed communities or students to their demise, these need to be seen as triggers that contribute to the ‘political environment’ of stress in mental health.
Politics, policies and mental health
India doesn’t conduct polls and surveys of this nature, but in the US, polls around president Donald Trump concluded that about half of the American population was stressed about his victory in 2016. This was the result of two surveys, by the American Psychological Association and The Washington Post.
In India, as in other parts of the world, social and communal conflict create deep and long lasting trauma with victims and survivors. Research in India after the Gujarat riots, for example, showed that survivors felt individual and interpersonal trauma. If communal violence and its political motivations can impact mental health, it is time they are recognised as factors that affect our psychosocial ‘environment’.
Some lessons can be taken from the United Kingdom’s Behaviour Insights Team led by David Halpern. In an article, he calls for inclusion of behavioural economics in policy making and explains how his team invites psychologists, policy makers and economists to bring in findings from social psychology and economics into public policies. The team has worked on sectors like labour and employment.
A person’s mental health does not operate in a vacuum that is so deep and internal that external factors do not penetrate it. While the government has embarked on mental health policy measures, targeting specific mental health areas, it needs to look at other factors in the broader ‘environment’ which also covertly impact mental health.
In a developing country like India, with growth happening in many simultaneous directions, a 0.07% budget allocation to mental health is vastly insufficient if mental health needs to be understood as a truly ‘environmental’ issue.
While the government has recognised the need for mental health intervention over the last two years, it’s high time that it also includes its own role as an influencer in a citizens’ psychological well being.
Prateek Sharma is a student of psychology, a researcher and a mental health activist based out of Chennai working to promote progressive and inclusive mental healthcare in India.