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Mental Health Care and Wellness
Last updated on October 10, 2023 by ClearIAS Team
Greater declines in life satisfaction are linked to depression and anxiety than to debt, divorce, unemployment, Parkinson’s disease, or Alzheimer’s disease.
People with mental diseases are subjected to human rights violations all around the world, some of which are as serious as being chained or caged.
Does mental health have a definition?
Also read: Effect of Technology on Children
Table of Contents
Mental health
The World Health Organization (WHO) defines mental health as a condition of well-being in which every person is able to reach their full potential, manage everyday pressures, engage in productive and fruitful employment, and contribute to their community.
A fundamental human right, mental health is essential for socioeconomic, communal, and personal growth. The WHO emphasises that having a healthy mental state involves “more than just being free of mental impairments or illnesses.”
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Peak mental health involves maintaining continual well-being and enjoyment in addition to avoiding active illnesses.
Factors Affecting Mental Health
Our mental health continuum and how it is protected or undermined depends on a number of individual, societal, and systemic factors.
- People may be more susceptible to mental health issues due to personal psychological and biological characteristics like emotional intelligence, substance use, and heredity.
- People are more likely to develop mental health issues when they are exposed to unfavourable social, economic, geopolitical, and environmental conditions, such as poverty, violence, inequality, and environmental squalor.
- Risks can appear at any stage of life, but those that happen during developmentally vulnerable times, notably early childhood, are the most harmful.
- For instance, physical punishment and strict parenting are known to harm children’s health, and bullying is a major risk factor for mental health issues.
- Similar protective factors persist throughout our lives and help us be more resilient. They comprise, among other things, our unique social and emotional capacities and characteristics as well as satisfying interpersonal relationships, high-quality education, respectable employment, secure neighbourhoods, and cohesive communities.
Also read: Is Exam Stress Killing You? Get Expert Consultation Now!
Measures to Support Mental Healthcare Services
In light of the barriers and solutions identified, several broad avenues are initiated to support mental healthcare.
Worldwide initiatives
- Every year on October 10, World Mental Health Day is commemorated with the overarching goals of increasing awareness of mental health concerns worldwide and mobilising support for mental health.
- The 66th World Health Assembly also approved the WHO’s Comprehensive Mental Action Plan for 2013–2020 .
- The WHO launched the Mental Health Atlas in 2017 and updates it every three years.
- It is a compilation of information on global mental health policies, legislation, funding, human resources, accessibility and use of services, and mechanisms for data gathering. It acts as a manual for nations developing and organising their mental health services.
- Globally significant, the Sustainable Development Goals include preventing suicide as one of its goals (SDG 3.4).
Government of India initiatives
- Since 1982, the government has been carrying out the National Mental Health Program (NMHP) to address the enormous burden of mental diseases and the lack of skilled experts in the field of mental health.
- Modernization of State Mental Hospitals and Upgrading of Psychiatric Wings of Medical Colleges/General Hospitals were added to the program’s 2003 re-strategy.
- To provide community mental health services at the level of primary healthcare, the District Mental Health Programme (DMHP) was also introduced in 1996.
- Every affected individual has access to mental healthcare and treatment from programmes managed or sponsored by the government, thanks to the Mental HealthCare Act of 2017.
- The application of Section 309 IPC has been severely narrowed, and attempts to commit suicide are now only punished under special circumstances.
- The Kiran Helpline was established by the Ministry of Social Justice and Empowerment in 2020 to support anyone struggling with anxiety, stress, depression, suicidal thoughts, and other mental health issues.
- The Manodarpan Project is a ministry of education initiative designed to offer kids, families, and teachers psychosocial support for their mental health and well-being amid the Covid-19 pandemic.
- The MANAS (Mental Health and Normalcy Augmentation System) mobile app was introduced by the Indian government in 2021 with the goal of promoting mental health among all age groups.
- The Prime Minister’s Science, Technology, and Innovation Advisory Council approved MANAS as a national programme (PM-STIAC).
Also Read: Mechanisms, Laws, Institutions and Bodies for Vulnerable Sections – Clear IAS
Challenges in Mental Health Promotion
- A high public health burden is a challenge. According to India’s most recent National Mental Health Survey 2015-16, 150 million people need mental health care interventions.
- In India, there are few psychiatrists (0.3), nurses (0.12), psychologists (0.07), and social workers (0.07) working in the field of mental health for every 100,000 people (0.07).
- Public access to inexpensive mental healthcare has been hampered by the low financial resource allocation of slightly over a per cent of GDP to healthcare.
- The poor are also stressed because the majority of mental healthcare is in urban areas and is not available in primary healthcare facilities in rural areas, which increases out-of-pocket expenses. Loss to Economy: Due to delayed or non-treatment of mentally ill persons, there is a loss in terms of human capital and an overall loss to the economy in the form of lost man-days.
- According to the WHO, young adults are more at risk for mental problems. To fully profit from India’s demographic dividend, the government must pay special attention to the mental health of young people given that the majority of the country’s population—more than 50%—is under 25.
- Proper rehabilitation of mentally ill people is required after their treatment, however, this is currently lacking.
- Societal isolation is caused by a lack of knowledge about the signs and symptoms of mental illness, social stigma, and the abandonment of the mentally ill, particularly the elderly and the poor.
- The patient’s current mental condition has become significantly worse as a result of family members’ reluctance to seek treatment for the patient.
- Mental health issues tend to worsen during economic downturns, necessitating extra care.
- It is alarming and a flagrant violation of human rights when mentally ill individuals are exposed to and frequently suffer from physical, sexual, and unjust detention, even in their own homes and mental healthcare facilities.
- By allocating greater resources to the budget, more mental healthcare institutions and associated infrastructure will be built. Adequate professional availability in mental health care.
- For sufferers to get therapy as soon as possible to eliminate stigma and prejudice in society to dissuade people from receiving dubious care from faith healers. For instance, “The Live Love Laugh Foundation” wants to transform how we view mental health, decrease stigma, and increase awareness.
- For more than 51,000 individuals, there is only one primary healthcare facility in India. More funding is required to provide patients with quicker, cheaper, and easier access to healthcare services, as well as training at the grassroots level for ASHA, ANM, and AWW centre staff on how to identify mild to severe mental health issues like schizophrenia, anxiety, depression, and alcohol abuse.
- By establishing self-help groups of carers’ families and NGOs, individuals can engage the community and lessen the stigma associated with mental illness.
- In public healthcare facilities, the provision of services should be sensitive, compassionate, and free from stigma and discrimination. There is a need for police training and sensibilization regarding the identification of acute mental disorders and the taking of necessary action to safeguard the human rights of those who are mentally ill, their families, and their fellow citizens.
- India needs ongoing funding to spread knowledge about mental health and persistent problems related to it.
- People with mental health issues will continue to find it difficult to get the support they need if people continue to see mental illness with dread and resistance. This is because they are afraid of being judged or labelled.
The experts emphasised that there was no reliable database in India and that the delay in care for those with mental illness or intellectual disability and their families increased the burden of disease, disability, and associated treatment costs to the family and to the community as a whole.
All segments of the population’s mental health difficulties can be addressed by the NMHP, National Health Mission , National Adolescent Health Programme, and Ayushman Bharat . But since C OVID-19 has made mental diseases worse everywhere, more needs to be done. The epidemic may be the ideal opportunity to investigate different policy possibilities, such as raising awareness of mental health online.
Article Written By : Atheena Fathima Riyas
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Essay on Mental Health for Students [500+ Words Essay]
January 2, 2021 by Sandeep
Essay on Mental Health: People generally tend to ignore their minds’ health while maintaining physical fitness. Balance of the physical and mental health leads to a fit and sound health system. Emotionally strong individuals have better strength to fight depression, anxiety, stress and negative thinking. People with mental illness show a disturbing pattern of thinking, emotional display and behaviour. Fitness exercises, meditation, yoga and counselling, are great ways to maintain good mental health.
Essay on Mental Health 500 Words in English
Below we have provided Mental Health Essay in English, suitable for class 5, 6, 7, 8, 9 and 10.
“The only journey is the journey within.” – Rainer Maria Rilke
Mental health is the psychological well being of a person. It is the absence of any mental illness. Being psychologically fit means that a person can cope up with stress and perform normal life activities under normal conditions. It is the ability of a person’s mental functioning to work in a productive and useful way.
World Mental Health Day is celebrated every year on October 10th. The day is filled with seminars and debates aimed at increasing awareness about mental health. Numerous investments are also made by people and companies in the treatment and awareness of mental health.
Signs of Troubled Mental Health
A human being needs an average of 7 to 9 hours of sleep a night. But when you are exhausted, and you still can’t sleep, it is a sign that your mental health is suffering. Sometimes overworking oneself can lead to not only physical exhaustion but severe mental exhaustion as well. People develop insomnia (the inability to fall asleep) as a result.
Anxiousness can be another sign. It can often lead to panic attacks and rapidly racing thoughts. Because of this mental pressure, a person can also fall victim to chest pains and problems in breathing. Loss of focus is another symptom of bad mental health. It happens when you feel like there is so much going on in your life at one time, and you start making careless mistakes, thereby losing the ability to focus properly.
Being constantly on edge is another factor. It can be noticed when you’re easily put off by the smallest happenings or comments and get offended and fight with your family members, friends or co-workers. It takes place out of too much irritation that is built up inside. A feeling of disconnect with your loved ones can also have an adverse impact on your mental health. It leads to you feeling lonely and may even sink you into the depths of depression.
Important Benefits of Good Mental Health
Good mental health leads to happiness. It lets you spend more time with your loved ones and pursue your favourite hobbies. You take out time for others as well as yourself. Having stable and well mental health also helps you save a lot of money. You need not pay for doctor visits, psychologist consultations, medicines, etc. Good mental health will leave you feeling energized and full of enthusiasm. You would succeed in doing all your tasks before time with utmost efficiency, productivity and determination.
Things like stress and depression can lead to a lot of fatal health issues and may even result in suicide in extreme cases. Being mentally healthy increases the longevity of your life as you experience more joy and satisfaction. Mental well being also helps us in thinking clearer and uplifts our self-esteem. We may also connect with ourselves spiritually and act as role models to others. We would also be able to help others and not be a mentally draining burden on them.
Issues with Mental Health and Mental Healthcare in India – Explained, pointwise
- 1 Introduction
- 2 What is the status of Mental Health in India?
- 3 What are the harmful effects of poor Mental Health?
- 4 What are the reasons for poor status of Mental Health in India?
- 5.1 Legal Measures
- 5.2 Schemes and Initiatives
- 6 What steps can be taken further?
- 7 Conclusion
Introduction
Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990. Suicides rates in India are amongst the highest when compared to other countries at the same socio-economic level. The latest survey by India’s National Institute of Mental Health and Neurosciences (NIMHANS) found that nearly 150 million Indians are in need of mental healthcare services, but fewer than 30 million are seeking care. This shows several issues with mental healthcare in India including access and social attitude to mental health. The Government has taken several initiatives to improve access to mental healthcare services in addition to gradually changing the discourse on mental health. However, as evident in the data, there is a need for further effort to address the issues.
What is the status of Mental Health in India?
The WHO defines Mental Health as, “ Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in “.
The WHO calls Mental health as a basic human right. And it is crucial to personal, community and socio-economic development.
According to the WHO, mental illness makes about 15% of the total disease conditions around the world. In 2019, India’s suicide rate was at 12.9 per 1,00,000 persons. This was higher than the regional average of 10.2 and the global average of 9.0. Suicide has become the leading cause of death among those aged 15–29 in India.
In 2017, an estimation of the burden of mental health conditions for the States across India revealed that as many as 197.3 million people (~14% of the population) required care for mental health conditions . This included around 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders .
According to the National Mental Health Survey conducted by NIMHANS in 12 States, the prevalence of mental morbidity is high in urban metropolitan areas. Nearly 1 in 20 persons suffer from depression. 0.9 % of the surveyed population were at high risk of suicide.
According to the NCRB data, 1,64,033 people committed suicide in 2021, a 6.2% rise in comparison to 2020.
What are the harmful effects of poor Mental Health?
Impact on Physical Health : A study found that positive psychological well-being can reduce the risks of heart attack and stroke. On the other hand, poor mental status can lead to poor physical health or harmful behaviour. Depression has been linked to many chronic illnesses . These illnesses include diabetes, asthma, cancer, cardiovascular disease, and arthritis.
Impact on Relationships : Mental-health conditions during adolescence and young adulthood can have a significantly negative impact on the development of safe and healthy relationships with peers, parents, teachers, colleagues and partners.
Impact on Productivity : It impacts a person’s ability to concentrate and engage in productive activities.
The WHO Report on Mental Health and Development (2010) highlighted the risks of a cyclical relationship between vulnerability and poor mental health , in which people with such conditions are a vulnerable group subject to stigma, discrimination, violence, marginalization and other violations of their human rights.
What are the reasons for poor status of Mental Health in India?
Lack of Awareness and Sensitivity : In India, mental health issues are not considered as healthcare issues. Any person suffering from mental issues is considered weak. Stigma and discrimination often undermine social support structures. Persons suffering from such issues are often tagged as ‘lunatics’ by the society. This leads to a vicious cycle of shame, suffering and isolation of the patients .
A survey conducted in 2018 showed that while 87% of the respondents showed some awareness of mental illness, 71% also used terms associated with stigma .
Source: WEF
Lack of Mental Healthcare Personnel : There is a severe shortage of mental healthcare workforce in India. According to the WHO, in 2011, there were 0.301 psychiatrists and 0.047 psychologists for every 100,000 patients suffering from a mental health disorder in India. In contrast, the ratio in most developed countries is in excess of 10.
Gap in Treatment : At present, only 20-30% of people with mental illnesses receive adequate treatment. One major reason for such a wide treatment gap is the problem of inadequate resources.
Low budget Allocation : Developed countries allocate 5-18% of their annual healthcare budget on mental healthcare, while India allocates roughly 0.05% (Organization for Economic Co-operation and Development, 2014) of its healthcare budget. This is the lowest among all G20 countries. Despite a rise in mental illness issues, the Union Ministry of Health allocated less than 1% of its budget to directly deal with psychological illnesses in 2022.
Changed Lifestyle : Increased use of certain kinds of social media is exacerbating stress and mental illness, especially among the young people. Social media detracts from face-to-face relationships , which are healthier, and reduces investment in meaningful activities. More importantly, it erodes self-esteem through unfavourable social comparison. In addition, some experts contend that the shift to nuclear families has reduced the avenues of relieving one’s anxieties as family members are not emotionally available at most crucial times.
Income Inequalities : Mental issues are closely linked with poverty. People living in poverty are at greater risk of experiencing mental health conditions. On the other hand, people experiencing severe mental health conditions are more likely to fall into poverty through loss of employment and increased health expenditure.
What steps have been taken to improve Mental Health in India?
Legal measures.
The Mental Healthcare Act, 2017 : The Act makes several provisions to improve the state of mental health in India. The Act rescinds the Mental Healthcare Act, 1987 which was criticised for failing to recognise the rights and agency of those with mental illness. The Act seeks to ensure rights of the person with mental illness to receive care and to live a life with dignity . It provides the Right to Access to Healthcare : Every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate Government. It also empowers person with mental illness to make an advance directive that states how he/she wants to be treated for the illness.
The Act decriminalised suicide stating that whoever attempts suicide will be presumed to be under severe stress , and shall not be punished for it.
Rights of Persons with Disabilities Act, 2017 : The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide an effective mechanism for ensuring their empowerment and inclusion in society.
Schemes and Initiatives
National Mental Health Programme (NMHP) : Keeping with the WHO’s recommendations, the programme was introduced in 1982 to provide mental health services as part of the general healthcare system. The District Mental Health Programme (DMHP) component of the NMHP has been sanctioned for implementation in 704 districts for which support is provided to States/UTs through the National Health Mission.
Facilities made available under DMHP at the Community Health Centre (CHC) and Primary Health Centre (PHC) levels, include outpatient services, assessment, counselling/ psycho-social interventions , continuing care and support to persons with severe mental disorders , drugs, outreach services, ambulance services etc. In addition to above services there is a provision of 10 bedded in-patient facility at the District level.
Generating Awareness : To generate awareness among masses about mental illnesses Information, Education and Communication (IEC) activities are an integral part of the NMHP . At the District level, sufficient funds are provided to each District under the DMHP (under the Non-communicable Diseases flexi-pool of National Health Mission) for IEC and awareness generation activities in the community, schools, workplaces, with community involvement.
Under the DMHP various IEC activities such as awareness messages in local newspapers and radio, street plays, wall paintings are undertaken by the States/UTs.
National Tele Mental Health Programme : The Government has announced a National Tele Mental Health Programme in the Budget of 2022-23, to further improve access to quality mental health counselling and care services in the country.
Kiran : A 24/7 toll-free helpline called Kiran was established by the Ministry of Social Justice and Empowerment in 2020 to offer support to those dealing with anxiety, stress, depression, suicide thoughts, and other mental issues.
Manodarpan : Students will receive psychosocial help as part of an effort under the Atmanirbhar Bharat Abhiyan , with the goal of improving the students’ mental health and overall well-being. Its components include Advisory Guidelines for students, teachers and faculty of School systems and Universities along with families; National level database and directory of counsellors; Toll-free helpline; Handbook on Psychosocial Support etc.
Issuance of Guidelines/Advisories : Guidelines/ advisories on management of mental illness have been issued by the Government. All the guidelines, advisories and advocacy material can be accessed on the website of the Union Ministry of Health and Family Welfare under ‘Behavioural Health – Psychosocial Helpline’.
What steps can be taken further?
There is a need of an urgent and well-resourced ‘whole-of-society’ approach to protect, promote and care for the mental health of people. This should be based on the following pillars.
First , there is a need to address the deep stigma s urrounding such issues which prevents patients from seeking timely treatment and makes them feel shameful, isolated and weak.
Second , mental health should be made an integral part of the public health programme to reduce stress, promote a healthy lifestyle, screen and identify high-risk groups and strengthen interventions like counselling services. Special emphasis should be given to schools. In addition, special focus should be on groups that are highly vulnerable to mental health issues such as victims of domestic or sexual violence, unemployed youth, marginal farmers, armed forces personnel and personnel working under difficult conditions.
Third , Infrastructure should be improved for mental health care and treatment. Innovative models are required to deepen the penetration of services and staff . ASHAs can be trained for this purpose. Community health workers (ASHAs) can not only educate and sensitize women and children about mental diseases but also guide them to reach the right expert in their locality.
Fourth , The above interventions will require enhanced allocation to mental healthcare in the Budget. Substantial investment will be needed to address the wide treatment gap in the health infrastructure and human resources.
Fifth , Careful mapping and research needs to be undertaken to produce quality data , that is essential to understand the size of the problem. This in turn should be utilised to implement a comprehensive approach, supported by heightened political commitment, scientific understanding and a citizen driven movement.
Sixth , the WHO has recommended Three Paths to transformation towards better Mental Health.
Source: WHO
The status with respect to mental issues has worsened since COVID-19 pandemic. The mental healthcare system in India is under-equipped to deal with the crisis. Urgent interventions, in terms of enhanced budget, increased workforce, and improved awareness are necessary to address the challenge.
Syllabus : GS II, Issues relating to development and management of Social Sector/Services relating to Health.
Source : Indian Express , Indian Express , Economic Times , PIB
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National Mental Health Programme - Facts for UPSC
National Mental Health Programme (NMHP) was started in 1982 with the objectives to ensure availability and accessibility of minimum mental health care for all, to encourage mental health knowledge and skills and to promote community participate in mental health service development and to stimulate self-help in the community. As mental health awareness is important for all, so is important for the IAS Exam aspirants.
Why National Mental Health Programme
The need of NMHP has always been felt. The latest Lancet Report’s findings also reflect on the mental health of the people in India. Hence, NMHP is a right step towards mental health support.
Read about mental healthcare in the linked article.
Findings of the Lancet Report [Indian Scenario]:
- 197.3 million people were reported to have mental disorders in 2017.
- 45.7 million people suffered depression in 2017.
- 44.9 million people suffered with anxiety in 2017.
- The contribution of mental disorders to the total Disability-Adjusted Life-Years (DALYs) in India increased from 2·5 percent in 1990 to 4·7 percent in 2017.
- Depressive Disorders – 33.8 percent
- Anxiety Disorders – 19 percent
- Idiopathic developmental intellectual disability – 10.8 percent
- Schizophrenia – 9.8 percent
- Bipolar disorder – 6.9 percent
- Conduct Disorder – 5.9 percent
- Autism spectrum disorders – 3.2 percent
- Eating disorders – 2.2 percent
- Attention-deficit hyperactivity disorder – 0.3 percent
District Mental Health Programme
During IX five year plan, District Mental Health Programme was initiated (1986) based on Bellary Model developed by NIMHANS, Bengaluru.
Components of District Mental Health Programme
- Early detection and treatment
- Public Awareness Generation
Objectives of National Mental Health Programme
- Minimum mental heathcare for all – To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population;
- Application of Mental Health Knowledge – To encourage the application of mental health knowledge in general healthcare and in social development; and
- Community Participation – To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.
National Mental Health Policy
The census 2011 mentioned that around 15.05 lakh Indians were facing some sort of mental illness. The National Mental Helath Policy which was introduced in 2014 aims to:
- Promote mental health
- Prevent mental illness
- Enable recovery from mental illness
- Promote destigmatization and desegregation, and
- Ensure socio-economic inclusion of persons affected by mental illness
- Provide accessible, affordable and quality health and social care to all persons through their life-span within a rights-based frame work
Important Terms Related to Mental Health
- Mental Health Problems – Psychosocial distress, mental illness and mental disability refer to mental health problems.
- Mental Illness – Schizophrenia, Bipolar Disorder, Depression acocunt for mental illness.
- Persons with mental illness – Those persons who have mental illness.
- Persons affected by mental illness – Those persons with mental illness along with their significant others.
FAQ about National Mental Health Program
What are the components of national mental health programme, when did national mental health programme start.
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UPSC Essentials: Case Study of the week- The impact of social media on young India’s mental health
The best things carried to excess are wrong. this is true for social media as well. this case study talks about how social media is impacting the mental health of youth. aspirants may take down value addition points for upsc-cse. don't forget to solve the mcq below..
Articles from The Indian Express fit as case studies or simply as enriching fodder for GS I, IV and Essays. The power of a tool is only as good as how we use it. One such tool is social media affecting mental health especially of youth. We will go beyond the case study to discuss a few things about mental health issues. Articles by Sukriti Chauhan, Shireen Yachu, Virander S Chauhan and Dalbir Singh will be useful.
Case studies are an important part of the UPSC civil services exam, especially the ethics paper. But case studies can also be very beneficial for value addition in the essay, GS mains and interview. With a dearth of examples, try to enrich your answers with articles and stories in The Indian Express .
One cannot deny that Social media has become a daily habit in our lives, especially among youth. Individuals across different age groups use social media platforms for communication and networking. Clearly, there is a growing dependency on social media. What is worrying is that constant use of social media leads to many problems like
—exposure to risky content
—changes in behavioural patterns
—inferiority complex
—cyber-bullying
This results in grave mental health challenges and illnesses.
Impact of social media on youth. It is imperative to address the current challenges to regulate social media use, especially among the young generation.
The Problems
There can be many problems which can be highlighted, but let us focus on three of them-
1. Depression-
According to UNICEF, 1 in 7 Indians aged 15 to 24 years feel depressed. Depression is linked to lack of self-esteem, poor concentration and other maladaptive symptoms, and can lead to difficulties in communication, failure to work or study productively, amplified risk of substance use and abuse, as well as suicidal thoughts. One of the key risk factors for these prevalent rates of depression is social media.
2. Internet Persona-
As social beings, we inherently have a need for social acceptance, and social media often becomes a tool for validation. The number of likes one’s posts or images garners becomes a quantitative measure for many, in relation to their looks, and intelligence, and even extends to their worth as a person. Individuals strive to maintain an ‘internet persona’ which paints a rosy picture of one’s life, using filters to hide parts considered ‘not good enough. Body dysmorphia- It is common among young people and has increased over the past few years. Use of algorithms on these platforms forces people to only watch similar content.
3. Lack of socialization-
Excessive social media use takes time away from doing other things that may benefit your mental health like connecting with others in person, spending time in nature and taking care of yourself.
The Suggestions/Solutions
1. We must take action on mental health seriously and monitor the incidence of psychiatric disorders (like, depression, anxiety) and identify the factors of risk and resilience. Do not shy away from accepting the overuse of social media as the reason behind the psychiatric disorder.
2. There is a need to conduct a disaggregated situational assessment of the diverse young demographic in our country. Such an assessment should keep in mind the differences associated with class, gender and other social factors.
3. Need to focus on socialization in family schools and professional spaces along with physical exercises and meditation. Let us bring ourselves closer to nature and natural things.
4. Need of creating awareness and dialogue that would help in de-stigmatising the issue, in order to allow autonomy for the individual to share feelings in a safe space.
5. Support systems like family and peers, need to be equipped with understanding the factors related to the issue and initiate supportive steps. Family members and teachers are seen as role models. Restricting them from social media will inspire youth too.
6. Additionally, to address the structural challenges, there is a need to reimagine the workspace and educational framework. Social media dependence in such spaces can be reduced to an extent that it doesn’t become addictive.
7. Pragmatic government policies based on empirical evidence, strong political will, social inclusion, mental health literacy, vibrant media and responsive corporate sector coupled with innovative technologies and crowdsourcing could mitigate this apathy.
Beyond the case: The Mental Health Issue
—Mental illness is an amalgamation of biological, social, psychological, hereditary, and environmental stressors.
—The World Health Organization defines mental health as a state of well-being, where an individual realises their capabilities, can cope with the normal stressors of life, work productively, and is able to contribute to their community.
—In India, according to NIMHANS data, more than 80 per cent of people do not access care services for a multitude of reasons, ranging from lack of knowledge, stigma and high cost of care.
—The “Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic” study, published in Lancet public health, has estimated an increase of about 35 per cent in the prevalence of anxiety and depression in India during the COVID-19 pandemic.
—As per the National Mental Health Survey, 2016, the prevalence of mental disorders in the age group 13-17 years was 7.3%. The most common prevalent problems were Depressive Episodes & Recurrent Depressive Disorder (2.6%), Agoraphobia (2.3%), Intellectual Disability (1.7%), Autism Spectrum Disorder (1.6%), Phobic anxiety disorder (1.3%) and Psychotic disorder (1.3%).
—Currently, as per WHO, for 1,00,000 population India has 0.3 psychiatrists, 0.12 nurses and 0.07 psychologists and 0.07 health workers. These reflect an alarming shortage of human resources and a dire need to scale up investment to address the issue.
—Though Mental Health Act 2017 has granted patients the legal right to live with dignity without discrimination, coercion and harassment, the endeavour in this segment is too scattered and lacks focus and coordination. It should be noted that this act envisages the establishment of the Central Mental Health Authority and State Mental Health Authority.
—The Union Budget 2022-2023 took the consideration the issue of mental health, and announced the National Tele-Mental Health Programme in India, for 24*7 free tele counselling services.
—To address the mental health issue promotion of awareness through campaigns, utilising celebrities and social influencers, mobilising the support of NGOs, deeper engagement of local communities and local governments are some of the measures which could improve outcomes.
— An efficient and robust community-integrated model will have the ability to build a response system of cadres of community volunteers and leaders to create ‘safe spaces’. They would build upon locally established peer support networks such as Self-Help Groups (‘SHGs’), activity-based groups, and civil society organizations to provide care.
—It is important that any community-based mental health program provides access to institutional social care benefits by building strategic partnerships with the local governments, panchayats, educational institutions and other stakeholders to enable referrals and access to existing social benefit schemes.
—Prioritizing availability of essential psychotropic drugs at all levels of healthcare.
—The theme of World Mental Health Day 2022 (10th October) is ‘Make mental health & well-being for all a global priority’.
—In 1982, the Indian government launched the National Mental Health Programme (NMHP) to improve the status of mental health in India. It has three components- treatment of the Mentally ill, rehabilitation, prevention and promotion of positive mental health
—WHO’s Comprehensive Mental Action Plan 2013-2020 was adopted by the 66th World Health Assembly. The Mental Health Atlas was launched by WHO in 2017.
—The Sustainable Development Goals target 3.4 and 3.5 talk about reducing mental illness.
—The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution.
Point to ponder: Can you think along the lines of community participation and awareness campaigns that could address the issue of mental health?
Consider the following statements and answer the following questions-
1. The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution.
2. The Union Budget 2022-2023 announced the National Tele-Mental Health Programme in India for 24*7 free tele counselling services.
3. NIMHANS is the apex centre for mental health and neuroscience education in the country which comes out with Mental Health Atlas.
Which of the following statements are correct?
a) 1 and 2 b) 2 and 3
c) 1, 2 and 3 d) Only 2
(Answer in the next article of UPSC Essentials )
( sources: PIB, Mental health in India: Impact of social media on young Indians , Mental health in India: Community-based interventions as the answer to India’s mental health burden )
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How to Tackle Mental Health Issues Before and during UPSC Civil Services exam
UPSC examinations are among the most competitive in the country, necessitating extensive preparation and mental fortitude. Many students’ mental health often suffers as a result of this. One may maintain their composure and avoid becoming overwhelmed by pressure by following the appropriate procedures, getting to the bottom of underlying problems, taking measures, and maintaining a balanced schedule with exercise and a balanced food. This is simply a test after all.
Need to tackle mental health issues
- Competitive examination candidates study hard and for a longer period of time. They could have a variety of health issues.
- Students could also experience long-lasting problems with their physical and mental health.
- Every day, a considerable amount of time is wasted, and over the course of a month, a large quantity of time is lost. Although it’s not always lost time, you must skip some of the unimportant details if you want to succeed.
- Even the brightest lights in the room sometimes have trouble keeping their minds calm and collected while they study for competitive exams like the UPSC exam and admission tests.
Health effects on Aspirants
- For examinations like the UPSC – Exam, the level of competition and the pressure to prepare may quickly send someone into a downward spiral of stress, anxiety, and even depression.
- The majority of students, both sexes, experience eating disorders as they get ready for exams. Extreme actions, feelings, and attitudes related to food and weight are called eating disorders.
- Poor Nutrition and Lack of Exercise: Students who study a lot don’t get enough nutrition and get pale. It has a negative impact on their general health.
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder
- When left untreated, these diseases can lead to major physical and mental concerns that pose a risk to life. Many students do not think they have a problem with their eating issue and do not seek therapy for it.
- If not adequately treated, eating disorders can have a major impact on a person’s health and lead to serious problems like heart disease, renal failure, stunted development, loss of female menstruation, and reproductive system failure.
- Due to the emphasis on “continuous testing,” students may also experience mental health problems including anorexia and other disorders. They experience severe stress. While preparing for examinations, students sometimes have digestive issues. Studies have demonstrated that studying stress might exacerbate problems.
- Chronic heartburn (or gastroesophageal reflux disease, GERD)
- Irritable bowel syndrome (IBS)
- Indigestion/dyspepsia,
- Constipation.
- The most prevalent mental condition among students preparing for exams is anxiety disorders. When worry disrupts your capacity to function, creates a great deal of stress, and fills you with terror, this is when anxiety disorders develop.
- According to several research studies, prolonged sitting can raise your risk of developing obesity and the metabolic syndrome, a group of diseases marked by high blood pressure, diabetes, extra body fat around the waist, and abnormal cholesterol levels.
- It is occasionally noted that students taking competitive exams experience depression. It can occasionally result in additional symptoms or even suicide. Candidates who suffer from depression, a common but dangerous disorder, report feeling hopeless and removed from reality.
- Feelings of sadness or unhappiness
- Change in appetite or weight
- Slowed thinking or speech
- Loss of interest in activities or social gatherings
- Fatigue, loss in energy
- Sleeplessness
- Feelings of guilt or anger over past failures
- Trouble concentrating
- Indecisiveness
- Anger or frustration for no distinct reason
Strategy to Tackle mental health issues before and during UPSC Civil Services exam
The best strategy is to use counselling to address mental health issues while studying for exams. Many institutions provide applicants access to their free and private in-house counselling service, which is provided by trained counsellors and psychotherapists. Academic advisers are in a perfect position to help students find mental health options even if they may not have formal counselling training. Students may self-report behavioural difficulties, or advisors may notice behaviours that might point to underlying mental health problems.
- Proper Rest is Necessary: Sleeping sufficiently is the secret to happiness, assuming there is such a thing. With enough sleep, consciousness and thinking are improved. A 90-minute sleep cycle is typical. The brain typically needs 4-5 cycles, or 6 to 7:30 hours of sleep, to completely recover and be prepared for the next day. Avoid doing anything stimulating right before bedtime, such as studying, watching TV, playing games, etc. This facilitates the body’s transition into sleep state.
- Have Faith in Yourself: You can never experience the flavour of achievement in life if you just have questions and concerns about your own talents. You should remain confident in yourself and trust that you are prioritising your efforts correctly, such as acquiring study materials, receiving instruction as needed, creating an examination strategy, and meticulous preparation.
- Do not ponder over the previous paper: You still have a strong opportunity to pass the UPSC test, despite having many things on hold. Nobody studies the best possible amount for this exam. Depending on how you write it on that piece of paper. If the harder paper arrives, it won’t only affect you; it will come as a complete surprise to everyone. Success is determined by efforts, not by outcomes. Being the best is not as crucial as just doing your best.
- Set Realistic Goals: Establish your exam objectives and plan your preparation accordingly. Do not force yourself deeper into the stress and anxiety-filled cave. As much as you can, try to solve the problems from last year and write notes for each one for better comprehension.
- Take care of your health: Take good care of your health when preparing for or taking the CSE because a healthy mind can only exist in a healthy body. Eat healthily, get adequate rest, and move your body by going on a walk, doing yoga, or playing your favourite sport. Establish a routine of sleeping in and rising at the same time each day. Healthy people use their time more efficiently and are less prone to mental illnesses. Consider sound physical condition a requirement for effective CSE performance.
- Increase Your Concentration Power: Due to their high levels of anxiety, the majority of students complain that they struggle to focus on their studies. Take a moment to relax and consider your accomplishments and life objectives if you have a similar feeling. Setting a time-based goal is also advised for the applicants in order to get better results.
- Engagement with NGOs and Charities: Engage with NGOs and charitable organisations to gain a better understanding of the need for social welfare. This is a great method to not only relax after a long day of studying but also to be quietly reminded of the actual purpose of UPSC, which is to improve the world a little bit more than it currently is.
- Ensuring a Balanced Diet with Regular Exercise: A healthy diet for everyone must be balanced. In order to preserve health throughout the test time, a healthy diet becomes extremely crucial. Foods heavy in fat, sugar, and caffeine are more harmful than beneficial. One becomes energetic, irritated, and occasionally even moody when they consume too much of any of these. A healthy diet, eaten at regular intervals, helps keep the mind steady, as does little exercise. “A healthy mind dwells in a healthy body,” as the saying goes.
- Know When to Get Help: Some people feel much better when exams are over, but that is not the case for all folks. A tell-tale sign when you need help is when a person’s mood is low even after the exams are over. Anxiety or low mood when severe, persists, and interferes with everyday life. Seeing a psychiatrist is a good place to start. Always remember going to a psychiatrist doesn’t mean you have gone mad and need to go to a mental hospital.
- Be flexible during exams: Be accommodating during test season. Do not worry about unfinished domestic tasks or disorganised bedrooms when you are spending the entire day rewriting. It is OK to put off a few tasks while you devote yourself to preparation. Not that you get to have fun all day while studying as a result. Exams also don’t go on forever. After the exam, you can always finish up any unfinished business.
- Meditation: Meditation is one of the most underutilised forms of self-therapy. Historically, using mindful meditation techniques to manage anxiety has had excellent benefits. Focusing may be challenging at times, especially in extreme circumstances. You can make wise judgments and maintain composure through mediation.
- It is Normal to Feel Anxious: Never forget that feeling a little terrified is normal. Exam anxiety is a typical response. The trick is to channel these nerves for good. You may, for instance, practise papers in exam-like settings or even visit the exam site in advance. Stress is much reduced when one faces their anxieties and follows through on these actions rather than putting them off.
- Make Time for Treats: Reward yourself for finishing your revision and passing all of your exams. Rewards do not have to be substantial or pricey. Simple activities like cooking their preferred meal or watching TV can be included. Celebrate the conclusion of the exams by planning a treat for you and your family.
Mental Health tips for UPSC Aspirants
- Select the minimum necessary of books, and read the same book more than once. Remember to take breaks while studying at the same time.
- Attend webinars with mentors and high performers to correct any errors. It will help you clear up our uncertainty and provide you a lot of self-assurance.
- Additionally, staying up late studying is typically not a good idea. Multiple studies and medical professionals have demonstrated that a well-rested mind is far more likely to score well on a test than is a mind that has been awake all night.
- Get enough rest the night before your test.
- Even though students have a busy schedule, regular exercise is advised.
- Students with serious eating issues must get assistance from a specialist.
- They are capable of managing their time for education. After two to three hours of study, they should take a break rather than continuing to sit still. This will aid in managing digestive issues.
- It is usually advisable to eat often. Students’ diets must contain vitamins, protein, and minerals. in order to give them more energy to study.
- IAS candidates employ a variety of exogenous stimulants to reduce their anxiousness. They can frequently pause for tea or coffee. It is advised that applicants avoid making these behaviours routine before the exam starts.
- Your mental health is in danger whenever you seek for reliable information without guidance.
- Stop looking at various employment choices. Next, list the CSE syllabus’s essential topics that may be divided into categories based on their relative relevance.
- Next, create a flexible and practical schedule that you can adhere to on a regular basis.
- Finally, a serious mind’s ingrained tendency is to feel anxious before any exam. It can’t be prevented. But concentrating on minor adjustments, small routines, and small adjustments will eventually lead you to greater things.
Antidepressants and psychotherapy are effective therapies for overcoming exam-related depression. Some patients discover that the most effective treatment is a mix of antidepressants and psychotherapy. It is essential to seek professional counsel. The finest care can be provided by a doctor or mental health professional. In the current educational environment, students who are enrolled in college or preparing for a competitive exam have a variety of health issues, which have a significant negative influence on their performance. Knowing how to study well and organising oneself to overcome these issues would help one have a good future.
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Mental Health in India
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Mental Health
Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.
What is a Mental Disorder or Illness?
The term ‘mental disorders’ is used to denote a range of mental, behavioural disorders and psychosocial disabilities . They are generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others. Mental Disorders include depression, bipolar disorder, schizophrenia and other psychoses, dementia, and developmental disorders including autism . People with mental health conditions are more likely to experience lower levels of mental well-being, but this is not always or necessarily the case.
Factors responsible
Many factors contribute to mental health problems, including:
- Biological factors, such as genes or brain chemistry.
- Life experiences, such as trauma or abuse.
- Family history of mental health problems.
Mental illness is an amalgamation of biological, social, psychological, hereditary, and environmental stressors.
In a nutshell,
- Childhood abuse, trauma, or neglect.
- Social isolation or loneliness.
- Experiencing discrimination and stigma, including racism.
- Social disadvantage, poverty or debt.
- Bereavement (losing someone close).
- Severe or long-term stress.
- Having a long-term physical health condition.
- Unemployment or losing your job.
- Homelessness or poor housing.
- Being a long-term carer for someone.
- Drug and alcohol misuse.
- Domestic violence, bullying or other abuse as an adult.
- Significant trauma as an adult, such as military combat, being involved in a serious incident in which you feared for your life, or being the victim of a violent crime.
- Physical causes – for example, a head injury or a neurological condition such as epilepsy can have an impact on your behaviour and mood. (it's important to rule out potential physical causes before seeking further treatment for a mental health problem).
Who Is at Risk of Developing Mental Disorders?
The World Health Organisation (WHO) states that the determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.
Stress, genetics, nutrition, perinatal infections and exposure to environmental hazards are also contributing factors to mental disorders, says WHO.
Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990 . The contribution of mental disorders to the total disease burden doubled between 1990 and 2017. In 2017, an estimation of the burden of mental health conditions for the states across India revealed that as many as 197.3 million people required suffer from mental health conditions . This included around 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders . The situation has been exacerbated due to the Covid-19 pandemic , making it a serious concern world over.
In 2017, the President of India, Ram Nath Kovind asserted that India was “facing a possible mental health epidemic” . In the same year, 14% of India’s population suffered from mental health ailments, including 45.7 million suffering from depressive disorders and 49 million from anxiety disorders.
A study by the India State-Level Disease Burden Initiative showed that the disease burden in India due to mental disorders increased from 2.5% in 1990 to 4.7% in 2017 in terms of DALYs1 (disability-adjusted life years), and was the leading contributor to YLDs (years lived with disability) contributing to 14.5% of all YLDs in the country (India State-Level Disease Burden Initiative, 2017).
As per the report, the highest contribution to DALYs due to mental disorders in India in 2017 was from depressive disorders (33.8 per cent) and anxiety disorders (19 per cent).
The Lancet report also highlighted a substantially higher DALY rate of depressive and anxiety disorders in females than males. DALY rate of depressive disorders among females was 38.6 per cent whereas, in males, it stood at 28.9 per cent. Similarly, the DALY rate of anxiety disorders in females was reported at 21.7 per cent whereas, in males, it was at 16.2 per cent.
The prevalence of depression and anxiety disorders, as well as eating disorders, was found to be significantly higher among women. The association between depression and death by suicide was also found to be higher among women.
World Federation of Mental Health (WFMH) Report
In India, having a mental health disorder is perceived with a sense of judgement and there is stigma associated with those having mental health issues (The Live Love Laugh Foundation, 2018). Mental disorders are also considered as being a consequence of a lack of self-discipline and willpower. The stigma associated with mental health as well as lack of access, affordability, and awareness lead to significant gaps in treatment. The National Mental Health Survey (NMHS), 2015-16 found that nearly 80% of those suffering from mental disorders did not receive treatment for over a year. This survey also identified large treatment gaps in mental healthcare, ranging from 28% to 83% across different mental disorders (National Institute of Mental Health and Neuro-Sciences (NIMHANS), 2016).
The Live Love Laugh Foundation Report
The Deloitte study found that 80% of India's workforce reported mental health issues during the past year. Despite these alarming numbers, the report said social stigmas around mental health issues prevented 39% of the affected respondents from taking steps to manage their symptoms.
The common symptoms of anxiousness, irritability, lack of sleep and fading memory are considered normal, especially in the Indian context. In most cases, people keep living in denial due to the lack of awareness
Economic burden of mental disorders
Mental disorders place a considerable economic burden on those suffering from them – the NMHS (2015-16) revealed that the median out-of-pocket expenditure by families on treatment and travel to access care was Rs. 1,000-1,500 per month . Discussions with respondents also revealed that expenditure incurred on treatment of mental disorders often drove families to economic hardship . This burden was more pronounced in the case of middle-aged individuals – who were also most affected by mental disorders – as it affects their productivity thereby amplifying the burden not just on the individual, but also the economy.
The World Health Organization (WHO) estimates the economic loss to India on account of mental health disorders to be US$ 1.03 trillion. The NMHS also found that mental health disorders disproportionately affect households with lower income, less education, and lower employment. These vulnerable groups are faced with financial limitations due to their socioeconomic conditions, made worse by the limited resources available for treatment. Lack of State services and insurance coverage results in most expenses on treatment – when sought – being out-of-pocket expenses, thus worsening the economic strain on the poor and vulnerable.
Since the onset of the Covid-19 pandemic, several reports have indicated a worsening of mental health issues among individuals across age groups.
Legislation and building State capacity
The Mental Healthcare Act, 2017 makes several provisions to improve the state of mental health in India. This Act rescinds the Mental Healthcare Act, 1987 which was criticised for failing to recognise the rights and agency of those with mental illness.
The 2017 Act states that access to mental healthcare is a ‘right’ . It mandates for instituting Central and State Mental Health Authorities (SMHA), which would focus on building robust infrastructure including registration of mental health practitioners and implementing service-delivery norms. Although the Act required states to set up an SMHA in nine months of the Act being passed, as of 2019, only 19 out of 28 states had constituted an SMHA.
The National Mental Health Programme (NMHP) was introduced in 1982, in keeping with the WHO’s recommendations, to provide mental health services as part of the general healthcare system. Although the programme has been successful in improving mental healthcare access at the community level, resource constraints and insufficient infrastructure have limited its impact (Gupta and Sagar 2018).
As of 2021, only a few states included a separate line item in their budgets towards mental health infrastructure. After the passing of the Act in 2017, budget estimates for the NMHP increased from Rs. 3.5 million in 2017-18 to Rs. 5 million in 2018-19. However, this figure was reduced to Rs. 4 million in 2019-20 and has remained at the same level in subsequent years – even 2021-22 where several reports have indicated the worsening of mental health issues during the Covid-19 pandemic.
A survey by the Indian Psychiatry Society indicated that 20% more people suffered from poor mental health since the beginning of the Covid-19 pandemic. Emerging evidence indicates that during the Covid-19 pandemic, women exhibit relatively higher levels of psychological stress among the urban poor and households with migrant workers in rural areas – who were acutely affected by the lockdown restrictions – show higher incidence of mental health issues relative to those without migrants. Students were also severely affected by the lockdowns as it required adapting to a new learning medium and environment, as well as increased concerns about future prospects. To provide psychosocial support to students during the pandemic, the government introduced an online platform, ‘ Manodarpan’ – with an interactive online chat option, a directory of mental health professionals, and a helpline number.
Recently, India's Health Ministry also launched a 24-hour mental health service called Tele Mental Health Assistance and Networking Across States (Tele-MANAS). It aims to increase access to psychiatric care across the country, including in hard-to-reach areas. Callers are connected online to mental health specialists such as clinical psychologists, psychiatric social workers, psychiatric nurses or psychiatrists.
Developed countries allocate 5-18% of their annual healthcare budget on mental health , while India allocates roughly 0.05% (Organization for Economic Co-operation and Development, 2014).
Data provided by the government of India says there are less than 4000 psychiatrists to serve the country’s population of 1.3 billion . There is about one psychiatrist for 13,000 people. Indian Journal of Psychiatry says that to fill the gap in the next 10 years we will require 2700 psychiatrists annually.
Youth-The most vulnerable population
One of India’s most valuable resources is the young people of its country, and this generation needs to be nurtured for a bright future of the nation. According to Indian Journal of Medical Research, 2018, the world includes 1.8 billion young people aged 10-24 years, and nine out of 10 live in the developing countries. India has the world's highest number of this age bracket with 356 million.
Recently concluded National Mental State Survey of India evaluated the prevalence of mental disorders within the age of 18-29 years at 7.39%. The lifelong prevalence of such disorders is 9.54%.
According to the World Health Organisation (WHO) in 2019, 10-20 percent of all adolescents worldwide include youngsters between 10 to 19 years experience mental disorder . In addition to that it stated suicide the second leading cause of death among 15–29-year-olds globally.
Anxiety, depression, suicide, substance abuse are the major challenges facing the youth today. Many times, youngsters cannot cope with stress and they are inclined to use various coping mechanisms such as substance abuse.
The Lancet Public Health posted that India reports 36.6% of suicides globally and it exceeded as the major cause of death among women and teenage girls from 15-19 years.
Mental health in youngsters is a major concern, primarily because they are afraid to talk about it as they fear discrimination and judgments by peers.
A big challenge is to remove the stigma and secretiveness regarding mental health which makes youngsters feel like their illness is something to be ashamed of. These things prevail mostly due to various misconceptions and lack of information and awareness in the society.
When it comes to teenage girls, they have to deal with the pressure to look perfect, behave perfectly. Not just that, they have to deal with gender-based violence, lack of financial independence, income inequality as well as socio-economic disadvantage . Females are also exposed to sexual violence which leads to Post Traumatic Stress Disorder.
Concluding Remarks
Acknowledging the extent of the issue would be the first step towards addressing the mental health crisis in the country. The next and most pertinent step – given the socioeconomic groups largely affected by the crisis – would be to take initiative towards making mental healthcare more accessible, with targeted interventions for vulnerable groups.
It is important for everyone to be involved actively in promoting mental health awareness as well as awareness regarding the absurd stigma related to mental health. Workshops in schools, colleges, and corporations can help stimulate a movement for mental health.
Careful mapping and research need to be undertaken to produce quality data, that is essential to understand the size of the problem. This in turn should be utilised to implement a comprehensive approach, supported by heightened political commitment, scientific understanding and a citizen driven movement.
In the context of national efforts to strengthen mental health, it is vital to not only protect and promote the mental well-being of all, but also to address the needs of people with mental health conditions.
This should be done through community-based mental health care , which is more accessible and acceptable than institutional care, helps prevent human rights violations and delivers better recovery outcomes for people with mental health conditions. Community-based mental health care should be provided through a network of interrelated services that comprise:
- Mental health services that are integrated in general health care, typically in general hospitals and through task-sharing with non-specialist care providers in primary health care;
- Community mental health services that may involve community mental health centers and teams, psychosocial rehabilitation, peer support services and supported living services; and
- Services that deliver mental health care in social services and non-health settings, such as child protection, school health services, and prisons.
The vast care gap for common mental health conditions such as depression and anxiety mean countries must also find innovative ways to diversify and scale up care for these conditions, for example through non-specialist psychological counselling or digital self-help.
All WHO Member States are committed to implementing the “Comprehensive mental health action plan 2013–2030", which aims to improve mental health by strengthening effective leadership and governance, providing comprehensive, integrated and responsive community-based care, implementing promotion and prevention strategies, and strengthening information systems, evidence and research. In 2020, WHO’s “Mental health atlas 2020” analysis of country performance against the action plan showed insufficient advances against the targets of the agreed action plan.
WHO’s “World mental health report: transforming mental health for all” calls on all countries to accelerate implementation of the action plan. It argues that all countries can achieve meaningful progress towards better mental health for their populations by focusing on three “paths to transformation”:
- Deepen the value given to mental health by individuals, communities and governments; and matching that value with commitment, engagement and investment by all stakeholders, across all sectors;
- Reshape the physical, social and economic characteristics of environments – in homes, schools, workplaces and the wider community – to better protect mental health and prevent mental health conditions; and
- Strengthen mental health care so that the full spectrum of mental health needs is met through a community-based network of accessible, affordable and quality services and supports.
WHO gives particular emphasis to protecting and promoting human rights, empowering people with lived experience and ensuring a multisectoral and multistakeholder approach.
Talking about India specifically, offering subsidies and grants for starting clinics, hospitals, tech-enabled innovations, research, public health campaigns, and peer-based interventions is the need of the hour. Policies need to be enacted to make mental health treatment a national priority, which will then have a positive effect on tackling other ailments. Minimizing the stigma will help in not just reducing the financial burden due to mental health illness, but will also help the government to achieve its targets in other medical fields like diabetes, hypothyroidism, hypertension and cardiology, which are affected by overlooking mental health.
Mental health in India needs us to be part of a dialogue in which we are all speaking the same language.
It is time to break the silence around mental health and illness;
As Glenn Close once said, “What mental health needs is more sunlight, more candor, and more unashamed conversation.”
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Mental health in India
- October 11, 2022
- Posted by: OptimizeIAS Team
- Category: DPN Topics
Subject: Governance
Context: On Monday, world observed as World Mental Health Day.
- Mental health problems were already a major contributor to the burden of illness in India before the pandemic, with a third of all female and a quarter of all male suicide deaths in the world occurring in this country
- Poor awareness about symptoms of mental illness, myths & stigma related to it, lack of knowledge on the treatment availability & potential benefits of seeking treatment are important causes for the high treatment gap
National Mental Health Programme (NMHP) in 1982
- To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population;
- To encourage the application of mental health knowledge in general healthcare and in social development; and
- To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.
Mental Healthcare Act, 2017 :
The Act seeks to ensure rights of the person with mental illness to receive care and to live a life with dignity. The key features of the Act are:
- Rights of Persons with Mental Illness: Right to Access to Healthcare, Right to live with dignity, Right to Confidentiality
- The Act empowers person with mental illness to make an advance directive that states how he/she wants to be treated for the illness and who his/her nominated representative shall be.
- The Act mandates the government to set up Central Mental Health Authority at national-level and State Mental Health Authority in every State.
- A mentally ill person shall not be subjected to electro-convulsive therapy without the use of muscle relaxants and anaesthesia. Further, electroconvulsive therapy cannot be used on minors
- Decriminalization of Suicide
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- Mental Health Essay
Essay on Mental Health
According to WHO, there is no single 'official' definition of mental health. Mental health refers to a person's psychological, emotional, and social well-being; it influences what they feel and how they think, and behave. The state of cognitive and behavioural well-being is referred to as mental health. The term 'mental health' is also used to refer to the absence of mental disease.
Mental health means keeping our minds healthy. Mankind generally is more focused on keeping their physical body healthy. People tend to ignore the state of their minds. Human superiority over other animals lies in his superior mind. Man has been able to control life due to his highly developed brain. So, it becomes very important for a man to keep both his body and mind fit and healthy. Both physical and mental health are equally important for better performance and results.
Importance of Mental Health
An emotionally fit and stable person always feels vibrant and truly alive and can easily manage emotionally difficult situations. To be emotionally strong, one has to be physically fit too. Although mental health is a personal issue, what affects one person may or may not affect another; yet, several key elements lead to mental health issues.
Many emotional factors have a significant effect on our fitness level like depression, aggression, negative thinking, frustration, and fear, etc. A physically fit person is always in a good mood and can easily cope up with situations of distress and depression resulting in regular training contributing to a good physical fitness standard.
Mental fitness implies a state of psychological well-being. It denotes having a positive sense of how we feel, think, and act, which improves one’s ability to enjoy life. It contributes to one’s inner ability to be self-determined. It is a proactive, positive term and forsakes negative thoughts that may come to mind. The term mental fitness is increasingly being used by psychologists, mental health practitioners, schools, organisations, and the general population to denote logical thinking, clear comprehension, and reasoning ability.
Negative Impact of Mental Health
The way we physically fall sick, we can also fall sick mentally. Mental illness is the instability of one’s health, which includes changes in emotion, thinking, and behaviour. Mental illness can be caused due to stress or reaction to a certain incident. It could also arise due to genetic factors, biochemical imbalances, child abuse or trauma, social disadvantage, poor physical health condition, etc. Mental illness is curable. One can seek help from the experts in this particular area or can overcome this illness by positive thinking and changing their lifestyle.
Regular fitness exercises like morning walks, yoga, and meditation have proved to be great medicine for curing mental health. Besides this, it is imperative to have a good diet and enough sleep. A person needs 7 to 9 hours of sleep every night on average. When someone is tired yet still can't sleep, it's a symptom that their mental health is unstable. Overworking oneself can sometimes result in not just physical tiredness but also significant mental exhaustion. As a result, people get insomnia (the inability to fall asleep). Anxiety is another indicator.
There are many symptoms of mental health issues that differ from person to person and among the different kinds of issues as well. For instance, panic attacks and racing thoughts are common side effects. As a result of this mental strain, a person may experience chest aches and breathing difficulties. Another sign of poor mental health is a lack of focus. It occurs when you have too much going on in your life at once, and you begin to make thoughtless mistakes, resulting in a loss of capacity to focus effectively. Another element is being on edge all of the time.
It's noticeable when you're quickly irritated by minor events or statements, become offended, and argue with your family, friends, or co-workers. It occurs as a result of a build-up of internal irritation. A sense of alienation from your loved ones might have a negative influence on your mental health. It makes you feel lonely and might even put you in a state of despair. You can prevent mental illness by taking care of yourself like calming your mind by listening to soft music, being more social, setting realistic goals for yourself, and taking care of your body.
Surround yourself with individuals who understand your circumstances and respect you as the unique individual that you are. This practice will assist you in dealing with the sickness successfully. Improve your mental health knowledge to receive the help you need to deal with the problem. To gain emotional support, connect with other people, family, and friends. Always remember to be grateful in life. Pursue a hobby or any other creative activity that you enjoy.
What does Experts say
Many health experts have stated that mental, social, and emotional health is an important part of overall fitness. Physical fitness is a combination of physical, emotional, and mental fitness. Emotional fitness has been recognized as the state in which the mind is capable of staying away from negative thoughts and can focus on creative and constructive tasks.
He should not overreact to situations. He should not get upset or disturbed by setbacks, which are parts of life. Those who do so are not emotionally fit though they may be physically strong and healthy. There are no gyms to set this right but yoga, meditation, and reading books, which tell us how to be emotionally strong, help to acquire emotional fitness.
Stress and depression can lead to a variety of serious health problems, including suicide in extreme situations. Being mentally healthy extends your life by allowing you to experience more joy and happiness. Mental health also improves our ability to think clearly and boosts our self-esteem. We may also connect spiritually with ourselves and serve as role models for others. We'd also be able to serve people without being a mental drain on them.
Mental sickness is becoming a growing issue in the 21st century. Not everyone receives the help that they need. Even though mental illness is common these days and can affect anyone, there is still a stigma attached to it. People are still reluctant to accept the illness of mind because of this stigma. They feel shame to acknowledge it and seek help from the doctors. It's important to remember that "mental health" and "mental sickness" are not interchangeable.
Mental health and mental illness are inextricably linked. Individuals with good mental health can develop mental illness, while those with no mental disease can have poor mental health. Mental illness does not imply that someone is insane, and it is not anything to be embarrassed by. Our society's perception of mental disease or disorder must shift. Mental health cannot be separated from physical health. They both are equally important for a person.
Our society needs to change its perception of mental illness or disorder. People have to remove the stigma attached to this illness and educate themselves about it. Only about 20% of adolescents and children with diagnosable mental health issues receive the therapy they need.
According to research conducted on adults, mental illness affects 19% of the adult population. Nearly one in every five children and adolescents on the globe has a mental illness. Depression, which affects 246 million people worldwide, is one of the leading causes of disability. If mental illness is not treated at the correct time then the consequences can be grave.
One of the essential roles of school and education is to protect boys’ and girls' mental health as teenagers are at a high risk of mental health issues. It can also impair the proper growth and development of various emotional and social skills in teenagers. Many factors can cause such problems in children. Feelings of inferiority and insecurity are the two key factors that have the greatest impact. As a result, they lose their independence and confidence, which can be avoided by encouraging the children to believe in themselves at all times.
To make people more aware of mental health, 10th October is observed as World Mental Health. The object of this day is to spread awareness about mental health issues around the world and make all efforts in the support of mental health.
The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical wellbeing and get the necessary help when either of them falters.
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Mental health care is hard to find, especially for people with Medicare or Medicaid
Rhitu Chatterjee
With rates of suicide and opioid deaths rising in the past decade and children's mental health declared a national emergency , the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday.
The report, from the Department of Health and Human Services' Office of Inspector General, finds that Medicare and Medicaid have a dire shortage of mental health care providers.
The report looked at 20 counties with people on Medicaid, traditional Medicare and Medicare Advantage plans, which together serve more than 130 million enrollees — more than 40% of the U.S. population, says Meridith Seife , the deputy regional inspector general and the lead author of the report.
Medicaid serves people on low incomes, and Medicare is mainly for people 65 years or older and those who are younger with chronic disabilities.
The report found fewer than five active mental health care providers for every 1,000 enrollees. On average, Medicare Advantage has 4.7 providers per 1,000 enrollees, whereas traditional Medicare has 2.9 providers and Medicaid has 3.1 providers for the same number of enrollees. Some counties fare even worse, with not even a single provider for every 1,000 enrollees.
"When you have so few providers available to see this many enrollees, patients start running into significant problems finding care," says Seife.
The findings are especially troubling given the level of need for mental health care in this population, she says.
"On Medicare, you have 1 in 4 Medicare enrollees who are living with a mental illness," she says. "Yet less than half of those people are receiving treatment."
Among people on Medicaid, 1 in 3 have a mental illness, and 1 in 5 have a substance use disorder. "So the need is tremendous."
The results are "scary" but "not very surprising," says Deborah Steinberg , senior health policy attorney at the nonprofit Legal Action Center. "We know that people in Medicare and Medicaid are often underserved populations, and this is especially true for mental health and substance use disorder care."
Among those individuals able to find and connect with a provider, many see their provider several times a year, according to the report. And many have to drive a long way for their appointments.
"We have roughly 1 in 4 patients that had to travel more than an hour to their appointments, and 1 in 10 had to travel more than an hour and a half each way," notes Seife. Some patients traveled two hours each way for mental health care, she says.
Mental illnesses and substance use disorders are chronic conditions that people need ongoing care for, says Steinberg. "And when they have to travel an hour, more than an hour, for an appointment throughout the year, that becomes unreasonable. It becomes untenable."
"We know that behavioral health workforce shortages are widespread," says Heather Saunders , a senior research manager on the Medicaid team at KFF, the health policy research organization. "This is across all payers, all populations, with about half of the U.S. population living in a workforce shortage."
But as the report found, that's not the whole story for Medicare and Medicaid. Only about a third of mental health care providers in the counties studied see Medicare and Medicaid patients. That means a majority of the workforce doesn't participate in these programs.
This has been well documented in Medicaid, notes Saunders. "Only a fraction" of providers in provider directories see Medicaid patients, she says. "And when they do see Medicaid patients, they often only see a few."
Lower reimbursement rates and a high administrative burden prevent more providers from participating in Medicaid and Medicare, the report notes.
"In the Medicare program, they set a physician fee rate," explains Steinberg. "Then for certain providers, which includes clinical social workers, mental health counselors and marriage and family therapists, they get reimbursed at 75% of that rate."
Medicaid reimbursements for psychiatric services are even lower when compared with Medicare , says Ellen Weber , senior vice president for health initiatives at the Legal Action Center.
"They're baking in those discriminatory standards when they are setting those rates," says Steinberg.
The new report recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to increase payments to providers and lower administrative requirements. In a statement, CMS said it has responded to those recommendations within the report.
According to research by Saunders and her colleagues at KFF, many states have already started to take action on these fronts to improve participation in Medicaid.
Several have upped their payments to mental health providers. "But the scale of those increases ranged widely across states," says Saunders, "with some states limiting the increase to one provider type or one type of service, but other states having rate increases that were more across the board."
Some states have also tried to simplify and streamline paperwork, she adds. "Making it less complex, making it easier to understand," says Saunders.
But it's too soon to know whether those efforts have made a significant impact on improving access to providers.
CMS has also taken steps to address provider shortages, says Steinberg.
"CMS has tried to increase some of the reimbursement rates without actually fixing that structural problem," says Steinberg. "Trying to add a little bit here and there, but it's not enough, especially when they're only adding a percent to the total rate. It's a really small increase."
The agency has also started covering treatments and providers it didn't use to cover before.
"In 2020, Medicare started covering opioid treatment programs, which is where a lot of folks can go to get medications for their substance use disorder," says Steinberg.
And starting this year, Medicare also covers "mental health counselors, which includes addiction counselors, as well as marriage and family therapists," she adds.
While noteworthy and important, a lot more needs to be done, says Steinberg. "For example, in the substance use disorder space, a lot of addiction counselors do not have a master's degree. And that's one of their requirements to be a counselor in the Medicare program right now."
Removing those stringent requirements and adding other kinds of providers, like peer support specialists, is key to improving access. And the cost of not accessing care is high, she adds.
"Over the past two decades, [in] the older adult population, the number of overdose deaths has increased fourfold — quadrupled," says Steinberg. "So this is affecting people. It is causing deaths. It is causing people to go to the hospital. It increases [health care] costs."
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The Menstrual Mood Disorder You’ve Never Heard About
E ver since she was a teenager, Tanya knew her mood swings were a problem. She had periodic bouts of anger and depression that left her wanting to die. Her life was a roller coaster of highs and lows but doctors couldn’t figure out what was wrong. Five years ago, she decided she’d had enough. She wanted to end her life.
Tanya managed to talk herself out of it and instead did some googling. She stumbled across a website about premenstrual dysphoric disorder (PMDD), a menstrual mood disorder, that impacts roughly 3 to 8% of menstruators. PMDD means having severe and debilitating mood swings right around one’s period. Around a third of people with PMDD have attempted suicide, and over 70% have regular suicidal ideation .
“It just hit me,” Tanya told me. “I went through my life and so many moments made sense.” She called her doctor the next day. He sent her to get tested for diabetes.
Tanya finally managed to get a PMDD diagnosis in 2019 at the age of 26, but she was haunted by the question: Why had she never heard of PMDD before and why was it so hard to get a diagnosis?
Although research shows suicidal ideation is linked to specific times during the menstrual cycle, today most people still haven’t heard of PMDD, including doctors. According to a 2022 survey of PMDD patients, over a third said their general practitioners had no knowledge of premenstrual disorders, and about 40% said their mental-health-care providers had no knowledge of premenstrual disorders. But PMDD has been around since periods have been around and we’ve known about it for nearly a century.
So why aren’t we getting people the help they need? The answer, as history shows, is more complicated than we think.
While the menstrual cycle has been notoriously understudied, the first papers on PMDD appeared in 1930s. In the 1950s British physician Dr. Katrina Dalton began studying PMDD —or “premenstrual syndrome” as she called it, and opened a clinic in London . Still, PMDD mostly flew under the radar until 1980, when Dalton served as a medical expert for three women accused of crime. During the trials Dalton showed that the women committed the crimes right before their period, and that their symptoms disappeared with treatment. She was able to get them a reduced sentence.
Overnight there was a media boom around PMS. The magazine Glamour even polled readers about the validity of using PMS as a legal defense: (24% were for, 71% against, and 5% unsure). As a result, the growing awareness around PMS bled over to the medical community. In 1984 psychiatrist Robert Spitzer proposed PMS should be added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook used by doctors to diagnosis mental health problems. Spitzer was the chair of the committee revising the third version of the DSM, and he’d been getting several invites to conferences about PMS. Adding PMS to the DSM meant that the medical community was recognizing it as a formal disorder that could be diagnosed and treated.
Read More: 5 Foods That Ease PMS Symptoms
However, experts were divided on where to draw the line between PMDD (the severe, debilitating mood swings) and PMS (garden variety grumpiness and irritability). When the Washington Post asked experts about the prevalence of PMS in 1984, estimates ranged from 3% to 90% of women . In a sense, both of these estimates were true: only a few people have severe symptoms, but up to 90% of people do have mild symptoms before their period. It became clear that experts were conflating PMDD and PMS and this was reflected in popular culture. Suddenly, anyone who had a period was seen as unstable. Products with sexist jokes abounded, such as greeting cards that read “What’s the difference between a woman with PMS and a terrorist? Answer: You can negotiate with a terrorist.”
Controversy erupted. A group of feminists spearheaded a campaign to stop PMDD’s inclusion in the DSM. They argued that including PMDD would be tantamount to calling menstruation a mental illness. Much of their reaction was rooted in the atmosphere of the ‘70s and ‘80s as women were fighting for gender equality on several fronts from work to reproductive rights. In the 1970s, for the first time, over half of women were working outside the home. The Supreme Court ruled to protect the right to abortion in Roe v. Wade. However, this equality was also precarious and under threat—conservatives defeated the Equal Rights Amendment which would have prohibited gender discrimination. For feminists, PMDD and the sexist jokes it generated seemed to be another attempt to discredit women and chip away at the progress feminists had made for women’s rights.
One of PMDD’s major critics, Dr. Joan Chrisler, attended a lecture in the 1970s, early on in her career on why there were no great women artists or novelists. The conclusion: women’s creativity declines when they are menstruating. This inspired Chrisler to devote her career to fighting menstrual stigma. In an era rife with sexism, adding PMDD to the DSM set off alarm bells.
Read More: A History of How Employers Have Addressed Women’s Periods
To further complicate matters, in the early 2000s, drug manufacturer Eli Lilly stuck its finger in the pie. Eli Lilly’s patent on its blockbuster drug Prozac, which treated depression, was set to expire and it’s share prices had tanked. The company desperately needed a new market that would buy Prozac.
Eli Lilly landed on PMDD as their next likely market. Early studies already suggested that Prozac could treat PMDD, but the problem was that experts were still debating whether PMDD belonged in the DSM as an official diagnosis at all. Undaunted, Eli Lilly embarked on a massive campaign to market Prozac to people with PMDD. It sponsored a round table discussion on Prozac’s effectiveness for PMDD, which found that at least 60% of patients with PMDD respond to antidepressants. It repackaged Prozac as “Serafem” a play on the word “seraphim”, the angels who guard the throne of God. If that wasn’t enough to drive home the point, they changed Prozac’s green and yellow pills to pink and purple. Finally, they rolled out a series of ads that suggested any woman who was feeling grumpy should consider medication. The ads didn’t distinguish between PMDD and PMS. Rather, they imply any sign of irritability in women should be treated.
This unleashed another wave of furor. Feminists were insulted—and rightfully so. The last thing the women’s movement needed was a drug companies suggesting a woman’s anger is a mental health condition. The media had a field day writing about drug companies “inventing” new diseases and marketing drugs without diagnoses. (Tragically, Prozac actually works on PMDD. Studies have found SSRIs like Prozac can relieve PMDD symptoms in up to twelve hours, even though it takes weeks to work for anxiety and depression.)
In some ways the feminists lost their battle. PMDD eventually did become a diagnosis in the DSM in 2013, nearly three decades after it’d been first debated in the ‘80s. In other ways, they won the war. Dr. Tory Eisenlohr-Moul, a premenstrual mood disorder researcher at the University of Illinois Chicago, estimates that the backlash around PMDD set care back by 10 to 15 years. She pointed out there’s been a chilling effect on the conversation around the link between menstruation and mood. Doctors are afraid to bring it up, because they don’t want patients to think they are sexist.
Yet, in reality, the biggest victims of the fight over PMDD’s existence are people who have PMDD and the people who love them. Today, thousands of people still suffer because they don’t know they have PMDD.
Tanya’s PMDD diagnosis changed her life. While she elected not to try medication, the diagnosis alone helped her understand her breakdowns, and helped her explain what was going on to family and friends. She decided to train in psychotherapy so she can help other people understand PMDD. “My tutor has been a counselor for 10 years and still hasn’t heard of PMDD,” she said. “I want to help people work through this pain.”
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The use and impact of surveillance-based technology initiatives in inpatient and acute mental health settings: A systematic review
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Background: The use of surveillance technologies is becoming increasingly common in inpatient mental health settings, commonly justified as efforts to improve safety and cost-effectiveness. However, the use of these technologies has been questioned in light of limited research conducted and the sensitivities, ethical concerns and potential harms of surveillance. This systematic review aims to: 1) map how surveillance technologies have been employed in inpatient mental health settings, 2) identify any best practice guidance, 3) explore how they are experienced by patients, staff and carers, and 4) examine evidence regarding their impact. Methods: We searched five academic databases (Embase, MEDLINE, PsycInfo, PubMed and Scopus), one grey literature database (HMIC) and two pre-print servers (medRxiv and PsyArXiv) to identify relevant papers published up to 18/09/2023. We also conducted backwards and forwards citation tracking and contacted experts to identify relevant literature. Quality was assessed using the Mixed Methods Appraisal Tool. Data were synthesised using a narrative approach. Results: A total of 27 studies were identified as meeting the inclusion criteria. Included studies reported on CCTV/video monitoring (n = 13), Vision-Based Patient Monitoring and Management (VBPMM) (n = 6), Body Worn Cameras (BWCs) (n = 4), GPS electronic monitoring (n = 2) and wearable sensors (n = 2). Twelve papers (44.4%) were rated as low quality, five (18.5%) medium quality, and ten (37.0%) high quality. Five studies (18.5%) declared a conflict of interest. We identified minimal best practice guidance. Qualitative findings indicate that patient, staff and carer perceptions and experiences of surveillance technologies are mixed and complex. Quantitative findings regarding the impact of surveillance on outcomes such as self-harm, violence, aggression, care quality and cost-effectiveness were inconsistent or weak. Discussion: There is currently insufficient evidence to suggest that surveillance technologies in inpatient mental health settings are achieving the outcomes they are employed to achieve, such as improving safety and reducing costs. The studies were generally of low methodological quality, lacked lived experience involvement, and a substantial proportion (18.5%) declared conflicts of interest. Further independent coproduced research is needed to more comprehensively evaluate the impact of surveillance technologies in inpatient settings, including harms and benefits. If surveillance technologies are to be implemented, it will be important to engage all key stakeholders in the development of policies, procedures and best practice guidance to regulate their use, with a particular emphasis on prioritising the perspectives of patients.
Competing Interest Statement
AS and UF have undertaken and published research on BWCs. We have received no financial support from BWC or any other surveillance technology companies. All other authors declare no competing interests.
Clinical Protocols
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463993
Funding Statement
This study is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (grant no. PR-PRU-0916-22003). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ARG was supported by the Ramon y Cajal programme (RYC2022-038556-I), funded by the Spanish Ministry of Science, Innovation and Universities.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Data Availability
The template data extraction form is available in Supplementary 1. MMAT quality appraisal ratings for each included study are available in Supplementary 2. All data used is publicly available in the published papers included in this review.
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Amid Tragedy, Anguished Pleas for Gaza
More from our inbox:, new york’s mental health shelters: a commissioner’s view, don’t miss the eclipse, trump and the bible.
To the Editor:
Re “ Just Let People Eat ,” by José Andrés, a chef and the founder of World Central Kitchen (Opinion guest essay, April 4):
What a humane, heartfelt and balanced essay by Mr. Andrés after the tragic death of seven World Central Kitchen aid workers in Gaza.
Now if only the Israeli people will hear his plea and require the government to open more humanitarian aid routes into Gaza. Food is not a weapon of war.
James Berkman Boston
José Andrés’s essay deserves to be read by all. He beautifully points out the commonality across religions and cultures of our need for food. He deserves the Nobel Peace Prize for his work and for calling on the world to concentrate on the most fundamental human need: nourishment for life itself.
Elena Reyes Fort Myers, Fla. The writer is a licensed psychologist.
Re “ Is Biden Willing to Use America’s Leverage With Israel? ,” by David E. Sanger and Peter Baker (news analysis, April 4):
President Biden is “outraged and heartbroken” over the deaths of the seven aid workers in Gaza. David Cameron, the British foreign secretary, says Israel must “make major changes to ensure the safety of aid workers.”
That these seven noble people died is a tragedy. But where has Mr. Biden’s newfound vocal outrage been as upward of 13,000 children, according to Gazan health officials, have been killed in Gaza by the Israeli military? And Mr. Cameron: What changes, if any, should Israel make to ensure their safety?
There is something essentially wrong when the deaths of seven aid workers instantly precipitate a huge reaction from the governments of the U.S. and U.K., and yet the deaths of thousands of Palestinian children have until recently elicited not much more than a resigned shoulder shrug.
Paul Schwartz Sparkill, N.Y.
Re “ Strikes by Israel Kill Aid Workers and Draw Outcry ” (front page, April 3):
An international “outcry” against what I believe was a targeted killing of seven World Central Kitchen workers is not enough. The failure to date by the international community to take concrete actions against Israel weakens international law.
Why has the international community (with few exceptions) declined to break off relations with Israel or at least withdraw ambassadors? Why have most Western nations not cut off weapons transfers and arms deals and applied sanctions?
It’s time to reassess the value of Israel’s relationship with the U.S. and its allies.
L. Michael Hager Eastham, Mass. The writer is co-founder and former director general of the International Development Law Organization, Rome.
“ Suspect in Fatal Subway Shoving Was In and Out of Mental Health Shelters ” (news article, March 31) calls attention to issues that New York City has been grappling with for many years.
From Day 1, Mayor Eric Adams’s administration acted with urgency to address long-overlooked crises of mental health and substance use challenges in the city — recognizing the critical role of health care agencies to get the right support for our most vulnerable New Yorkers. As we strengthen complex care coordination and enhance harm reduction across shelters, our efforts are headed in the right direction.
The story recognizes that a shelter is the last resort for those who’ve been failed by every social safety net across communities and levels of government but does not mention the monumental scope of the Department of Homeless Services’s efforts helping stabilize countless households.
The article refers to 50 fatalities over a four-year period. One fatality is too many, but in that time, the agency provided safe and supportive shelter to more than 265,000 individuals.
Against the backdrop of a national increase in overdose deaths, robust overdose prevention efforts helped reverse the majority of suspected overdoses and we saw a 25 percent decrease in fatalities resulting from overdoses in shelters.
While there is surely a lot more work to be done, we will continue to deliver for thousands of households in need, and the Adams administration remains committed to getting our most vulnerable New Yorkers the care they need and deserve.
Molly Wasow Park New York The writer is the commissioner of the New York City Department of Social Services.
Re “ They Can Hear the Sky Go Black ” (Science Times, April 2):
It’s not only sight that is affected by a total eclipse. Both blind and sighted people can feel its effects.
As the eclipse progresses the temperature drops noticeably, usually about 10 degrees, sometimes more. If there are birds or other animals around, they will grow silent. Crickets will start their evening song.
If you’re with a group of people, some may scream when the sun blots out. There will be cries of “oh my god, oh my god!” and similar exclamations. You may notice a visceral reaction. Everything else becomes irrelevant. Your breathing becomes shallow.
When the last ray of light winks out you may get a shot of adrenaline, a high that can last 15 or 20 minutes. When it’s over, people will try to explain their feelings to complete strangers. If you have the chance to see this eclipse, don’t miss it.
Christopher Murray Olympia, Wash.
Re “ Trump, Blasphemous Bible Thumper ,” by Maureen Dowd (column, March 31):
“There are six things that the Lord hates, seven that are an abomination to him: haughty eyes, a lying tongue, and hands that shed innocent blood, a heart that devises wicked plans, feet that make haste to run to evil, a false witness who breathes out lies, and one who sows discord among brothers.”
Proverbs 6:16-19
Johnny Galloway Williamsburg, Va.
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Mental Health at Work
Syllabus: Health
Source: WHO
Context: WHO and the International Labour Organization (ILO) have called for concrete actions to address mental health concerns in the working population.
- Over 12bn workdays are lost annually (costing about $1 trillion) due to depression and anxiety
- Work and Mental Health are closely intertwined : Good mental health enables people to work productively and a good work environment induces good mental health.
- WHO’s World Mental Health Report 2022 s howed that of one billion people living with a mental disorder in 2019, 15% of working-age adults experienced a mental disorder.
- Work amplifies wider societal issues that negatively affect mental health, including discrimination and inequality.
- Yet discussing or disclosing mental health remains taboo in work settings globally.
- WHO Mental Health Atlas found that only 35% of countries reported having national programmes for work-related mental health promotion and prevention.
- COVID-19 triggered a 25% increase in general anxiety and depression worldwide.
Significance of Mental Health at work:
- To uphold human rights
- Achieve SDG 3 on health and SDG 8 on decent work for all
- Reduce discrimination
- Increase labour productivity
Measures suggested in the guidelines:
- Psychosocial Risk management: Managing worries about close ones, their health and safety status, and business and societal interests.
- Promote mental health through training and improving mental health literacy
- Supporting those with mental health conditions to become productive
Government Initiatives
- Constitutional Provision : The right to Health (including mental healthcare) is a fundamental right under Article 21 of the Constitution.
- National Mental Health Program (NMHP) ( To address the huge burden of mental disorders and shortage of qualified professionals)
- Mental HealthCare Act 2017 (Guarantees every affected person access to mental healthcare and treatment from services run or funded by the government)
- Kiran Helpline (Ministry of Social Justice and Empowerment (2020) launched a 24/7 toll-free helpline)
Insta Links
Towards a stronger Mental Health Strategy
Q. Mental health is one of the most neglected social issues in India. Comment. (10M)
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40 facts about elektrostal.
Written by Lanette Mayes
Modified & Updated: 02 Mar 2024
Reviewed by Jessica Corbett
Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.
This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.
So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.
Key Takeaways:
- Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
- With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.
Known as the “Motor City of Russia.”
Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.
Home to the Elektrostal Metallurgical Plant.
Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.
Boasts a rich industrial heritage.
Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.
Founded in 1916.
The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.
Located approximately 50 kilometers east of Moscow.
Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.
Known for its vibrant cultural scene.
Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.
A popular destination for nature lovers.
Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.
Hosts the annual Elektrostal City Day celebrations.
Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.
Has a population of approximately 160,000 people.
Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.
Boasts excellent education facilities.
The city is known for its well-established educational institutions, providing quality education to students of all ages.
A center for scientific research and innovation.
Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.
Surrounded by picturesque lakes.
The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.
Well-connected transportation system.
Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.
Famous for its traditional Russian cuisine.
Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.
Home to notable architectural landmarks.
Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.
Offers a wide range of recreational facilities.
Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.
Provides a high standard of healthcare.
Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.
Home to the Elektrostal History Museum.
The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.
A hub for sports enthusiasts.
Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.
Celebrates diverse cultural festivals.
Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.
Electric power played a significant role in its early development.
Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.
Boasts a thriving economy.
The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.
Houses the Elektrostal Drama Theater.
The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.
Popular destination for winter sports.
Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.
Promotes environmental sustainability.
Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.
Home to renowned educational institutions.
Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.
Committed to cultural preservation.
The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.
Hosts an annual International Film Festival.
The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.
Encourages entrepreneurship and innovation.
Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.
Offers a range of housing options.
Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.
Home to notable sports teams.
Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.
Boasts a vibrant nightlife scene.
Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.
Promotes cultural exchange and international relations.
Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.
Surrounded by beautiful nature reserves.
Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.
Commemorates historical events.
The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.
Promotes sports and youth development.
Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.
Hosts annual cultural and artistic festivals.
Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.
Provides a picturesque landscape for photography enthusiasts.
The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.
Connects to Moscow via a direct train line.
The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.
A city with a bright future.
Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.
In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.
Q: What is the population of Elektrostal?
A: As of the latest data, the population of Elektrostal is approximately XXXX.
Q: How far is Elektrostal from Moscow?
A: Elektrostal is located approximately XX kilometers away from Moscow.
Q: Are there any famous landmarks in Elektrostal?
A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.
Q: What industries are prominent in Elektrostal?
A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.
Q: Are there any universities or educational institutions in Elektrostal?
A: Yes, Elektrostal is home to XXXX University and several other educational institutions.
Q: What are some popular outdoor activities in Elektrostal?
A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.
Q: Is Elektrostal well-connected in terms of transportation?
A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.
Q: Are there any annual events or festivals in Elektrostal?
A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.
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