1 Why mental health matters in India and what we can do about it? Vikram Patel London School of Hygiene & Tropical Medicine Public Health Foundation of India Sangath

Mental health problems affect people across the life course 2

Because mental health problems are common 3

The staggering numbers About million persons with a severe, enduring mental disorder or disability (nearly 1 million in Gujarat) Between 50 to 100 million persons with a wide range of mental health problems (3 to 6 million in Gujarat) 4

5 Because they are profoundly disabling (GBD 2010)

Because they worsen the outcomes of other health conditions 6

Because they affect the poor and disadvantaged 7

A CITY OF UNENDING NIGHTS

9 Because they kill our youth (Patel et al, Lancet 2012)

and the dispossessed 10

Because they are associated with stigma and discrimination 11

And are exposed to inhumane care 12

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Or irrational and costly care 15

Leaving some families with no choice 16

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The public health challenge 18

19 Despite evidence on what works

The treatment gap is over 50% in India Reaches an astonishing 90% in rural India, with profound abuses of human rights for many affected persons 20

India’s population 1.2 billion psychiatrists 3000 psychiatrists

Task-sharing for mental health We know what works, but how do we deliver these treatments in low resource settings? 22

23 Community mental health workers delivering care for schizophrenia in rural India (Chatterjee et al, Br J Psych 2003, 2009)

24 Community health workers supporting caregivers of persons affected by dementia (Dias et al, PLoS One, 2008)

25 Lady health visitors using CBT to treat postnatal depression in rural Pakistan (Rahman et al, Lancet 2008)

Lay health worker led intervention for common mental disorders in primary care (Patel et al, Lancet, 2010; Br J Psych 2011) 26

Reaching out to remote areas through tele-psychiatry 27

The solution? To provide comprehensive, integrated and responsive mental health and social care services in community-based settings. WHO Comprehensive Mental Health Action Plan,

Six actions to achieve this goal 1.Empower people with mental health problems, for e.g. through self-help groups 2.Build a diverse mental health workforce, in particular community mental health workers to deliver psychosocial care 3.Establish collaborative mental health care teams with linkages between the community, PHC and medical colleges 29

Six actions to achieve this goal 4.Use technology to reach out to remote and rural areas 5.Start early to detect and treatment mental health problems, for e.g. child mental health programs 6.Reduce premature mortality, for e.g. through comprehensive suicide prevention programs 30

An enabling policy environment Radically new District Mental Health Program Considerably increased NMHP resources Draft radcially new Mental Health Care Bill Draft Mental Health Policy 31

Summary Mental health problems are the most neglected causes of health related human suffering in India Cost-effective and culturally appropriate interventions are available, and the policy environment has never been better The time to act is NOW! 32