Screaming Mind, Stapled Mouth : Mental Health and its Stigmatisation

Profile of the Interviewee:

Mr. Shiv Kumar academically holds several professional qualifications and is
currently working as a Counsellor with the National Career Service (Ministry
of Labour & Employment) Govt. of India New Delhi. He also holds expertise as
a Psychological Counsellor, a Clinical Psychotherapist and is qualified to conduct Psychometric assessments, and formulate strategies as to how to restructure the pattern of irrational thinking of emotionally distressed, unpleasant and dysfunctional persons. He has a rich experience of more than 30 years in related sectors. Mr. Kumar works as a Professional Counsellor for IDEA. IDEA offers a wide range of services, one of them being, academic counselling. Mr. Kumar plays a vital role in our scientific process of
counselling students. In addition, he guides IDEA’s Core Team’s perspective in other research interventions. According to Mr. Kumar, psychology is an essential aspect of life, for individuals of all streams and stature. To help the society with his expertise, he engages with educational institutions to guide the students of today in aspects of team building, motivation, and research.

Theme of the Interview:

Today, mental health issues are no longer a one in a hundred case. Due to the drastic changes in lifestyle, higher level of peer pressure, hectic lifestyle, people today experience lower levels of good mental health. And the problem is not limited to only working people or adults in general. Today, children, as young as adolescents struggle with mental and emotional health. To add to the problem, there is an immense cloud of taboo around the topic of mental health. People tend not to disclose having ill-mental health, and often suffer in silence, presumably due to the fear of judgment. The issue goes unaddressed for years and may lead to unfortunate cases of self-harm or even suicide. Mr. Shiv Kumar, as a recognised psychologist, is here with us today to talk about this issue.

Questions: 

What constitutes mental health? 

Mental health is an internal equilibrium or dynamic state which includes the emotional, psychological and social well-being wherein every individual identifies his or her own potential and limitations, can cope with the normal stresses of life, can work productively & fruitfully, and is able to make contribution to her or his community. Basically, the emotional and psychological health of oneself is our mental health. Just like our physical health, which relates to our body, mental health refers to our mind. How do people recognise their ill-mental health? Mental health, like physical health, does not show any outward signs. So when we break our leg, we know our physical health is not doing good because we can see the signs of illness. But diagnosing or recognising ill mental health is often trickier than we might think. But generally, there are signs that we can recognise to ascertain the state of our mental health. Observing and examining changes in our behaviour, pattern of thinking and attitude towards others are some signs and symptoms we might be at risk of ill mental health.

Such signs may be:

• Being withdrawn or lost in thought,
• Losing their sense of humour,
• Being erratic, unusually agitated, tearful, or, conversely, emotionless,
• Changes in appetite, weight or sleep hygiene patterns,
• Increased alcohol consumption.

Which are the major mental health issues students struggle with today and
why?

Mental health issues are caused by a number of factors that affect human
development at the prenatal, natal, and postnatal stages of life. The effects can be temporary or long lasting. In general, the causes are considered to be a
variety of Genetic predisposition, Environmental factors, Childhood abuse &
trauma or biopsychosocial factors, like academic grades, or social media. Even social conditions contribute to poor mental health, such as experiencing societal stigma & discrimination, social isolation, socio-economic conditions poverty & debt, bereavement.

As we all know, adolescent children also face many stress-inducing situations in life. Society has evolved and life is not as simple as it was for the older generations. There is immense pressure of expectations from families, teachers, peers and society in general. Nowadays, right from a young age, children are expected to make mature decisions pertaining to education, career, life. Teenage dating is also a normalised enough concept in society. The issue of alcohol and drug abuse is also known in the student community. All these issues, although not openly addressed by the Indian society, are prevalent and culminate into inducing stress and depression in children of tender age. 

 

The age of the internet also has a causative effect on the poor mental health of school and college students. The endeavour to present the perfect life on

social media leads students to experience anxiety and mental stress. The
emphasis on a “perfectness,” of life, of body and skin, has become a major
reason for children experiencing anxiety and stress.

This was about the social instigations, In medical terms, the major mental
health issues that students of today suffer from are depression , anxiety &
mood disturbances, addiction & substance abuse, suicidal behavior, eating
disorders like bulimia, anorexia, and binge eating, stress, trauma, ADHD &
autism.

 

What is the treatment for poor mental health?

 

Mental health treatment depends on the type of mental illness an individual
person is experiencing. Treatment is also based on severity and chronic
conditions. There are some strategies of treatments, mostly in many cases
successful combinations are of Therapeutic Psychiatric medications include
are (Antidepressants, Antipsychotic, Anti-Anxiety, Mood stabilisers) along with Psychotherapies interventions Such as (Behavioural therapy, cognitive
therapy, Interpersonal therapy, Psychoanalysis, Psychodynamic Psychotherapy and Supportive psychotherapy.

One can access such treatment from a therapist, who is a qualified psychologist. There are many such doctors who operate from government and private hospitals or run independent clinics. Such information is available on the internet.

 

Is treatment for poor mental health accessible in India?

 

There has been an attempt to fix the cyclic link between mental health and
poverty in India.

The government, doctors and businesses have taken action which aims to increase treatment and guarantees more rights to persons with mental illnesses. In 2016, the Indian parliament passed the Mental Health Care Act, 2017. This legislation provides for State Health Care Facilities, claiming that anyone with mental illness in India has the right to good quality, affordable health care. Individuals with mental health now have a guarantee of informed consent, the power to make decisions, the right to live in a community and the right to confidentiality. Anyone who violates or infringes on the right of those with mental illnesses is punishable by law. Hence, support of primary health care facilities, district level mental health care teams, more affordable care and expanded services of doctors in rural areas drawing significant links between mental health and poverty.

But despite such actions by the government, awareness pertaining to mental
illness is low in the rural sections of India. Uneducated individuals are not capable of recognising the state of their own mental health because they do not understand the concept of mental health itself. They are not aware of the fact that mental health is a scientifically accepted issue. There is a notion that merely being sad or low is okay and fixable by oneself. But such is not always the case, and patients have to rely on doctors and medicine.

The Constitution of India envisages the establishment of a new social order and it directs the States to record improvement in public health as one of the primary duties and aims at securing HEALTH FOR ALL. As we all might know, “health” is a subject in the State List but “mental health” is in the Concurrent List in the Indian constitution. The Ministry of Health and Family Welfare is the apex executive organisation dealing with health and family welfare issues in the country. There have been many Government schemes for the promotion of mental health. In 1982, the Government of India launched the National Mental health programme (NMHP) for the treatment of mentally ill individuals. Later on, District mental health was added in the year 1996.

There are many Helpline services, suicide prevention helplines like Sneha (Chennai), Aasra (Navi Mumbai), Samaritan Sahara (Kolkata) and Aasha in Chandigarh.

Does the Indian society accept discussion on mental health?

Indian society in general has stereotyped views about mental health and how it affects people in the community. Many people believe that people with
mental ill health are violent and dangerous, but the truth is patients are more
at risk of being attacked or harming themselves than harming others.

Ignorance and social stigma tends to make people think that poor mental health occurs due to black magic. Often people seek treatment from local healers as well as local temple priests.

Mental illnesses are considered equivalent to craziness. Which is why families do not wish to disclose that someone is mentally ill. Indian households also do not engage in talks on sex education, peer pressure, ragging, bullying, social media presence of children, which is why all students handle the stress of such issues alone. It is primarily because of this communication gap, that parents do not understand their children’s mental health. It is a dual error effect. Indian society, in the garb of culture and traditions have maintained a communication gap with their children all while harmfully dictating their children’s lives without addressing the essential issues, and this has resulted in an increase in poor mental health of children/students.

Indian society has a different take on mental health. The stigma around mental health illness is fuelled by many misconceptions about mental health popularly held to be true. Hence removing these myths is the first step towards reducing the stigma and discrimination and facilitating better access to mental health care.

There are many wrongful considerations like,

1. Does seeing a psychologist mean that I am crazy?
2. Mental illnesses are not real illnesses.
3. Children don’t experience mental health problems.
4. Mental illnesses are caused by personal weakness.
5. People with Mental health problems are violent and unpredictable.
6. Mental illnesses are lifelong / never recover from it.
7. Mental illnesses can be treated by prayers, witchcraft , magical rituals and
   positive thoughts.
8. There is nothing that can be done to someone with mental health
   problems.

Therefore, the ill-effects of this stigma in the Indian society due to ignorance
of mental health leads to aggravation of mental illness symptoms like stress and anxiety. There are many negative influences due to lack of coordination and understanding amongst the parents and children regarding mental health.

Do your patients accept their own mental illnesses openly?

As I have mentioned before, the stigma in society disallows patients to accept
their mental illnesses openly. Such individuals are prone to ridicule, social judgment and this often escalates the stress in patients. Thus, people choose to keep the hush around the matter of mental health intact. Many times, this stigma prevents patients from getting the support and help they need. Because to get treatment, one has to acknowledge the mental disorder. And the same is difficult in this society.

What is your advice to your student audience today?

Mental illness is a common problem, in fact 1 in 5 people will experience some sort of mental illness in their lifetime.

So, do not be afraid to reach out for help. Your family doctor is a good place to start. Doctors are obligated to maintain professional privilege, which means that they cannot disclose any of your details to anyone. Feel free to trust your doctor. Also, talk about the cause. Amongst your friends and peers. Initiate healthy discussion that aims at destigmatising the issue. Communicate with your elders also. Parents and teachers. Educate them also. Generational gaps often result in such stigmas. It is up to the youth of today to lead the charge and create change.

If someone’s family or society is not supportive of treatment, what can that person do?

There are many free clinics that offer mental health therapy. You may approach any such institution. Many NGOs and organisations also operate in this field, and can get you the help you need. The key lies in acknowledging the problem. You will face stigma but it is important not to bow down to it. Remember, for every person who stigmatises mental health issues, there is an advocate who talks about it openly. So, you are not alone.

And the same works the other way around as well. If you know someone who is going through a hard time, it is important to respond sensitively and to aid them in getting a medical diagnosis. There are a number of ways to encourage and help a friend, relative or colleague to talk openly about mental illness. It is important to provide an open and non-judgemental space with no distractions, build up a rapport and a relationship of trust to speak out courageously. Make sure you do not concoct assumptions or jump on your own diagnosis or solutions. Ask open-ended questions, talk about well-being with unconditional support, listen carefully and understand and paraphrase their concern, provide professional support and set boundaries and limits.

How can the education system of India aid in creating awareness about mental health?

Schools and colleges are microcosms of the world around us. Which is why it
is imperative to sensitise students right from a tender age. Normalising discussion and discourse about mental health at the school level will create a generation of people who will not stigmatise such an important issue. There must be a good quantity of discussion between educators and students on the issue. Students must be exposed to case studies, relevant laws and policies. Relevant seminars and talk shows can be organised for students to better understand this issue.

From including mental health narratives in the academic curriculum and removing discrimination and allowing early detection to empowering stakeholders for early detection and simple interventions, the educational system yields myriad opportunities for enhancing mental health awareness. An effective paradigm of mental health awareness includes combating stigma, enhancing prevention, ensuring early recognition and also stimulating simple and practical interventions within the community. Regularly organising free mental health screening, sharing information locally, spreading messages of hope to those in need, taking time for your own mental health, is the key to being a mental health champion.

But mere discussion is not enough. In practice, schools and colleges must tend to the mental health needs of their students. There must be a system of addressing the mental health of the students. Engaging a counsellor in every school and sensitising children about visiting the counsellor in times of need is also a step worth taking. A procedure for therapy must be established in every school where the privacy of the student is intact. Relationships of trust must be built between teachers and students. Often teachers complain to the parents of the child when the child confides in the teacher. Such only erodes
the students’ confidence. Instead the school should sensitise and guide the parents as well when a child is showing symptoms of mental illness. At college level, every institute must create a centre for mental health that advocates the positive discussion of mental illness.