Time to treat mental health as a development strategy
 Preeti Singh Saksena

Contrary to popular belief, almost eight out of ten individuals who
contemplate suicide give warning signals to indicate they need help. For
every death by suicide, there are around 20 to 50 attempts, making it
imperative to address both survivors of failed suicide bids and the grieving
friends and relatives of the deceased. Rising numbers indicate that suicide
is a public health problem that requires broad based, multi-tiered
interventions.

Most suicide prevention strategies are based on patchy data, owing to
suicides being mis-reported as death by other causes and because of the
reluctance in reporting suicidal attempts. According to the WHO's 2002 world
report on violence and health, 85 per cent of suicides oc cur in low/middle
income countries, but they account for less than 10 per cent of published
research.

Self-harm is criminalised in many countries, including India, and most
policies are narrowly focussed on mental illness rather than comprehensive
mental well being. In India, attempted suicide is a punishable offence under
Section 309 of the Indian Penal Code, carrying imprisonment upto one year.
This often leads to the harassment of vulnerable or mentally disturbed
individuals, and prevents survivors from seeking guidance or counselling.

According to Dr Achal Bhagat, Director of the NGO Saarthak, a new national
mental health policy is required, which would be 'preventive in scope and
would treat mental health as a development issue.' He advocates a 'cross
sectoral approach', integrating mental health service delivery with social
development programmes, tapping into their network and resources to maximise
the outreach and impact.

Less than one per cent of India's total health budget is spent on mental
health, with a large chunk being devoted to communicable diseases. A
national mental health programme has been in place since 1982, but its
implementation has been hindered by a greater focus on illness rather than
on comprehensive mental well being. Even the Mental Health Act of 1987 is
narrow in focus relating to severe illnesses and disability.

According to Dr Rajesh Sagar, Associate Professor of Psychiatry at AIIMS and
Secretary to the Central Mental Health Authority, 'one of the main reasons
that the objectives of the national mental health programme have not been
met is due to the acute shortage of mental health professionals in India'.
According to him, this can be partly addressed by providing additional
training to primary health care professionals to deal with mental health
problems.

For every 100,000 people, India has 0.4 psychiatrists, 0.04 psychiatric
nurses, 0.02 psychologists and 0.02 social workers and 0.25 psychiatric
beds, according to 2001 figures by WHO. To offset the gross shortage of
manpower, intervention must start with sensitising the first line of contact
in the community - schools, workplaces, emergency psychiatry and primary
healthcare providers.

In most developing countries it is the easy access to prescription drugs and
pesticides that translates into successful suicides bids and requires
greater focus. An estimated 250,000 sui cides globally are due to pesticide
poisoning, a trend reflected in the growing recourse to this method by a
number of farmers in India. Countries have sought to reduce access to lethal
means by regulating pesticides, guns and psychotropic substances.

Many countries have set up national programmes, with Finland boasting of the
world's only large scale fully implemented and evaluated national suicide
prevention programme, which enlisted the support of over 50,000
professionals from different fields. Between 1987-96, the suicide rate
indicated a drop of 8.7 per cent, inspiring similar efforts across the
globe.

Given the growing incidence of suicides, it is time to address the issue as
a public health concern. A national prevention plan can only succeed as part
of a broader development strategy.
topPressmart By Bodhtree


URL :
http://epaper.hindustantimes.com/artMailDisp.aspx?article=16_10_2006_012_024&typ=0&pub=264