World Mental Health Day: Stigma and lack of awareness on mental health disorders create treatment gap in Keralam

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Despite having one of the best models in the integration of mental health into primary care and community care offering follow-up care engagement, the stigma of mental health disorders and lack of awareness among the public continue to create a treatment gap in Keralam that the health system is struggling to address.

The National Mental Health Survey -1 (2015-16) reported a treatment gap of 86% in Keralam for common mental disorders, while it was 62.5% for severe mental disorders, indicating that a substantial proportion of people identified to have mental disorders were not receiving adequate care.

Stigma of mental illnesses and the public’s inability to recognise mild mental illnesses or depressive disorder that a chunk of the population, especially the elderly, seems to be suffering from is one reason the treatment gap remains unaddressed, mental health professionals point out.

The proportion of the elderly (aged 60 and above) in the State is currently around 18.7% and it is projected to reach 22.8% by 2036. A significant proportion of the elderly suffer from depressive disorders, with many community-based studies from Keralam reporting an average prevalence of around 52.4% to 58.2%.

“Many of these issues that need professional psychiatric care remain unaddressed as families fail to recognise the symptoms to be that of mental disorders. Also, the stigma of mental illnesses is not something that can be tackled overnight. Often, families refuse to acknowledge the problem because they fear that the community would label them for life,” points out a mental health professional.

“We need open conversations to address the issue of stigma but it is easier said than done. A chunk of the mild mental illnesses in the community remain untreated because people do not know that these are mental disorders that need medical support. Accessibility to care is another major issue — people may not be willing to travel far to access care,” says Kiran P.S., State Nodal Officer for mental health.

“The stigma is real. People who come on video consultations on the Tele Manas, the national mental health tele counselling service (dial 14416 or 1-800 891 4416), confess to counsellors how difficult it is for them to approach a mental health clinic for fear of being labelled,” he adds.

Stigma is not something that can be reduced through some awareness pamphlets. What is needed is training in mental health literacy, something that should start at the school-level, and the topic should be part of the school syllabus. A lot of misconceptions around mental health are being spread through the social media, which should be clarified for the public.

The District Mental Health Programme (DMHP) has a strong presence in all districts in Keralam, delivering mental health services and follow-up care to people at the primary care level.