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Awareness leads to better outcomes for mental health in India, says MHI

Laxmi Yadav, Mumbai
Friday, November 17, 2017, 08:00 Hrs  [IST]

Mariwala Health Initiative (MHI) has emphasized the need to increase awareness among people about mental health issues that will help early recognition and addressing of symptoms of mental health problems. This will lead to better treatment outcomes without increased calls on public or private resources.

Set up by Harsh Mariwala, MHI is an online platform to promote awareness and encourage best practices in the realm of mental health.

India has one of the highest prevalence of mental illness in the world. According to the ministry of health and family welfare report, India faces a treatment gap of 50-70 per cent for mental healthcare.

There are differences in mental healthcare in terms of access to, provision of services and affordability not just because of geographical locations and the urban-rural divide but due to systemic/ structural differences across caste, class, ability, gender and sexualities. MHI uses an intersectional approach to understand barriers to health care, and works with partners who use a similar approach to reach out to the most vulnerable within marginalised populations and make healthcare available, accessible, and affordable to them, said Rajvi Mariwala, director of MHI.

Raising awareness about mental health issues plays a crucial role in improving the scope and timing of care provisions. The focus should also be on persons with mental health concerns being in charge of their own mental health and move away from the top-down approach. Building agency and resilience is key. The approach of mental health organizations and policy makers has to focus on both promoting resilience so as to strengthen people and communities to manage mental illness, while also reducing the impact of risk factors that lead to mental disorders, said Rajvi.

She has called for adoption of a multi-pronged strategy focusing on people's involvement at multiple levels to tackle mental health issues i.e-- policy making, programming, advocacy, and grassroots work. MHI's partner organizations use this framework in their work with communities and at risk populations, as well as facilitating access to government social welfare schemes, she informed.

Mental health cannot be looked at in isolation because there are complex social factors, systemic and structural barriers all contribute to an individual's mental health. Therefore, everyone is responsible for how we function and promote better mental health for all. This requires a critique of mental health approaches and practices as they exist currently, with a sole bio-medical focus and located in individuals. There is no conversation around agency and rights.

Institutions, law, policy, education curricula, medical curricula and public services, all need to contribute and only then can there be holistic approach and an affirming mental health ecosystem. This also includes building a robust network of referrals between mental health providers and linkages to other social services. Within such a system then continuum of care will be a given and carers and their challenges will also be addressed, she added.

Appreciating the Mental Healthcare Act, MHI director said “It is a significant step in the right direction. The Act does declare provision of mental health provisions as a right as well as provides some rights to persons with mental illness, when in the past; the state has deprived people of their agency, and virtually, their citizenship. However, more provisions to safeguard rights and service delivery are required. It also remains to be seen how much the law has translated into real, on ground realities.”

It is individuals who must have a say in their health care, not just doctors who enforce a certain authoritative, and impersonal, recovery model. People themselves know what they go through, and their narrative should be centered in recovery and care. The focus should also be on social environments; on how to embrace people with a variety of mental health needs. This means that policy changes are required in all public institutions, ranging from mental health institutions to educational systems and curricula, work spaces, and public spaces, she opined.


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