This year the theme of the World mental health day is “Mental Health in an unequal world”. This theme was chosen by a global vote, including the World Federation of Mental Health (WFMH) members, stakeholders and supporters because the world is increasingly polarized, with the very wealthy becoming wealthier, and the number of people living in poverty still far too high.
We have also noticed that in the year 2020, inequalities in terms of race and ethnicity, sexual orientation and gender identity, and the lack of respect for human rights in many countries, including for people living with mental health conditions. Such inequalities have an impact on people’s mental health. This theme, chosen for 2021, will highlight that access to mental health services remains unequal, with between 75% to 95% of people with mental disorders in low- and middle-income countries unable to access mental health services at all, and access in high income countries is not much better.
Looking at the Indian perspective, Mental health disorders are prevalent in the community. The National Mental Health Survey (NMHS) conducted in 2015-16 reported the prevalence of any mental health condition as 10.6% (point prevalence) and 13.7% (lifetime prevalence). The prevalence of any mental health condition in Manipur is higher than the national average with 13.9 %( point prevalence) and 19.9% (lifetime prevalence).
Due to the Covid -19 pandemic, all of us are experiencing emotions, thoughts and situations we have never experienced before. It is not that there were no pandemics earlier but the pandemic of COVID-19 is on a completely different scale. The COVID-19 pandemic and its associated factors such as strict lockdown policies, physical distancing norms, sudden transition to online communication, immense grief in the families, and financial crisis proliferated stress situations among people exponentially. This resulted in upsurge of adverse mental health issues in many people. The COVID 19 pandemic has further highlighted the effects of inequality on health outcomes and no nation, however rich, has been fully prepared for this. The pandemic has and will continue to affect people, of all ages, in many ways: through infection and illness, death bringing bereavement to surviving family members; through the economic impact, with job losses and continued job insecurity; and with the physical distancing that can lead to social isolation. The impact of Covid-19 has further widened the existing inequalities in terms of health, economic and social strata. And in such a crucial state, all of us need to join hands and act urgently to maintain and promote the positive mental health. We need to support investment in mental health which still exists disproportionate to the overall health budget.
Let us first understand the concept of mental health and mental illness. As per the definition of World Health Organization (WHO), Mental health is a state in which an individual is able to: a) Realize his or her own potentials, b) Cope with the normal stresses of life, c) Work productively and fruitfully, and d) Make a contribution to her or his community.
Mental health includes our emotional, psychological and social well being. It affects how we think, feel and act. It also determines how we handle stress, relate to other events and make choices. Mental Health is important in every stage of life from childhood, adolescents and throughout adulthood. Few major components influencing the mental health include resilience, self-esteem, emotional well-being, spiritual well-being and social connectedness. Last but not least, having a wider perspective towards society, respect for others and acceptance of other’s beliefs and values are important for positive mental health.
Whereas, most mental illnesses are caused by a combination of factors including: stressful life events, biological factors (genetics, neurotransmitters, head injury), individual psychological factors (e.g. poor self-esteem, negative thinking), poor mental health, adverse life experiences during childhood (e.g. abuse, neglect, death of parents or other traumatic experiences), social factors like poverty, migration, poor access to health and sanitation etc. Even during the midst of these social and economic inequalities we should try to promote positive mental health to enable people to increase control over and improve their holistic health. Health promotion is not just the responsibility of health workers, it is a coordinated action that involves and benefits the whole community.
Mental health promotion is a positive, effective approach involving any practice that enhances capacity for good mental health for the whole population through action at the individual, community and societal levels following an integrated approach which includes:
1. Promoting harmony in the community through social networking
2. Reducing levels of violence in the community
3. Ensuring people are free from stigma and discrimination
4. Promoting the rights of people with a mental health disorder
5. Engaging in improving the facilities available for the treatment of mental health disorders in the community
6. Educating people and increasing the knowledge of the community about mental health disorders.
Some of the methods for mental health promotion in the community
Mental Health education: Mental Health education can be done through awareness campaigns on the occasion of World Mental Health day, World Suicide Prevention day and various other community awareness activities . It is the most cost-effective intervention in raising awareness and minimising stigma. The target groups include general public, patients, priority groups, leaders and decision makers.
Environmental modifications: Availability and provision for playgrounds, parks, healthy school environment, healthy environment at work place etc.
Life skills education: It is a method of health promotion that seeks to teach adolescents to deal effectively with the demands and challenges of everyday life (WHO 1997). Life skills include decision-making, problem-solving, creative and critical thinking, effective communication and inter- personal skills, self-awareness, and coping with emotions and stress.
Nutritional interventions: Adequate provision for maternal and child nutrition, to prevent substance abuse and also for better mental wellbeing.
Lifestyle and Behavioural modifications: It is very important for the individuals to stay away from substance abuse, violence and to practice healthy lifestyle which includes yoga, meditation and physical activity for a positive mental well-being.
Stigma and Discrimination
For people with mental health issues, the social stigma and discrimination they experience can make their problems worse and can predispose them to frequent relapses and turning their illness chronic.You can play a significant role in addressing the myths and stigma associated with mental illnesses, by disseminating the right knowledge. eg “Mental illnesses are treatable with proper treatment and counseling” against the held belief of “Mental illnesses are untreatable” etc.
The stigma and discrimination experienced by people who experience mental ill health not only affects that persons physical and mental health, stigma also affects their educational opportunities, current and future earning and job prospects, and also affects their families and loved ones. This inequality needs to be addressed because it should not be allowed to continue. We all have a role to play to address these disparities and ensure that people with lived experience of mental health are fully integrated in all aspects of life.
Promotion of Mental Health at various platforms
1. Family Enrichment and Positive Parenting
A healthy family is a family where everyone has and shows concern and interest for the other members of the family. They enjoy each other’s company. They are willing to support each other in times of crisis. They appreciate the other people in the family for what they are rather than for what they would like them to be. A healthy family looks for the good things and respects one another. They make plans to do things together: a family outing, a visit with relatives, the attending of a special event such as a school program. They appreciate the individual differences of the other person. They learn how to solve conflict.
Family environment could be a major risk factor for mental health disorder or may also act as protective factor for a person. It is thus important to educate parents about how their behavior affects children and their mental health.
The way parents treat their children affects the children deeply. It is well known that children with nurturing and loving parents have better mental health. However, children with over protective, over caring parents or neglecting parents are often more at risk to develop mental health disorders in later part of their life.
2. School as a platform for Mental Health Promotion
Schools are one of the strongest social and educational institutes available. They offer a great influence over the children, family and the community. They often act as a protective factor for children from potential hazards that will affect their psychosocial well-being and development. The interventions can reach children easily with the help of teachers. Teachers often recognize development disabilities or signs of early mental health problems in the child earlier as the child spends more time in the school.
3. Common Self-Care activities for maintaining one’s Mental Health
Self-care activities can help the individual maintain his/her mental health. It is important to have a healthy lifestyle, adequate sleep, good nutrition, regular physical activity, practice relaxation techniques including Yoga , talk to loved ones and avoid substance use such as tobacco and alcohol in order to maintain good physical and mental health.
4. Mental health promotion for vulnerable groups
There are certain social groups who are more likely to experience mental disorders and have limited access to care due to vulnerability. People living in poverty, being female and more prone to violence, or being a member of the disability, and/or LGBT+ communities also increase the likelihood of having a mental health problem, largely due to the negative impact of prejudice, discrimination, bullying and social exclusion etc. Furthermore, environmental circumstances such as being homeless, living in poor-quality housing, or having little access to green and blue space are all risks to mental health.
The 2021 World Mental Health Day campaign “Mental Health in an Unequal World’ provides an opportunity for us to come together and act together to highlight how inequality can be addressed to ensure people are able to enjoy good mental health.
Building a society in which people are less worried about their inequalities in terms of financial circumstances, gender identity, caste, access to mental health support etc. has the potential to reduce stress and anxiety, thereby increasing life satisfaction and work productivity and improvement in overall wellbeing. We should believe that it is possible to act, collectively and individually, to reduce the inequalities thereby improving the mental health of the people.
Proactive action is required at the individual, family, community and governmental level. Let us unite and build resilient communities by reducing the impact of social inequalities in which everyone can flourish equally.