Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.
General and Economic Information
Over 1.08 billion people reside in India, of which 32% are under the age of 15 and 8% are above the age of 60. Literacy rates are varying among sexes, with 68.4% of men and 45.4 % of women literate. According to a 2005 World Bank estimate, 41.6% of the total Indian population falls below the international poverty line of US $ 1.25 a day. There is a surplus of labor in agriculture, which in part contributes to the current lack of mental health facilities, as farmers are a large vote bank and use their votes to resist reallocation of land for higher-income industrial projects. In one estimate, over 85 per cent of rural households are landless, sub-marginal, marginal or small farmers; however, farm incomes have reportedly collapsed and public investment in agriculture has shrunk. While services and industry have grown at double digit figures, agriculture growth rate has dropped from 4.8% to 2%. About 60% of the population depends on agriculture whereas the contribution of agriculture to the GDP is about 18%. The percentage of India's GDP that is spent for charitable purposes is only 0.6 where the percentage is 2.2 in the United States.
Norms and Values
Indian culture is centered around respect for family and higher-ranked individuals. The younger generations usually are not allowed to question elders or assert their own points of view; if they do, their voices are subdued and discouraged. The caste system is still in place, though as around 20 million more individuals join the middle-class each year, the numbers of “untouchables” continue to shrink. In rural areas of India, there is still presence of a hierarchical household in which there is a high prevalence of domestic violence. This can amount to dreadful outcomes, when for instance a victim of domestic violence come to seek what in her view is guidance within the framework of counseling, but instead receives a cultural orientation on how the role of the Indian woman is to compromise and how with time the violence against the victim may reduce. For example in Punjab, one slap a day for a woman is almost a matter of culture in some parts. So where and how do we start sensitizing people of violence against women being a crime - in all forms, mental, physical and emotional? The International Centre for Research on Women (ICRW) suggests that 80 per cent men from Punjab think violence is justified if a wife is "disrespectful" and 60 per cent justify it if a wife "does not follow instructions". Such social customs and attitudes, which still consider women inferior, abet domestic violence. Scenarios where a woman comes to seek help in and receives counseling where she is brutally informed that "everything will be fine in due time" and that she must not leave her husband or abuser can result in very violent affairs.
The NHRC has emphasized the need of opening more than one women police thanas (stations) in a district of different states to deal with crime against women, but what is being done about the "cultural beliefs" in our legal system? In the meantime, every six hours, a young, married woman is burnt alive, beaten to death or forced to commit suicide, and one in five continues to face domestic violence from the age of 15. This, when violence against women has been already been recognised as a human rights violation. Victims of violence, physical, sexual and even psychological, many women are today a statistic in the National Family Health Survey. There is also a wrongful socio-cultural perception of the 'doctors of the mad', 'pagalo ke doctor', has to diminish, if our society is inclined to do justice to people in need of mental health care.
Mental Health Information
Throughout developing countries there is neglect towards the issue of mental health. Facilities are overcrowded, underfunded, and located few and far between. A major problem in developing countries is the existence of stigma towards mental illness and neurological disorders. Many patients are misunderstood as weak or dangerous. They are more likely to be the victims of violence rather than the perpetrators; it is an issue of human rights. This stigma leads to isolation, loss of social support, and psychological distress.
While there are as many as two crore (20 million) Indians suffering from mental illnesses, the country has only 3,500 psychiatrists and 1,500 psychiatric nurses to treat them. According to the Head of the Department of Psychiatry at New Delhi's G B Pant Hospital R C Jiloha, an estimated 1-2% of India's 100-crore plus population suffers from major mental disorders and about 5% of the population from minor depressive disorders. Most of the psychiatrists are based in cities or private hospitals. But it's the government hospitals that face an acute shortage, although they are the ones which treat the poor. In the United States there are 45,615 psychiatrists.
In India, the overall prevalence of mental illness is 5.8% and is composed of: organic psychosis (0.04%), alcohol/drug dependence (0.69%), schizophrenia (0.27%), affective disorders such as depression, manic-depressive, etc. (1.23%), neurotic disorders such as anxiety, OCD, etc. (2.07%), mental retardation (0.69%), and epilepsy (0.44%). Dementia and Alzheimer’s are reported to affect 0.8%-3.4% and 0.6%-1.5%, respectively. The incidence of post-partum depression has been reported as a shocking 11% of mothers in the 6-10 weeks post-delivery. The national suicide rate is 9.2 per 100,000 per year and has been found to correlate with the presence of a personal or family history of mental disorder). Almost 6.9% of children have been found to possess a disability and 2.7% exhibit mental disability.
In Gujarat, Mental health outpatient clinics treat approximately 37 users per 100,000 general populations. Of all users treated in mental health outpatient facilities, 34% are female and 15% are children or adolescents. The users treated in outpatient facilities are primarily diagnosed with schizophrenia (52%) and mood (affective) disorders (14%). There are 4.81 patients per 100,000 general populations in the mental hospitals. The patients admitted to mental hospitals belong primarily to the following two diagnostic groups, schizophrenia (61%) and mood (affective) disorders (26%).
Out of 600 districts in India, only 22 have Mental Health Facilities. According to the National Human Rights Commission, there are two types of mental health institutions. The first are 'dumping grounds' for families to abandon their mentally ill member, for either economic reasons or a lack of understanding and awareness of mental illness. The living conditions in many of these settings are deplorable and violate an individual's right to be treated humanely and live a life of dignity. Despite all advances in treatment, the mentally ill in these hospitals are forced to live a life of incarceration. The second are those that provide basic living amenities. Their role is predominantly custodial and they provide adequate food and shelter. Medical treatment is used to keep patients manageable and very little effort is made to preserve or enhance their daily living skills. These hospitals are violating the rights of the mentally ill persons to appropriate treatment and rehabilitation and a right to community and family life.
In the past two years, only around 600 personal were trained to be primary care professionals for mental health for the population of 1.08 billion individuals. To be considered a professional in mental health, one does not need a doctorate degree. Neither a mental health nor a substance abuse policy exists and the National Mental Health Program is present in only 24 districts. Mental Health Financing is sparse, with only 2.05% of the total health budget spent on mental health.
Psychiatric Beds and Professionals
Total psychiatric beds per 10,000 population 0.25
Psychiatric beds in mental hospitals per 10,000 population 0.2
Psychiatric beds in general hospitals per 10,000 population 0.05
Psychiatric beds in other settings per 10,000 population 0.01
Number of psychiatrists per 100,000 population 0.2
Number of neurosurgeons per 100,000 population 0.06
Number of psychiatric nurses per 100,000 population 0.05
Number of neurologists per 100,000 population 0.05
Number of psychologists per 100,000 population 0.03
Number of social workers per 100,000 population 0.03
One third of mental health beds are in a single state, Maharashtra, and several states lack mental hospitals entirely. Of the existing mental hospitals, 25% had shortages in both drug and treatment modalities, and 66% reported shortages of staff. Psychologists do not have the ability to prescribe medicine and there is no system of licensing clinical psychologists.
Availability of drugs is also problematic. At the level of primary health care, none of the 12 routinely available drugs (country: carbamazepine, phenobarbital, phenytoin sodium, sodium valproate, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, lithium, carbidopa, levodopa) are routinely distributed.
Volunteers that are involved with MINDS have a connection to India and/or mental health and hence are not only passionate about the cause, but also are well-versed in projects within the sector. Our plan has been tested and works, but we need funding to further expand and affect the rural population that is being left in the darkness. Due to our collaboration with a local institution that has a community-orientated mission, we not only develop trust with the targeted communities quickly, but we develop collaboration with village leaders and authoritative representatives in order to run our program successfully and effectively. All of our volunteers will work with local social workers, psychologists, and psychiatrists who originate from the targeted region.