Aviva Bhansali and Anushka Kelkar
“I had to either repay the money I owed or give up my life.” These are the words of Shubham Kitukale, a farmer living in India’s rural Vidarbha region. He slipped into serious mental distress when his failing farm led him to bankruptcy. Kitukale drank a bottle of pesticide at a nearby bus station.
He was lucky to wake up in a hospital the next day, and get counselling support through an NGO’s community mental health program in his village.
The sad truth is that while this may seem mundane to a majority of Indians, with 15,000 farmers committing suicide every year since 2001. However, the reasons behind this widespread catastrophe of farmer suicides are often attributed only to crop failure, climate change, high debt and the like.
Mental illness – which often increases the vulnerability of a farmer to resort to such drastic actions – is often ignored as a factor in conversations around this topic.
“It needs to be understood that at times a farmer under a debt of Rs 2 lakh shows a tendency to end his life, while another under a debt of Rs 10 lakh does not,” said Sarabjeet Singh, professor at Punjab Agricultural University.
Adopting this perspective while zooming out to the larger landscape of problems persisting in rural India, points to the critical role that mental healthcare-focused interventions have the potential to play in catalysing social impact on-ground.
Mental health is often misunderstood as an issue that only the privileged have the luxury of prioritizing. In fact, the situation in rural India is far worse because of triggering environments that increase an individual’s susceptibility to contract a mental illness; a lack of awareness on the subject and widespread stigma shrouded around mental illness; and a dearth of resources and facilities.
India is home to an estimated 56 million people suffering from depression and 38 million more from anxiety disorders, according to the World Health Organization (WHO). Although 20 percent of the country’s population suffers from mental health illnesses, only less than 12 percent of the population seeks help. Those who do are far more likely to be affluent and located in urban areas with access to mental health care services. This therefore sometimes leads to the misconception that the mental health crisis is only prevalent among the elite.
However, this is far from the truth – People residing in rural India are often desperately in need of mental healthcare. Given the triggering environments that they are often forced into, an individual’s susceptibility to contract a mental illness actually increases.
Those who have a biological predisposition to having a mental illness are more likely to develop it if their circumstances are particularly triggering. Since a typical rural Indian’s daily life is replete with such risk factors – crushing poverty, indebtedness, childhood trauma, malnutrition, broken families, physical/sexual/verbal abuse, alcoholism, etc. – he or she is more likely to slip into despair than someone else in the absence of these triggers.
It is critical for us to think about mental health as not just as a health issue, but as one that is inextricably linked to socioeconomic and cultural factors. With approximately 70 percent of the population residing in rural parts of India, it is more important than ever to understand the way that mental illnesses play out in rural India.
Awareness and access
With an aggregate literacy level of only 71 percent in rural India, this problem is compounded by a lack of awareness of what constitutes mental illness and how it manifests, and the widespread stigma surrounding it. When Sushma Kamble started displaying signs of schizophrenia, she was cast out by her family. They believed that she was the reason for all the misfortunes that struck her family--from her father’s death to her brother’s accident.
Sushma’s story is unfortunately far from uncommon. In a study conducted in Delhi, more than 50 percent of respondents from rural areas believed that mental disorders are caused by polluted air, and almost half thought them to manifest because of a loss of semen or vaginal fluid, diminished sexual desire, or punishment for past sins.
Moreover, even after recognizing the causes of mental illness symptoms correctly, a majority of people residing in rural India choose to go to local faith-based healers instead of mental healthcare practitioners. This is often due to the discrimination that these patients face from their communities when they visit these certified practitioners, and the difficulty involved in accessing mental healthcare services. Barring Kerala, each of India’s 29 states fell short of the WHO’s requirement of at least 1 psychiatrist for every 100,000 persons.
The challenges to solving the mental health crisis in rural India are immense, but the development sector’s willingness to address them has increased over the last few years. Dasra’s report, Mind the Gap, lays out key priorities for action in the mental health space in India. NGOs such as Ishwar Sankalpa, Minds Foundation, and The Banyan have taken up the mantle for paving the way for a transformative impact in this space.
Critical areas of focus have been integrating mental health into overall healthcare systems; linking solutions to other development priorities to enable full inclusion; and creating viable alternatives to institutional care, such as community-based models. However, India’s annual health expenditure is only 1.15 percent of the gross domestic product, and the mental health budget is merely less than 1 percent of this budget.
Hence, to accelerate traction in these areas, government representatives, philanthropists and non-profits need to come together and collaboratively champion the cause of our society’s most vulnerable and violated groups - so that millions of people can come out the shadows, regain their dignity and live fuller lives in a world that better understands them.The authors are Analysts at the Knowledge Creation and Dissemination team of Dasra — A strategic philanthropic organisation seeking to drive capital towards India’s most pressing problems.