"My wife was depressed, so I took her to a dargah"
According to the World Health Organisation, India is the most depressed country in the world. However, only one in 10 people suffering from mental health disorders receives treatment. In villages, people fail to recognize that there is a problem which needs medical intervention
Shivani Gupta 10 Oct 2019 10:52 AM GMT
"We got married when she was very young. After a few years of our marriage, she started behaving oddly. She used to get panic attacks, but the situation worsened after her father died," said Chagan Baman, 40, who lives in Chikhli village, 30 km from Indore in Madhya Pradesh and does labour jobs for a living.
"I lock her up in a room when I leave for work. She keeps looking at me through the window when I leave her behind," he added.
Chagan was married to Dali Bai, 30, who is suffering a psychotic disorder from past five years. She was married off at an early age of 15. Her father's sickness and death affected her mental health. Chagan told Gaon Connection that his wife gets violent and throws things around and sometimes she sets quilts and mattresses on fire. She doesn't sleep at night and keeps staring at the ceiling all night. She suffers from mood swings – she laughs some times, and cries the next moment. Her kids get scared of her when she starts howling.
His wife clearly suffers from some sort of mental illness. Under normal circumstances, she would have been taken to a psychiatrist. But in rural India, mental health-related awareness is still sparse and most of the villagers still opt for tantriks and ojhas (quacks or fake doctors) for treatment as patients suffering from schizophrenia or bi-polar disorders are considered to be possessed by evil spirits.
When Gaon Connection spoke to doctors from primary and community health centers and ASHA workers, we got an impression that mental health related issues are still a taboo in rural India.
"India is the most depressed in the world"
According to the World Health Organisation, India is the most depressed country in the world, followed by China and the USA. India, China and the US are the most affected countries by anxiety, schizophrenia and bipolar disorder, according to WHO. A study reported in WHO, conducted for the National Care Of Medical Health (NCMH), states that at least 6.5% of the Indian population suffers from some form of the serious mental disorder.
According to a study, only one in 10 people in India with mental health disorders receive treatment. There are less than 4,000 psychiatrists in the country. Low budget to mental healthcare, shortage of psychiatrists in villages make people suffer in silence.
Talking about the shortage of psychiatrists, availability and affordability of drugs, Dr Saif Ali, a medical officer in a community health center (CHC) in Barabanki district of Uttar Pradesh, said: "Medicines are available. These medicines are not very costly and some have been made available for free, but there's a shortage of specialists in our country." When we spoke to him, there were over 250 patients waiting outside his clinic.
As there is a lack of specialists in rural India, camps are organized once or twice a month in villages. In between these camps, the villagers remain devoid of any help.
At least 13.7% of the country's population is suffering from several mental disorders, while 10.6 % of them require immediate intervention, says report of National Institute of Mental health and Neurosciences (Nimhans). The study also suggested that nearly 150 million people in India need active medical intervention.
"They don't even know if they are mentally sick"
Taking about a particular case, Dr Saif Ali told Gaon Connection that he once treated a woman who had lost her child. She said she would lose her consciousness and had frequent headaches.
"People here in villages fail to explain their problem. They make symptoms up on their own. They complain about headaches and fainting. It becomes difficult for us to diagnose their problems," he said.
As per the National Mental health survey (2015-16) in India, one in 20 people over 18 years of age suffered from depression. As per this data, there were over 45 million depressed people in the country in 2015.
Villagers prefer babas over medicines
Chagan told Gaon Connection that he takes his wife to a baba living in the outskirts of Jaora village in Madhya Pradesh. The baba is well-known in the region for curing mental illness. "I took her to a dargah in a nearby village in Pathan Pipalaya. Baba gave us a sacred thread and holy water. He told me that my wife was given food which was fed to an evil spirit."
Even now, mental health disorders in villages are interpreted as karmic punishments. Superstitious beliefs, family's dignity, and reliance on babas make it difficult for rural patients with mental disorders to get the care they need.
Sometimes Chagan takes her to Simrol, the small town, for treatment. The doctors give her an IV drip or saline (which is given in case of dehydration). Chagan says that after she is given the IV drip, she feels better for a while.
Even though villages of India are home to nearly 70% of the country's population, yet it has a miserable low mental healthcare treatment rates compared to cities.
Chagan was told that there's a doctor who cures mentally ill people by charging Rs 2,500. But since he does labour jobs, he can't afford to spend so much on her. "I am saving money and then I will take her to the doctor," said Chagan.
How to reduce mental health care gap in rural India?
"This illness should be treated like any other physical illness," said Dr Saif Ali.
"Earlier, people were not aware about TB. They had several misconceptions related to TB. But with increasing awareness people have now accepted this as a disease. If we want people to treat mental health disorders, we need to spread awareness with the help of advertisements," added Dr Saif Ali.
Explaining the symptoms of depression and anxiety, he added: "A person suffering from depression will start avoiding social gatherings. He/she will either eat a lot or eat nothing. However, in anxiety people say that they remain restless, and report high blood pressure."
Family's support plays a major role, say psychiatrists, ASHA workers, and NGOs. "We offer emotional support to them and stay with them as they go through emotional trauma. We help them explore their feelings and look at options," said Vanita Naval, who works with Mitram Foundation – a suicide prevention helpline for the stressed and depressed people. She told Gaon Connection that even now the reported cases are far lower than the actual cases.
"The callers who call us are mostly depressed, in distress and suicidal. We come across callers who are across the spectrum of mental health from depression, anxiety, fear, and bipolar disorders. It is very important to get access to quality mental health care, secondary health care workers and counselors," added Vanita.
"Our services are free of charge and people who call us may remain anonymous if they wish," said Vanita Naval.
"They call them doctors of crazy"
People often neglect mental health care as they consider it socially awkward. They hesitate to seek help. They always think – What will people say? They're afraid that if word about their illness gets out, it may affect their social lives.
"People call us the doctors of mad. Mental health care has not been socially accepted even now," added Saif Ali.
When Gaon Connection reporter asked the medical officer if drugs should be made available over the counter like they are for fever and cold, he said: "These medicines can't be made over the counter as they are dangerous to consume without prescription."
(Inputs taken from Pushpendra Vaidya and Mohit Shukla)
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